The Global Fund to Fight AIDS, Tuberculosis and Malaria

"Global Fund" redirects here. For other uses, see The Global Fund for Children and Global Fund for Women.

The Global Fund to Fight AIDS, Tuberculosis and Malaria

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Founded	January 28, 2002 (2002-01-28) (first Board of Directors meeting)
Focus	Preventing and treating HIV and AIDS, tuberculosis and malaria
Location	Geneva, Switzerland
Key people	Mark R. Dybul, (Executive Director)
Mission	Investing the world’s money to save lives
Website	www.theglobalfund.org

The Global Fund to Fight AIDS, Tuberculosis and Malaria (often called The Global Fund or GFATM) is an international financing organization that aims to "[a]ttract and disburse additional resources to prevent and treat HIV and AIDS, tuberculosis and malaria." A public–private partnership, the organization has its secretariat in Geneva, Switzerland. The organization began operations in January 2002. Microsoft founder Bill Gates was one of the first private foundations among many bilateral donors to provide seed money for the project.

The Global Fund is the world's largest financier of anti-AIDS, TB and malaria programs and by mid-2012 has approved funding of USD 22.9 billion that supports more than 1,000 programs in 151 countries. According to the organization, it has financed the distribution of 270 million insecticide-treated nets to combat malaria, provided anti-tuberculosis treatment for 9.3 million people, and provided AIDS treatment for some 3.6 million people. In 2009, the Fund accounted for around 20 percent of international public funding for HIV, 65 percent for tuberculosis, and 65 percent for malaria.

The Global Fund is a financing mechanism rather than an implementing agency. This means that monitoring of programs is supported by a Secretariat of approximately over 400 staff (as of mid-2012) in Geneva. Implementation is overseen by Country Coordinating Mechanisms, committees consisting of in-country stakeholders that need to include, according to GFATM requirements, a broad spectrum of government, NGOs, UN, faith-based, private sector and people living with the disease. This has kept the GFATM Secretariat smaller than other international bureaucracies, yet it has also raised concerns about conflict of interest, as some of the stakeholders represented on the CCMs may also receive money from the GFATM, either as Principal Recipients, Subrecipients, private persons (e.g. for travel or participation at seminars) or contractors.

Fundraising

Since the Fund was created in 2002, public sector pledges have totaled USD 28.3 billion (95 percent of all pledges). The remaining USD 1.6 billion (5 percent) has been pledged from the private sector or other financing initiatives. The Fund states that from 2002 to 2015, 54 donor governments have pledged a total of USD 28.3 billion and paid USD 17.2 billion. From 2001 through 2010, the largest contributor by far has been the United States, followed by France, Japan, Germany, and the United Kingdom. The donor nations with the largest percent of gross national income contributed to the Fund from 2008 through 2010 are Sweden, France, Norway, the Netherlands, and Spain.

The global financial crisis has significantly impacted the fund. The Fund stated in May 2011 that it was short by USD 1.3 billion for 2011 through 2013, seeking at least USD 13 billion to cover minimum estimated needs but only holding pledges of USD 11.7 billion. The organization was also adversely affected by revelations of USD 25 million missing from community programs in four nations in Africa, which caused Sweden and Germany to suspend their donations until the completion of audit in 2011.

Creation

The genesis of the Global Fund emerged during discussions between donor and multilateral agencies toward the end of 1999, leading up to the July 2000 G8 Summit in Okinawa, Japan. During that time, under the leadership of World Health Organization (WHO) Director-General Gro Harlem Brundtland and WHO Deputy Director General David Nabarro, discussions were initiated with donors other UN agencies concerning the creation of a new global health fund to help achieve these targets. Just prior to the Summit, WHO publicly called for a "massive effort to tackle infectious diseases" and for creation of "a new mechanism to take proven interventions to scale. The mechanism would achieve internationally agreed targets to cut TB and malaria mortality by 50%, and HIV infection by 25%."

