Leaders of UNAIDS and the Global Fund to Fight AIDS, Tuberculosis and Malaria have expressed their mutual concern at waning donor support for HIV. Executive Directors Michel Sidibé and Michel Kazatchkine highlighted the importance of financial contributions to the Global Fund being in line with the real costs of HIV treatment and care. According to Michel Sidibé: "The gap is big. For the first time in the last financial year, we saw a reduction in allocation coming from donor countries for helping to fight the pandemic. This is the moment that we need to scale-up, rather than flat-line or step down."
European countries reduced their payments to the Global Fund significantly during 2008/09 – contributing US$600 million less than the previous year. Michel Kazatchkine emphasised the need to increase donor support in line with the growing demand for healthcare to sustain the "considerable progress" in global health made over the last decade.
Successes of the Global Fund
In 2002, when the Global Fund was first established, very few people living with HIV in resource-limited settings were able to access antiretroviral treatment (ART). Today, UNAIDS estimates that over five million people have now started ART. There is also some evidence that deaths from AIDS and HIV incidence are beginning to decrease, albeit slowly.
The Global Fund, financed by a host of donor nations and agencies, has a robust reputation in field of health financing. Morolake Odetoyinbu, the Chair of the Implementer’s Block in Nigeria, explains that the Global Fund works directly with governments to set up health programmes targeting national priorities. It currently pays for the treatment of over 2.5 million people (about 50% of those on ART in Africa, and close to 70% of people on ART in Asia).
A dire deficit
However, now the Global Fund is facing a massive deficit. The exact amount is unknown, but estimates from the International Treatment Preparedness Coalition range from US$4 to 6 billion. Michel Sidibé is fearful of the threat the deficit poses to the scale-up of treatment programmes: “We need a fully funded Global Fund. Today, millions of people are living in the hope that tomorrow they will continue to have access to the pills that have helped them to transform their lives.”
This is the moment that we need to scale-up, rather than flat-line or step down. Michel Sidibé, Executive Director of UNAIDS
Financing healthcare is a sound investment in the future, Sidibé explained, as both governments and the private sector derive massive financial benefits from healthy and productive populations.
When challenged about the Global Fund’s ability to manage its finances and prevent corruption, Morolake Odetoyinbu responded: “If you steal from the Global Fund, you will be sent to jail.” The Global Fund has stringent mechanisms in place to ensure accountability, and has in the past withdrawn funding from Zambia, Uganda and other states because of improper use.
Kazatchkine estimates that, if the current levels of demand continue for the next two years, the Global Fund will need between US$17 and 20 billion to pay for the health needs of the developing world. The Fund is next due to seek contributions in October 2010.