The buzz on Global Fund replenishment: Our top 10 picks

U.S. Secretary of State John Kerry, President Barack Obama, French officials and African first ladies have all thrown their weight behind a robust Global Fund replenishment this week, as health advocates and policymakers are gathered in Washington, D.C., to solicit funding commitments for the international initiative to combat AIDS, malaria and tuberculosis.

Health, economic and political dynamics are changing in countries and regions where the Global Fund has delivered resources to health ministries and NGOs.

Now, as Global Fund advocates make the rounds to champion their achievements and lock down billions for the fourth replenishment, those changes in the global health landscape have raised questions about the fund’s future and how to accelerate progress toward the ultimate elimination of these three killer epidemics.

Devex is tuned into the discussions in D.C. this week — and here are the 10 buzz topics to watch out for as The Global Fund cashes in on its network of global support:

1. Historic new pledges

With $12 billion committed — including a pledge of up to $5 billion over the next three years from the United States — the Global Fund has reached its goal and surpassed its pledge total from the previous $9.2 billion replenishment.

The successful replenishment comes on the back of strong commitments from France, Britain and Japan, as well as increased attention to private sector contributions. The Bill & Melinda Gates Foundation announced a $500 million contribution.

2. Building out a health platform

Major international health initiatives are hounded by stories of patients traveling to one clinic for testing or treatment for HIV, and then having to walk miles to another clinic for treatment of tuberculosis or other diseases to which HIV and AIDS leaves them more vulnerable.

But so far, many observers say the integration of health and development goals across the major initiatives has been more rhetorical, and the Global Fund and PEPFAR continue to operate as silos with vertical programming for the delivery of individual disease-specific treatments and commodities.

Health leaders reiterated this week that both entities have built the platform for an integrated approach to funding foreign health systems, and many health advocates hope this is true.

Others though, worry what it might mean that taxpayer dollars originally intended to confront the HIV and AIDS emergency are now providing countries with funding to target a broader range of health and development goals.

3. How to maintain focus on vulnerable populations amid localization drive

National economies are growing in the developing world — sub-Saharan Africa is home to seven of the 10 fastest-growing economies in the world. At the same time, aid spending in donor countries is coming under increased scrutiny under tighter budget negotiations.

For that reason, policymakers and taxpayers are calling on Global Fund eligible countries to swallow a heavier piece of the programming pie and shoulder more responsibility as partners rather than recipients.

But that transition raises eyebrows among health advocates who worry whether populations most vulnerable to HIV — sex workers, injecting drug users and homosexuals — will receive the kind of attention and outreach in countries that are less tolerant to those populations.

That focus on vulnerable populations makes programs 55 percent more effective and  is absolutely necessary to achieve the goal of ending the HIV epidemic.

4. Getting smarter on procurement

The logistical complications of distributing health commodities, like malaria bednets, are massive, and conferees at the replenishment this week have stressed the importance of “getting smart on procurement.” The Global Fund has taken steps to arrange for procurement of bed nets in Africa, instead of buying the nets in Asia and shipping them overseas. The result, said Global Fund Director Mark Dybul, is higher quality and wider distribution.

5. Prevention vs. treatment

Experts agree that not enough attention has been paid to prevention and the challenges of fostering effective behavior change when it comes to HIV and AIDS, TB and malaria. According to the Global Fund, 30 percent of overall funding is spent on prevention – slightly more than the 29 percent the fund spends on treatment. Still, some argue that prevention – especially preventing sexual transmission of HIV – has not been adequately addressed.

6. ‘New’ frightening HIV strain

This week reports surfaced of a new, “more aggressive” strain of HIV in West Africa, which develops into full-blown AIDS in less time — five years instead of seven — than most other strains. Were such a strain to become more prevalent, it would surely complicate the demands of timely testing and treatment.

7. Eastern Europe falling behind

According to Dybul, “Eastern Europe is where we’re losing the war” on tuberculosis and HIV. While the world has responded rapidly and decisively to Africa’s HIV and AIDS epidemic, Eastern Europe has garnered far less attention from development and health donors, and the result is a region moving in the wrong direction on HIV and TB.

8. Alarming TB rates in Nigeria (but not because of HIV)

It might be better case detection, or it might not. Either way, tuberculosis rates in Nigeria are alarming. The Nigerian government and its supporters have to do more to erase the stigma that accompanies TB infection, experts say, especially since a large proportion of new TB cases seen in the country are not the result of HIV — one of the most common drivers of TB infection.

9. Bed nets vs. larvicides for malaria prevention

What is the best way to fight malaria? It depends on where you’re doing the fighting, says Dybul.

Some representatives from malaria-endemic countries have raised questions about whether malaria bed nets or larvicidal treatments that attack the malaria parasite are more effective tactics in the fight against the mosquito-borne disease. Bed nets, they argue, are often misused as fishing nets or chicken enclosures.

According to experts, larvicidal treatments can be useful, but in places that don’t have a large number of water sources.

10. Focus on women and girls

As part of the transition to the new funding model, the organization is reviewing its monitoring and evaluation processes, including the indicators used to assess grant performance — but critics claim the new indicators also fail to reflect the experiences and the challenges faced by women in the HIV epidemic especially in sub-Saharan Africa.

Michael Wilkerson,a researcher at AIDS-Free World, a U.S.-based advocacy group, recently wrote an open letter to Dybul asking for the Global Fund to use its position to influence governments and the United Nations over the develop new indicators that will provide a more comprehensive account of the issue.

It remains to be seen how the organization plans to tackle this issue.

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