ICAI publishes new information note on the UK’s work with the Global Fund, as seventh replenishment takes place

20 Sep 2022

• To coincide with the Global Fund’s next round of fundraising from 19 to 21 September, the Independent Commission for Aid Impact (ICAI) publishes an information note on the UK’s engagement with the fund.
• The Global Fund to Fight AIDS, Tuberculosis and Malaria is the world’s largest funder of efforts to defeat three of the deadliest diseases affecting the world’s population.
• ICAI’s report looks at the Global Fund’s performance, the impact of COVID-19 on its work, the UK’s role in the Fund, and suggests lines of enquiry for future scrutiny.
• The UK government is yet to make its pledge for the seventh replenishment, which will be against a backdrop of reduced aid resources and the objective to decrease the use of multilateral aid channels like the Global Fund.

The UK’s role within the Global Fund to Fight AIDS, Tuberculosis and Malaria comes under the spotlight in a new information note published today, Tuesday 20^th September, by the Independent Commission for Aid Impact (ICAI).

The report from the aid watchdog is an information note, written in the context of the Global Fund’s next round of fundraising. It provides a factual account of the UK’s financial and strategic engagement with the Global Fund since 2019 and how this fits into the UK’s development cooperation on health. The report is not evaluative and is not scored, but it does conclude with a set of key questions for any future investigation by ICAI or other scrutiny bodies.

The Global Fund is part of a global health partnership of governments, international agencies, private companies, civil society, and community organisations working to improve global health outcomes. As such, it depends on other agencies to fulfil its aims. It deliberately quotes results for the ‘partnership’ rather than for its own work. It reports that 50 million lives have been saved since 2002 due to the partnership efforts to tackle the three diseases. Other partnership results cited include the following:

• Life expectancy has risen dramatically in many countries.
• The number of deaths each year caused by AIDS, tuberculosis and malaria has decreased by 70%, 21% and 26% respectively since 2002
• 133 million mosquito nets were distributed by the partnership in 2021
• In 2021, 23.3 million people accessed antiretroviral therapy for HIV, which represents an increase in people treated, despite the COVID-19 pandemic.

The information note observes that the Global Fund’s organisational effectiveness, impact and value for money are highly rated by external bodies. It also notes that the COVID-19 pandemic has had a severe impact on the Global Fund’s efforts to curb AIDS, tuberculosis, and malaria, as well as its impact on broader health systems. Most areas of testing and treatment for the three diseases have seen a decline, including significant drops in the numbers treated for malaria and tuberculosis. This is the first time that key programmatic results have declined globally during the 20-year history of the Global Fund.

The report notes that as part of its commitment to the Global Fund for the sixth replenishment in 2019, the UK established a performance agreement with the Global Fund covering four key areas: (i) leadership and collaboration; (ii) organisational effectiveness, including equity and sexual exploitation, abuse, and harassment; (iii) impact; and (iv) sustainability. This was linked to a £100 million performance tranche, which was dependent on the Global Fund achieving certain conditions. These have been met to date.

The Global Fund has a replenishment model, where different countries host the replenishment meeting every three years and thus have an incentive to lead the pledging process. This model has been very successful and has led to a significant increase in resources over the course of the Fund’s 20-year lifespan. The seventh replenishment takes place from 19 to 21 September 2022, hosted by the US. The UK government has yet to pledge for the seventh replenishment and is later in doing so than it was for the sixth replenishment.  It has also delayed some of its payments under the sixth replenishment, but a commitment has been made to Parliament that the government is on track to fulfil its 2019 pledge.

ICAI Lead Commissioner Dr Tamsyn Barton, who oversaw the information note, said:

“It is generally agreed that the Global Fund has performed well despite the multiple challenges of the COVID-19 pandemic. In its new 2023-28 strategy the Global Fund has committed to address some identified problems, such as to strengthen community engagement and leadership, and to address power imbalances on the Country Coordinating Mechanisms. The strategy strongly reflects UK priorities.

“However, the government will make its pledge for the seventh replenishment against a backdrop of reduced aid resources. This shortage has been exacerbated by unanticipated calls on the humanitarian budget relating to the Ukraine crisis. It will also be made in the context of the international development strategy’s objective to reduce the share of the UK’s spending going through multilateral channels. The government will therefore have to make difficult choices between institutions in its funding of the global health system and to balance its bilateral and multilateral funding for health to achieve its overall global health objectives.”

The report concludes by suggesting lines of enquiry that the UK Parliament’s International Development Committee or other scrutiny bodies may wish to pursue:

1. Multilateral commitments: Can FCDO square a large reduction in the proportion of multilateral spending with its reliance on the Global Fund to meet its global health objectives, and particularly Sustainable Development Goal 3.3?
2. Women and girls are disproportionately affected by HIV and malaria. What is the Global Fund’s role within the government’s objectives for women and girls?
3. Global health ecosystem: How does FCDO’s support for the Global Fund interact with support to other global health initiatives? What complementary investments should the UK make to maximise Global Fund performance and impact?
4. Value for money and the private sector: How can FCDO continue to use the Global Fund to maximise the value for money of its health investments, deliver cost savings through market shaping and leverage private sector investment in tackling malaria and other health challenges?
5. Global health security and pandemics: What role does FCDO believe that the Global Fund should play in preventing and responding to future pandemics and strengthening overall global health security?