Global Fund pushes countries to spend faster — or lose funds

NAIROBI — The Global Fund to Fight AIDS, Tuberculosis and Malaria is cracking down on countries that don’t spend the entire grants they’ve received from the fund for their HIV and AIDS, malaria and TB programs. In a change in policy, when the Global Fund’s three-year funding implementation cycle ends, countries can no longer apply for extensions to use up the remaining funds.  

For the first time, the Global Fund placed a firm deadline at the end of December last year which prevented countries with unspent funds from using those funds into the new year. This is a shift from the past when the fund was more flexible on extensions for the use of unused funds.

Now, the funds come back to the Global Fund and are reallocated into the new funding cycle. This was done to increase predictability, for both the countries to which the Global Fund provides grants, but also the fund’s donors. It was also done to enhance the impact of the fund’s work on its targeted diseases, Cynthia Mwase, head of the Africa and Middle East grant management directorate for the Global Fund, told Devex

Despite having been warned several years ago that this would happen, some countries have had a difficult time adjusting to the fund’s new way of working, said Mwase.

“Many countries were not expecting there would be a very firm and hard ‘no’ at the end of December. We are still getting requests to extend and the answer is no,” she said. “It’s been very, very difficult for a lot of them. I know going forward we should see improvements in absorption. Those countries now realize they will lose the money.”

The Global Fund raises and invests almost $4 billion per year to support country-led health programs. When deciding on a country grant, the Global Fund looks at economic capacity and disease burden. The country’s ability to spend the money within the implementation period — also known as its absorption rate — is also a factor in determining how much money a country will receive from the fund.

Spending funds on agreed programs can be a challenge for some developing countries because they don’t have enough institutional capacity to reach both the high-density and low-density areas in their country with medical services. There can also be a gap in technical knowledge, such as a shortage of epidemiologists or lab technicians, she said. A delay in submitting funding requests by countries can also push back implementation.

A 2017 audit of Mozambique’s use of the funds, for example, showed that the Global Fund paid 84 percent of the grant to the country directly to medicine suppliers. This helped with the country’s overall absorption of the grant. But despite this, the nation’s ministry of health still struggled with spending the rest of the money. One of the reasons for this was the drawn-out procurement processes that delayed programming.

The fund is working with countries to overcome some of these challenges. It sets up program management units within ministries of health, for example, that provide administrative and technical support to help with the management of the grant. In recent years, it also created a partnerships forum that brings together stakeholders and countries on a regular basis to examine barriers to implementing the programs. Organizations such as the World Health Organization and the Joint United Nations Programme on HIV and AIDS are involved with supporting countries with implementation and blockages through this forum, said Mwase.

One of the other drivers behind this change in enforcement of deadlines is impact. Key to getting ahead of these diseases is timely implementation, she said. With HIV, for example, reducing infections requires effective prevention programs and getting people on treatment to suppress the virus and reduce the chance that the disease spreads. With tuberculosis, if the country does not place people on treatment it can lead to more cases of drug-resistance TB, which is more expensive to treat.

“Doing the right things, on time, is critical for gaining control of these diseases,” Mwase said.