The concept for this WHO initiative – initially called the Massive Attack on Diseases of Poverty (or sometimes just “MAD-OP,” for its ambitious aspirations) – was for the first time shared by the WHO Director-General’s office with its entire Cabinet on December 20, 1999. The original concept suggested tackling “malaria, tuberculosis, unsafe pregnancy, AIDS, diarrhoeal diseases, acute respiratory infections and measles.” It also called for increased efforts to eradicate or eliminate Guinea Worm, polio and leprosy by 2005, and make “monumental improvements in the delivery of effective and responsive health care." In a subsequent memo to WHO Cabinet Members and Regional Directors on March 14, 2000, the concept paper included reference to potentially new resource mobilization possibilities, noting that, “Partners could indicate that they are preparing to be in a position to handle at least (an additional) $15 billion over the next five years.” By that time, the concept had evolved to concentrate on a smaller group of illnesses: TB, HIV/AIDS, malaria, unsafe childbirth and vaccine preventable diseases.

By the time of the G8 Experts’ Meeting on Global Health Issues, April 19–20, 2000 in Tokyo, the group of diseases had been narrowed even further. “The discussion focused on the three major infectious and parasitic diseases, HIV/AIDS, TB, and malaria which were identified as the highest priority areas among others through the G8 process.”

At the Okinawa Summit, G8 nations for the first time established measurable global targets for addressing AIDS, TB and malaria. Immediately following the Summit, WHO went on record stating that the G8’s commitment to fight AIDS, TB and malaria would cost at least $25 billion over the next five years, suggesting that 60 percent of this funding should be spent on HIV/AIDS, and the rest evenly split for campaigns against TB and malaria.

In July 2000 at the XIII International AIDS Conference, 2000 Professor Jeffrey D. Sachs, then Chairman of the WHO Commission on Macroeconomics and Health, called for a global fund to fight AIDS. On September 28, 2000, the European Commission, WHO and UNAIDS announced that they were taking a common stand against the epidemics of HIV/AIDS, TB and malaria in the developing world. “I want to see the EU playing a larger and more effective role in assisting developing countries to confront these epidemics,” said the President of the Commission, Romano Prodi.

In October 2000, WHO and the city of Winterthur, Switzerland convened a Massive Effort Advocacy Forum to engage over 200 public agencies, private sector and civil society organization in a process of building ownership and support to massively scale up donor funding to fight diseases of poverty. The city of Winterthur agreed to pay for the venue and lodging of all Massive Effort guests. Speakers included Brundtland and Swiss President Ruth Dreifuss, in addition to Prof. Jeffrey Sachs via satellite. This subsequently led to WHO, Credit Suisse/Winterthur Group and the Swiss/Kenyan NGO Double Incentive Project (DIP) establishing and funding the Massive Effort Campaign, for the short term purposes of igniting, jump starting and building global support the fight against AIDS, TB and malaria.

For its initial year in WHO's parlance, the concept of a "massive effort" was a thunder clap that drew many important decision makers into the discussion. But as the creation of a well-resourced Global Fund grew more realistic, the phrase increasingly began to sound to some ears as foreshadowing of a WHO proprietary initiative, which was not the organization's intent. The phrase was gradually abandoned within WHO, and led to the Massive Effort being spun off as a new AIDS, TB & malaria advocacy NGO.

During the final months of 2000 and early 2001, political jockeying over who might host the Global Fund intensified. Many initially assumed hosting the Global Fund was WHO's end game. On August 19, 2000, The Washington Post reported that "Clinton Signs Bill Establishing Global Fund to Fight AIDS," effectively intending to locate it inside the World Bank. According to The Washington Post, "President Clinton signed a bill today that sets up a global trust fund for AIDS patients that has been likened to a kind of Marshall Plan against the infectious disease." Soon thereafter, UNICEF's Carol Bellamy suggested that UNICEF was better equipped to know "How to Distribute AIDS Drugs" in her March 2001 The New York Times op-ed.

