Andrey Rylkov Foundation
for Health and Social Justice

Geneva, we have a problem!

The Global Fund’s New Funding Model (NFM) has passed its pilot phase. The upcoming GFATM Board Meeting (November 7/8 in Geneva) will tie up some of the loose ends. Full roll-out of the NFM is envisaged for 2014. This is great news. But: Geneva, we have a problem!

New Allocation Criteria a Bitter Pill for Many

One of the most fundamental shifts in the NFM is the newly developed allocation criteria for countries and diseases. In a nutshell, the NFM tries to correct a perceived distortion in the way the Fund’s resources have historically been distributed. At the core is a calculation of epidemiological data such as HIV, TB or malaria disease burden, coupled with a measure of a country’s “ability to pay”. The latter is an assumption based on the respective country’s income ranking according to World Bank Criteria. This model might work well to increase funds for the poorest countries with the highest disease burden in Africa and elsewhere. However, some perceive the Global Fund’s use of national income and disease burden as the only two main allocation criteria  a ‘blunt tool’ that cannot truly indicate where the greatest needs really are.

The trouble starts if you happen to be born in Russia or many others so called middle- or high-income countries in the region referred to as Eastern Europe and Central Asia (EECA)[1]. The region has a high burden of Multi Drug Resistant Tuberculosis and is the only place globally where HIV continues to rise. Many EECA countries face quite concentrated epidemics. In essence this means that, e.g. HIV or TB does not affect so much the general population – yet – but is spreading primarily in what is referred to as Most at Risk Populations (MARPS). These often include drug users, sex workers or other – socially, regionally or for other reasons – marginalized groups. In many EECA countries, governments may have sufficient resources to provide services but are often unwilling to do so. For example only 23% of people eligible for ARV in the region are receiving it; a rate that is half of that in sub-Saharan Africa. In such cases, human rights issues rather than “ability to pay” are the main obstacle for people in need of prevention, treatment and care.

The Global Fund: A Lifeline for Marginalised Groups

Over the last decade, the Global Fund has played a unique and indispensable role in responding to the HIV epidemic among people who use drugs. Harm Reduction Programmes including the provision of clean syringes are amongst the most successful interventions to support health and prevent infections in drug users. Between 2002 and 2009, the Global Fund approved an estimated $263 million for activities carried out in 22 countries from EECA[2]. This has made the GFATM by far the most important donor, and has enabled the steady expansion of harm reduction programmes. In a region where drug users have traditionally been criminalised and excluded, the Global Fund pushed for their human rights and full inclusion.

However, according to the logic of the Global Fund’s NFM, most middle or high income countries have a relatively low disease burden and a relatively high ability to pay. This means that e.g. the EECA region might lose up to 50% of its funding from the GFATM. Also, the rule that – as an exception to this arithmetic – NGOs from certain countries can apply for funds and implement programmes directly might be abandoned at the upcoming GFATM Board Meeting. In absence of political will at the top of the countries in question, the side effects of the Global Fund’s New Funding Model might turn out lethal for many people in EECA and beyond.

Germany can play an important role

Germany has experience in harm reduction at home and has good contacts in the region. It is one of the biggest donors to the Global Fund. It will be important to delve deeper into analysing the dramatic consequences of the NFM for MARPs in Middle and High Income Countries such as in the EECA region and how they can be avoided. For reasons of human rights, public health, and – not least – strategic thinking: Eastern Europe and Central Asia is just around the corner.

Tobias Luppe

Global Health Policy Advisor with Oxfam – represents NGOs in the German Government Delegation to the GFATM Board.

Ivan Varentsov

Civil Society Action Team (CSAT) Regional Coordinator, Eurasian Harm Reduction Network (EHRN)


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