Examining the Impact of Global Fund Reforms on Implementation

The Global Fund to Fight AIDS, Tuberculosis and Malaria is a crucial partner in global health. It currently provides two-thirds of the international financing to fight TB and malaria, and approximately one-fifth of international funding against AIDS, in addition to funding health system strengthening.

Due to the misuse of Global Fund resources in a few countries in 2010, the Global Fund secretariat began implementing strategies to mitigate risk of fraud. A high-level panel was commissioned to review and make recommendations to further reform the Global Fund’s risk management systems, financial and fiduciary controls, and oversight mechanisms. The panel’s report was released in September 2011 and the Board of the Global Fund moved to implement many of the recommended reforms as part of its Consolidated Transformation Plan.  

While the Global Fund to Fight AIDS, Tuberculosis and Malaria is facing immense challenges, it also has a critical opportunity to ensure that the measures introduced to fight fraud and reduce risk do not result in increased bureaucracy and rigidity,  but serve to strengthen civil society through increased opportunities for participation and ownership of programs. The Open Society Foundations and the Communities Living with HIV, Tuberculosis and Affected by Malaria delegation to the Global Fund conducted research to better understand the impacts of the Global Fund’s enhanced approach to risk management on civil society implementers, and to explore concerns voiced by grant implementers that risk aversion may be hampering program implementation.  

The following report examines the viewpoints and experiences of Global Fund implementers representing 50 unique countries. Drawing upon their perspectives, this report provides recommendations for how the Global Fund can more effectively balance accountability and flexibility, and offers strategies to better engage civil society implementers in designing and implementing systems that will enhance and not hamper their work.