An article published in the British medical journal The Lancet by Harvard academics Amir Attaran and Jeffrey Sachs in January 2001 called for an order of magnitude increase in foreign aid budgets for HIV/AIDS, over those the researchers documented in the 1990s. Attaran and Sachs proposed a new funding stream of $7.5 billion or more to fund projects proposed and desired by the affected countries themselves, and that a panel of independent scientific experts validates as having epidemiological merit against the pandemic. Attaran and Sachs also recommended that the new funding stream "must be based on grants, not loans, for the poorest countries", unlike the World Bank, which was the largest multilateral HIV/AIDS funder then existing.

On April 21, GlaxoSmithKline CEO Jean-Pierre Garnier called for a "Marshall Plan" to fight AIDS in Africa. This followed on an announcement by 38 pharmaceutical companies that they would drop their challenge to prevent South Africa from providing cheaper generic ARVs.

On April 23, 2001, an informal meeting of "stakeholders including some G8 and non-G8 members, representing different constituencies," was hosted by DFID and CIDA in London, to discuss the proposed “Global Fund for Health and AIDS.” A number of potential options were on the table, including the "Ottawa Fund," a UNAIDS concept paper submitted on behalf of all UN agencies, and a proposal by Italy, which was about to host the upcoming G8 Summit. According to the minutes of the meeting, the aspirations of the group were to focus on HIV/AIDS, malaria and TB, with the potential to expand to other health conditions including children’s illnesses and maternal health. This fund would be characterized by “highly visible operating systems, transparency of processes, the relentless pursuit of results, speedy disbursement, support for a diversity of service providers (including faith-based organizations) under common (usually national government) stewardship. Investors would be able to top predict the likely impact of their investments.” It was noted the following week in a video conference with the UN Secretary General's office that, with the possible exception of France, "none of the bilaterals are keen to support an HIV/AIDS specific fund." Canada, Japan The Netherlands, and the EC were most interested on focusing on the three diseases, with the UK, Italy and Sweden potentially wanting a broader mandate, and with Denmark, Norway and Germany being unclear about their positions.

On April 26, 2001, in Abuja, Nigeria, at the urging of a wide range of parties—and particularly due to the emerging consensus among bilateral and UN agencies, the UN Secretary General Kofi Annan made the first explicit public call by a highly visible global leader for this new funding mechanism, proposing "the creation of a Global Fund, dedicated to the battle against HIV/AIDS and other infectious diseases." A month later, The Economist editorialized that "...the fund itself must not be devoured by a voracious UN bureaucracy. Mr Annan wants an independent board to administer the money... (and that) the amount of money needed, after all, is not huge: it is about half America's annual spending on pot-plants and flowers."

The first private contribution to the Global Fund was made by Kofi Annan. Having just been named the recipient of the 2001 Philadelphia Liberty Medal on May 3, 2001 Annan announced that he would donate his US$100,000 award to the Global Fund "war chest" he had just proposed creating. On May 8, the International Olympic Committee also made a US$100,000 contribution to the Global Fund.

In an address during WHO's World Health Assembly on May 15, 2001, WHO Director-General Gro Harlem Brundtland described the challenges of going to scale smartly yet rapidly. "The timetable is necessarily a tight one. You might say that we are going to have to sail in the boat, while we are still building it. But the world is not going to wait while we get every detail in place." There was strong pressure that the Global Fund become operational by the year's end."

On May 31, France became the second bilateral donor after the US to announce a contribution to the Global Fund. This initial pledge was for US$ 127 million.

South Africa's Minister of Health gave notice that support from the Global Fund might not be welcomed in the single country home to the most HIV infections. "South African Health Minister Manto Tshabalala-Msimang told the conference a global fund being set up to fight AIDS, TB and malaria should not be used to force AIDS advisers on the region. 'We know what AIDS is and we know what is happening here. The region has its own experts on AIDS,' she said.

Early resistance to the promise of the Global Fund wasn't limited to Manto during the first week of June 2001. Andrew Natsios, head of the U.S. Agency for International Development, told The Boston Globe that Africans were incapable of following complicated, multi-drug AIDS treatment, which requires taking different pills at specified times of day, because many of them "don't know what Western time is." According to Natsios, "Many people in Africa have never seen a clock or a watch their entire lives, . . . they know morning, they know evening, they know the darkness at night."

