The 46th Global Fund Board meeting increased potential resources for tuberculosis while protecting HIV and malaria
The Global Fund Board has just concluded its 46th meeting from 8th to 10th of November 2021. The Board has adopted a new Global Disease Split after much discussion over the months (See Aidspan Link).
What is the Global Fund disease split?
The Global Fund Board uses the disease split to allocate resources from replenishment among the three diseases it fights. The Global Fund funding cycle is three years; the Global Fund raises funds (through replenishment) and allocates those funds to about 100 countries using a formula that includes countries’ capacity to pay, the burden of disease and the disease split. Currently, HIV gets about 50%, TB-18%, and malaria 32% after allocating resources across countries. Following the adoption of this change, for the next allocation cycle, here is the new disease split.
- Funds available funds for country allocation up to and including US$ 12 billion will be apportioned following the existing split: 50% for HIV/AIDS, 18% for tuberculosis, and 32% for malaria; and
- Any additional available funds for country allocation above US$ 12 billion will be apportioned as follows:
- 45% of such funds will be apportioned to HIV/AIDS;
- 25% of such funds will be apportioned to tuberculosis; and
- 30% of such funds will be apportioned to malaria.
Why the change in the Global Fund disease split?
TB advocates have drawn attention to the higher mortality of that disease. About 1 500 000 die of TB each year out of about 10 million are affected by TB each year. In contrast, the annual death from HIV is about 680 000. Out of the 229 million cases of malaria, 400 000 die.
Table 1: burden and annual deaths due to HIV, malaria and TB
| Disease burden | Annual deaths from disease | |
| HIV | 38,000,000 | 680,000 |
| Malaria | 229,000,000 cases (annual) | 400,000 |
| Tuberculosis * (Including TB Missing*) | 10,000,000* 3,000,000 | 1,500,000 |
African Constituencies drew attention to the burden of the diseases and not only the mortality. They were concerned that reducing funding to those HIV and malaria amid COVID19 might lead to higher mortality in a few years. Mortality is a consequence of failed prevention or treatment.
Currently, more than 70% of people living with HIV are in Africa. The continent is also home to more than 90% of people affected by malaria. In contrast, only 24% of people affected by TB are in Africa.
How does the change of Global Disease Split impact Africa?
Technically, the disease split is a zero-sum game in the Global Fund. In other words, increased funding for TB will come out of HIV and malaria. And as a whole, the continent may receive less funding.
The Secretariat underscored that the final allocation to all countries also depends on many factors in a presentation to the African constituencies during pre-board meeting. The first one is a successful replenishment; then disease burden and gross national incomes. As African countries sadly still have lower GNI than others on average, they will receive more funding. The Secretariat explained that it was the growth rate of the funding that would decrease and not the amount itself if the replenishment brings similar resources.
Note that the Global Fund uses qualitative adjustment to modify further the country’s initial allocation amount suggested using the formula. The qualitative adjustment aims to maximize the impact of Global Fund investment by considering the key populations and other elements of context like absorption of previous grants. Thus, the Global Fund can slightly change the results that the formula gives to increase or decrease.
TB advocates have also highlighted the higher mortality of TB in Africa than in other parts of the work. Thus, they asserted that changing the disease split will not only have negative consequences for Africa as more money for TB will help decrease mortality for that disease.
Implementation matters
Overall, it is important to note that the disease split and country allocation are not the only determinants of the Global Fund investments in our countries. Implementation and grant absorption matter. Those also drive the portfolio optimization, which is a process by which the Global Fund re-allocates resources that will not be used by the country they were originally allocated to by the end of the cycle to other countries that need them. The overall absorption of grants in 2019 was 81%, meaning on average 19% of the allocation was unused by the programs.
In other words, the funds available for programs can differ from the allocation, which is itself based partly on disease split.
Thus our countries need to focus on implementing activities.
By Djesika Amendah
