Whatever It Takes to raise at least $18 billion for the Global Fund
Whatever It Takes to raise at least $18 billion for the Global Fund
The Global Fund launched its 7th Replenishment Investment Case in February 2022, calling for a 30% increase in investments to raise at least US$ 18 billion. This will allow the Global Fund to get the HIV, TB and malaria responses back on track, strengthen health and community systems, maximise health equity, prepare for and catalyse domestic funding for health. This is a substantial increase, which reflects the scale of the impact and devastation caused by COVID-19 on HIV, TB and malaria.
As part of the 7th Replenishment Communities and Civil Society Global Week of Action, Aidsfonds calls on all donors to see this target as a bare minimum, and increase their pledges by at least 30% and ensure a successful 7th Replenishment. Inaction would not only mean an inability to scale-up services, but would lead to a reversal of the hard-won gains in the HIV, TB and malaria responses, with devastating consequences for the poorest and most marginalised.
Aidsfonds also calls on the Global Fund, in line with its 2023 to 2028 strategy, to put communities at the centre, and ensure that the scale-up of funding for health systems benefits community systems.
What will a $18 billion investment achieve?
The Investment Case projects that with an investment of at least US$ 18 billion the Global Fund will have reduced new HIV infections by 68%, and by 72% among adolescent girls and young women in most affected counties by 2026. The Global Fund also forecasts that HIV-related deaths will be reduced by 68% and that 20 million deaths will be prevented across the three diseases.
Every US$ 1 invested in the Global Fund produces health gains of US$ 31, with 75% of the gains occurring in low- and lower-middle-income countries. Additional funding will also allow the Global Fund to deliver on the commitment it made in its 2023-2028 Strategy, and scale up investments in health equity, reducing gender and health inequities and upholding human rights. This is critical to delivering on the promise of leaving no one behind.
Beyond helping the world get back on track in the HIV response, investment in the Global Fund also accelerates progress toward SDG 3 of good health and well-being for all and universal health coverage, by strengthening community and health systems and improving pandemic preparedness, with US$ 6 billion of the Replenishment target being allocated to strengthen health systems and community networks. In addition to the Global Fund’s own investments, the partnership expects to catalyse scale-up of domestic health investment of up to US$ 59 billion.
The Global Fund is unique in the global health architecture, as being one of the few that invests in strong community and health systems, gender equality, health equity (including for children) and human rights.
For communities, a successful 7th Replenishment of the Global Fund is about access to lifesaving health care. It is about breaking barriers on human rights and gender equality that limit the ability to access services. It is about community leadership
- Rosemary Mburu, Coordinator Global Fund Advocates Network (GFAN) Africa
Investing in Communities
Communities are the best placed to deliver programmes that address the social barriers they are facing. That means that these programmes must be financed. After 40 years, there is ample evidence that the way to reach key populations and those in situations of vulnerability is through programmes led by those populations. Strong links between community-led programmes and systems for health and social protection can achieve better outcomes for those left furthest behind.
Community leadership has been essential to the success of the Global Fund from the start, ensuring interventions are designed and prioritised to meet the needs of those most affected, and reaching the most marginalised and vulnerable. Ensuring that people and communities (including key populations such as sex workers, people who use drugs and LGBTIQ+ people) are at the center of all of the Global Fund’s policies and actions is at the heart of the new Global Fund Strategy for 2023-2028.
For communities to truly be at the centre of the Global Fund’s work and Strategy, the Global Fund must prioritise funding for communities and community-led interventions. In countries where people are criminalised, a direct funding stream or other innovative measures will have to be developed to provide the funding for communities.
In 2021, the world came together at the United Nations High-Level Meeting on AIDS. There, the global community committed to the Political Declaration on HIV and AIDS, which commits to increasing the proportion of HIV services delivered by communities, including by ensuring that by 2025, community-led organisations deliver:
- 30 % of testing and treatment services, with a focus on HIV testing, linkage to treatment, adherence and retention support, and treatment literacy;
- 80 % of HIV prevention services for populations at high risk of HIV infection, including for women within those populations
- 60 % of programmes to support the achievement of societal enablers
We call on donors and the Global Fund partnership to advocate for direct funding to communities to ensure that the barriers to accessing health care are addressed and to truly put communities at the centre of the Global Fund’s work. This could be as a share of catalytic investments, a strategic initiative, a proportion of the Global Fund’s funding or country portfolio and/or a case by case review of country grants for countries where this is not included. As the Global Fund further unpacks the Investment Case, we ask that the work of communities is also included in the results highlighted by the Fund, and direct investment in communities is advocated for with all donors and partners.
Health systems strengthening and Pandemic Preparedness
The Global Fund is the largest multilateral funder of health systems strengthening and the Investment Case includes an investment of US$ 6 billion for health systems strengthening and to contribute to pandemic preparedness. Research shows that one-third of the Global Fund’s investments in HIV, TB and malaria have contributed to strengthening health systems and pandemic preparedness, through strengthening communities, investing in primary health care facilities and community health workers and laboratory networks and disease surveillance systems. The Global Fund is uniquely positioned to support countries to reinforce their health systems’ preparedness, because it is already investing heavily in the same key components. However, we highlight that sustained strengthening of community systems is central to a strong health system and the Global Fund should prioritise this.
Ensuring equity, gender equality and human rights
The Global Fund is one of the only institutions that includes equity, gender equality and human rights as its key strategic pillars. As so well said in the Investment Case: “When HIV infection rates for key populations are up to 25 to 35 times higher, and six in seven new HIV infections among adolescents aged 15 to 19 years in some countries in sub-Saharan Africa occur among girls, then the answer is not just more money, but the political will to make significant changes in policies, laws, behaviours and attitudes.”
One of the key reasons why we are off track in the HIV response is because of insufficient progress in the enabling environment. An investment in the Global Fund is an investment in ensuring gender equality, health equity and human rights.
Ending HIV in children
None of the global 2020 HIV targets for children and adolescents were met, including the Start Free Stay Free AIDS Free targets and those agreed in the 2016 Political Declaration to Ending AIDS. Over the last four years, progress towards child and adolescent HIV treatment and prevention have slowed, halted and, in some cases, reversed. In 2020, the number of children aged 0-9 years who newly acquired HIV was more than eight times the target. Children and adolescents affected by HIV are also amongst those least served by efforts towards social and economic targets across the Sustainable Development Goals, including Universal Health Coverage.
Addressing the biomedical needs of children and adolescents requires far greater attention. Alongside efforts to address wider social and economic factors, we must invest in scaling up biomedical innovations for children and adolescents. An investment in the Global Fund is an investment in ending HIV in children.