Beginning of June 2001, the Massive Effort Campaign mobilized the first larger corporate contribution to the Global Fund from Credit Suisse/Winterthur Group for US$1 million.

On June 19, 2001, the Bill & Melinda Gates Foundation committed $100 million, spread over a few years. Signaling that stopping the transmission of AIDS was the foundation's top global health priority, the Foundation announced that it would commit $100 million to the Global Fund over a multi-year period. The foundation also used the occasion to call on other organizations and governments around the world to support the new fund. Additionally, by the end of June, the UN Foundation set up a new mechanism for channeling private donations to the Global Fund.

The decision to create the new funding mechanism was expected to be taken by heads of state at the 2001 G8 Summit in Genoa (Italy), at the urging of United Nations Secretary General Kofi Annan, and largely along the lines WHO, Attaran and Sachs described. The United Nations system had been considered ill-conceived to implement a major increase in development funding. Multiple organizations were converging with small-scale projects on countries with limited institutional capacities, which exacerbated a series of problems, including poor coordination, duplication, high transaction costs, limited country ownership and lack of alignment with country systems.

Before the start of the Genoa G8, the United States, Britain and Japan had already contributed $200 million each, France had committed $127 million, and the Bill and Melinda Gates Foundation had committed $100 million. On July 13, Germany announced its contribution to the Global Fund amounting to US$131 million. On July 18, Canada committed US$100 million and the European Commission agreed to a Euro 120 million contribution. On July 20, Russia contributed $20 million.

The G8 didn't disappoint in calling for the creation of the Global Fund, although pledges were significantly lower than the $7 to $10 billion annually called for by Kofi Annan. According to the G8’s final communique, “At Okinawa last year, we pledged to make a quantum leap in the fight against infectious diseases and to break the vicious cycle between disease and poverty. To meet that commitment and to respond to the appeal of the UN General Assembly, we have launched with the UN Secretary-General a new Global Fund to fight HIV/AIDS, malaria and tuberculosis. We are determined to make the Fund operational before the end of the year. We have committed $1.3 billion. The Fund will be a public-private partnership and we call on other countries, the private sector, foundations, and academic institutions to join with their own contributions - financially, in kind and through shared expertise.”

In July 2001, Kofi Annan appointed Ugandan cabinet minister Crispus Kiyonga to chair the Transitional Working Group that would establish the Global Fund. The Transitional Working Group was composed of representatives from more than 40 countries, UN agencies, the World Bank, private groups and NGOs, and met for the first time in Brussels on October 11–12.

The September 11 attacks created serious challenges for the Global Fund. In the three months prior to 9/11, the New York Times had expressed its support for fully financing the Global Fund in four separate editorials; it wouldn't be until three months after 9/11 that it would again editorialize in support of the Global Fund.[{Results from a search through the LexisNexis data base for results related to the Global Fund appearing in New York Times editorials}] According to Timothy Wirth, former US Senator and head of the UN Foundation, "The attacks had a very damaging impact on funding, and we have to get everyone moving again to rebuild that momentum. The victims of Sept. 11, beyond the direct victims of the violence, have been the world's poorest people, particularly those with AIDS. The United States cannot say to the rest of the world, 'Help us' (in fighting terrorism) when we're not willing to help the rest of the world."

A key piece of evidence arguing for the importance of the Global Fund was delivered on December 20, 2001, when the Commission on Macroeconomics and Health made its findings public. Created by WHO's Brundtland and chaired by Sachs, the report promised that "A drastic scaling up of investments in health for the world’s poor will not only save millions of lives but also produce enormous economic gains." This report was particularly timely in reengaging journalists and refocusing the attention of policy makers on diseases of poverty and the emerging Global Fund, months following 9/11.

Officially operational in 2002, the Global Fund was intended to introduce a new aid paradigm based on partner country leadership, donor alignment with partner countries' development strategies, harmonization of donor actions, managing for results, and donor and partner being mutually accountable for results. This was subsequently conceptualized by the OECD in its 2004 Paris Declaration on 'aid effectiveness'.

The Global Fund's initial 18-member policy-setting board held its first meeting on January 28–29, 2002, and issued its first call for proposals. The first Secretariat was established in January 2002 with Paul Ehmer serving as team leader, soon replaced by Anders Nordstrom of Sweden who became the Fund's interim executive director. By the time the Global Fund Secretariat became operational, the Fund had already received $1.9 billion in pledges. In the months to follow, the Bush Administration was sharply criticized in the media for promising to pledge only $200 million a year. However, within months, under the leadership of President George W. Bush, the President's Emergency Plan for AIDS Relief (PEPFAR) was created with bipartisan support from Congress, becoming the largest commitment by any nation to combat AIDS, tuberculosis and malaria. Fifteen billion dollars was given to a five-year plan running from 2003-2008.

At its inception, the Fund was adamant that it would not be about "business as usual," but would be grounded in "tough love" as it wrote its checks. On February 14, 2002, The Wall Street Journal headlined that the "Disease Fund Plans Tough Standards." In the article, a Bush administration official is quoted saying, "We envision a level of fiscal accountability . . . that’s unheard of in international development assistance."

In March 2002, a panel of international public health experts was named to begin reviewing project proposals that same month. In April 2002, the Global Fund awarded its first batch of grants - worth $378 million – to fight the three diseases in 31 countries.

Leadership

Richard Feachem was named as its first Executive Director in April 2002 and was about to get off to a rocky start days before the opening of the July 2002 International AIDS Conference in Barcelona, a bi-annual meeting attended by tens of thousands of the world's leading AIDS researchers, implementers, care givers and activists. According to John Donnelly of The Boston Globe, "Richard G.A. Feachem, about to become the first director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, is already under fire from activists who want him to quit for saying the fund has plenty of money to start. At a critical time in the fight against the three killer infectious diseases, and on the eve of the 14th International AIDS Conference in Barcelona, Feachem is set to begin building an organization almost from scratch while fending off the activists." During this defining moment, the Massive Effort Campaign, the activist NGO created, contracted and entrusted to ensure the Global Fund's successful launch throughout its first four years, was able to help prevent the Global Fund from being killed in its crib.

Feachem served from July 2002 until March 31, 2007. Michel Kazatchkine was then selected over the Global Fund’s architect, David Nabarro, even though Nabarro was “considered the strongest of three shortlisted candidates to head the Global Fund ... A selection committee has evaluated the three nominees' qualifications and ranked ‘Nabarro first, Kazatchkine second and (Alex) Cotinho third,’ according to a Fund source.” Eventually, Michel Kazatchkine, a public health expert with over 20 years of experience in the field, was selected to be the Global Fund's second Executive Director. The September 2005 conference in London mobilized 3 billion euro, just over half the pledges at the Gleneagles G8 summit. On September 21, 2011, the AIDS Health Foundation called for Kazatchkine's resignation in the wake isolated yet unprecedented reports of "waste, fraud, and corruption" in order that "reforms may begin in earnest.” On January 24, 2012, Michel Kazatchkine ultimately declared his resignation, following the decision made by the Global Fund Board in November, 2011 to appoint a General Manager, leaving Dr. Kazatchkine’s role to that of chief fund-raiser and public advocate. Communications later disclosed by the U.S. government stated that Kazatchkine's performance was deemed unsatisfactory by the Global Fund Board, notably in relation to the funding of activities related to the FIrst Lady of France at the time, Carla Bruni-Sarkozy.

Following Dr. Kazatchkine’s resignation, the Global Fund announced the appointment of Gabriel Jaramillo, the former Chairman and Chief Executive Officer of Sovereign Bank, to the newly created position of General Manager. Jaramillo, who had retired one year earlier had since served as a Special Advisor to the Office of the Special Envoy for Malaria of the Secretary General of the United Nations, and was a Member of the High-Level, Independent Panel that looked at the Global Fund’s fiduciary controls and oversight mechanisms. Jaramillo immediately took full charge in reorganizing and reducing Global Fund staff in response to the previous year's critics of the Global Fund.

Dr. Mark R. Dybul was appointed Executive Director of the Global Fund to Fight AIDS, TB and Malaria on November 15, 2012. He previously served as the United States Global AIDS Coordinator, leading the implementation of the President's Emergency Plan for AIDS Relief (PEPFAR) from 2006 to 2009.

Operations

The Global Fund provides initial grant funding on the basis of the technical quality of applications, as evaluated by an independent Technical Review Panel. The Fund assesses implementation capacity of the applicants through a contracted ´Local Fund Agent´ - in most countries one of the international financial audit companies - before providing the financing. Grants are signed for an initial period of two years. It provides funding to programs based on achievement towards agreed indicators and actual expenses. The performance and expenses are periodically reviewed by the ´Local Fund Agent´.

The objective of the Global Fund — to provide funding to countries on the basis of performance — was supposed to make it different from other international agencies at the time of its inception. Other organizations may have staff that assist with the implementation of grants. However, the Global Fund's five-year evaluation concluded that without a standing body of technical staff, the Global Fund is not able to ascertain the actual results of its projects. It has therefore tended to look at disbursements or the purchase of inputs as performance. It also became apparent shortly after the Global Fund opened that a pure funding mechanism could not work on its own, and it began relying on other agencies (notably WHO) to support countries in designing and drafting their proposals and in supporting implementation. UNDP, in particular, bears responsibility for supporting Global Fund-financed projects in dozens of countries. As a result, the Fund is most accurately described as a financial supplement to the existing global health architecture rather than as a separate approach.

Bilateral donors pledged millions (in some cases billions) of US dollars in support of Global Fund programs. The originally innovative approach to its financing principles was considered key to its success. Since its inception, the Global Fund has committed US $22.9 billion to more than 1,000 grants in 151 countries (as of June 2012).

In March 2010, Dow Jones Indexes signed a memorandum with The Global Fund to explore the creation of co-branded indexes that could be licensed as the basis for investment products. The Global Fund aims to strengthen its engagement with the private sector, while the Dow seeks to add to its range of socially conscious indexes.

The Global Fund became incorporated as a Foundation under Swiss law. It is a new kind of public-private partnership but is often confused as being part of the United Nations family. This may be because until January 1, 2009 Global Fund staff were officially World Health Organization (WHO) staff members and besides this the World Health Organization (WHO) provided administrative services to the Global Fund secretariat and is also based in Geneva, Switzerland.

Effective January 1, 2009, the Global Fund became an administratively autonomous organization, terminating its administrative services agreement with the World Health Organization (WHO).

In March 2009, the head of the Fund criticized statements made by Pope Benedict XVI, according to whom AIDS "cannot be overcome through the distribution of condoms, which even aggravates the problems."

Replenishment phases

As of 2010, the Global Fund has entered its "replenishment phase", i.e. it needs funders to commit themselves to continued financing. Alarms have been raised prior to the 2010 October meeting about a looming deficit in funding, which would lead to people currently undergoing ARV treatment losing access to this - increasing the chance of them becoming resistant to treatment. UNAIDS Executive Director Michel Sidibé has dubbed the scenario of a funding deficit an "HIV Nightmare".

In 2010, the Global Fund has stated that it needed at least 20 billion dollars in 2011-13, and 13 billion just to "allow for the continuation of funding of existing programs". Its 2001-2010 budget includes 19.4 billion dollars, with 600 interventions in 145 countries and 5.7 million lives saved.

Italy, a founding member of the Fund, announced at the Aquila 2009 G8 Summit a una tantum contribution of 30 million €. Both the una tantum and the 2009 and 2010 contributions (130 million € each) have not been disbursed (in fall 2010), for a total debt of 290 million €.

At the October 2010 replenishing meeting $11.8 billion USD was mobilized, with the USA being the largest contributor - followed by France, Germany and Japan. The Global Fund has said that the $1.2 billion USD lack in funding will "lead to difficult decisions in the next three years that could slow down the effort to beat the three diseases".

In 2011, the organization's internal investigation identified 13 countries, most in Africa, where several million dollars' worth of antimalarial drugs where stolen and presumably sold on the black market. A Global Fund spokesman confirmed that the organization suspected malaria drug valued at USD 2.5 million were stolen from Togo, Tanzania, Sierra Leone, Swaziland, and Cambodia from 2009 to 2011, with some cases earlier. Investigations were continuing to determine the amount of theft in other countries.

In November 2011, the Fund's board cancelled all new grants for 2012, only having enough money to support existing grants.

However, following the Global Fund’s May 2012 board meeting, it announced that an additional $1.6 billion would be available in the 2012-14 period for investment in projects that save lives.

On December 2, 2013, the Global Fund held its 4th Replenishment in Washington D.C. where US$12.0 billion was pledged in contributions from 25 countries, as well as the European Commission, private foundations, corporations and faith-based organizations. It was the largest amount ever committed to fighting the three diseases.

Corruption and misuse of funds

In January 2011, the Associated Press reported vast corruption in programs financed by the Global Fund. The article cited findings of the GFATM OIG office that up to 2/3 of funds in some of the reviewed Global Fund’s grants were lost to fraud and the OIG report showed that systematic fraud patterns have been used across countries. GFATM responded to the AP story with a news release on January 24, 2011, stating that, "The Global Fund has zero tolerance for corruption and actively seeks to uncover any evidence of misuse of its funds. It deploys some of the most rigorous procedures to detect fraud and fight corruption of any organization financing development."

In the days following the AP story, a number of op-eds, including one by Michael Gerson which was published in the Washington Post on February 4, 2011, sought to put the controversy surrounding the misuse of Global Fund grants in perspective. In his op-ed, Gerson stated, "The two-thirds figure applies to one element of one country's grant - the single most extreme example in the world. Investigations are ongoing, but the $34 million in fraud that has been exposed represents about three-tenths of 1 percent of the money the fund has distributed. The targeting of these particular cases was not random; they were the most obviously problematic, not the most typical."

These newly uncovered misuses of funds were investigated and made public by the Global Fund Inspector General's Office (OIG), an auditing unit independent from the Global Fund Secretariat that manages the disbursements of funds to the programs (the selection of new applications for grants is done by the Technical Review panel and the GFATM Board - both independent entities from the GFATM secretariat). This point was also highlighted by Gerson in his February 4, 2011, op-ed where he noted, "The irony here is thick. These cases of corruption were not exposed by an enterprising journalist. They were revealed by the fund itself. The inspector general's office reviewed 59,000 documents in the case of Mali alone, then provided the findings to prosecutors in that country. Fifteen officials in Mali have been arrested and imprisoned. The outrage at corruption in foreign aid is justified. But this is what accountability and transparency in foreign aid look like. The true scandal is decades of assistance in which such corruption was assumed instead of investigated and exposed." The GFATM Secretariat has posted a series of news releases on the GFATM website to publish their views on these dealings.

The OIG has been newly reinforced and was created during 2005, three years after the GFATM was founded.

During these investigation the U.N. Development Program (UNDP) that manages and supervises a large proportion (12%) of the fund's spending as a Primary Recipient (primary responsible for the execution of a GFATM grant under GFATM terminology) has claimed diplomatic immunity and contractual clauses to limit the GFATM Inspector General´s access to internal audits and books of investigated programs in the more than two dozen nations.

The OIG has only examined a small percentage of the grants so far. Previous reviews of grants and the organization have shown substantial misconduct in some programs, lack of adequate risk management and operational inefficiency of the Global Fund.

Severe cases of corruption have been found in several African countries such as Mali, Mauritania, Djibouti and Zambia. Global Fund spokesman, Jon Liden, said; "The messenger is being shot to some extent. We would contend that we do not have any corruption problems that are significantly different in scale or nature to any other international financing institution." Subsequent Global Fund statements have omitted any reference to other agencies.

In response to the findings, Sweden, the fund's 11th-biggest contributor, has suspended its $85 million annual donation until the corruption problems are resolved. Together with Sweden, Germany, the 3rd biggest contributor to the fund has also blocked any financing until a special investigation has been completed.

These findings come on top of previously discovered massive abuse of funds, corruption and mismanagement in a series of grants that forced the GFATM to suspend or terminate these grants after such dealings became publicly known with Uganda, Zimbabwe, Philippines, Ukraine being the largest of these grants (more than US$100 million each).

The story widened in February 2011 when the Financial Times reported that the fund’s board of directors had failed to act previously on concerns over accountability, including the conclusion of an external evaluation in 2009 which criticized the Fund's weak procurement practices. Warnings of inadequate controls had also been reported periodically. In Feb. 2011 the FT also reported that its own review found that neither Global Fund staff nor the Local Fund Agents (the entities entrusted with audit-like tasks at country level) had noticed the deficiencies reported by the Inspector General.

Financing, major donations and administration

The GFATM is almost completely funded by contributions from the largest developed nations governments / tax payers. GFATM audited annual returns show that currently more than 96% of its yearly contributions are received from government organizations. Its largest private contributor by far is the Gates Foundation.

• In June 2001, Winterthur Group, the Swiss-based financial services group, a sponsor of the Massive Effort Campaign and at the time a subsidiary of Credit Suisse, became the first corporate contributor to the Global Fund with a gift of $1 million.
• In January 2006, Bono and Bobby Shriver announced the launching of the Product Red campaign, proceeds from which would go to the Global Fund. Questions have been raised by nonprofit watchdogs and marketing experts regarding the unusually high advertising budgets spent on Product Red that some (until 2007) estimated as high as $100 million. GFATM published data states that until February 2011 the Product Red campaign has contributed less than 1% ($163 million) of the almost $19 billion contributions received since establishing the GFATM 2001/02.
• In August 2006, the Gates Foundation contributed $500 million to the Global Fund, calling the fund "one of the most important health initiatives in the world".
• In October 2010, at the Global Fund replenishment meeting, donors pledged USD 11.7 billion for the years 2011 -2013. Major pledges included
  • United States – USD 4 billion
  • France – USD 1.48 billion
  • Germany – USD 822 million
  • Japan – USD 800 million
  • Chevron – USD 25 million
• In October 2011, Sweden announced a three-year pledge (2011-2013) of USD 300 million
• On January 26, 2012, The Bill and Melinda Gates Foundation announced a contribution of USD 750 million at the World Economic Forum annual meeting in Davos, Switzerland
• On October 21, 2013, Tahir Foundation and The Bill and Melinda Gates Foundation announced that their foundation is investing US$130 million in the Global Fund to Fight AIDS, Tuberculosis and Malaria. The Tahir contribution, by far the largest ever made to the Global Fund by a private foundation in an emerging economy, will support efforts to diagnose, treat, and prevent AIDS, TB and malaria, leading causes of death and disability in Indonesia

10th anniversary

On January 26, 2012, the Global Fund celebrated its 10th anniversary at a special event hosted by Bill Gates and Ban Ki-Moon in Davos during the annual World Economic Forum annual meeting. Earlier the same day at a press conference in Davos, Bill Gates announced a new contribution of $750 million from the Bill and Melinda Gates Foundation to the Global Fund. In addition, some of the Global Fund’s best-known supporters and advocates including Bono, Bill Clinton, Ban Ki-Moon, Bill Gates, Tony Blair, Jeffrey Sachs, and Gro Harlem Brundtland appeared in a video and series of portraits celebrating 10 years of Global Fund impact and calling for continuing action on the Fund’s 10th birthday. Another 10th anniversary video was also released the same week, produced by "Auntie Retroviral," in which the Global Fund's ten most harmful "villains" were exposed.

See also

• Student Global AIDS Campaign
• Friends of the Global Fight Against AIDS, Tuberculosis, and Malaria

External links

• Official website in six languages
• Friends of the Global Fund
• Friends of the Global Fight
• Friends of the Global Fund, Japan
• Friends of the Global Fund, Africa
• Friends of the Fund Europe (Amis du Fonds mondial, Europe)
• Pacific Friends of the Global Fund to Fight AIDS, Tuberculosis and Malaria
• ACTION: Advocacy to Control TB Internationally
• A Global Fund Project in Pakistan
• World Trade Organisation