GFO Issue 461, Article Number: 3
ABSTRACT
Faced with a sharp decline in international aid, growing competing priorities, and an imminent risk of financial crisis, the Global Fund is making budget cuts—postponing certain expenditures related to infrastructure, equipment, and research—to keep its HIV, tuberculosis, and malaria programs running. While COVID-19 response efforts remain untouched for now, other critical initiatives risk delays, legal hurdles, and disruptions, particularly for frontline NGOs and contracted partners. The message is clear: “Protect what matters, adapt to the crisis.”
The way forward? “Do more with less, without leaving the most vulnerable behind.” But were there really any unnecessary expenses to begin with?
In any case, this new budgetary reality is expected to shape much of the discussion at the 53rd Board Meeting, to be held from May 7 to 9, 2025, in Geneva, Switzerland.
In a recent communication, the Global Fund informed countries, principal recipients, Country Coordinating Mechanism (CCM) members, and Board members of a major shift with significant implications. In response to an increasingly unstable global financial landscape, the institution has decided to implement swift and substantial adjustments to ensure the continued operation of essential programs against HIV, tuberculosis, and malaria.
As a temporary measure, the partnership is introducing transitional actions aimed at preserving core services. According to the Global Fund, these adjustments are intended to maximize available resources while maintaining life-saving interventions. As stated in the letters sent to stakeholders, which we were able to review: “Our aim is to work together to maximize your country’s ability to adapt its Global Fund grants to the rapidly evolving external context, and thus to ensure we continue to optimize the impact of our investments, protecting the gains and sustaining our progress.”
But what do these letters actually say? And what do they reveal about the Global Fund’s current strategy?
What does it cover and how?
1. Capital Investments:
The implementation of capital investments will be deferred until further notice. This category typically includes expenditures on fixed assets such as infrastructure projects or major physical improvements related to the health programs. By postponing these investments, the Global Fund aims to conserve financial resources while prioritizing essential, ongoing program activities.
2. Purchase of New Vehicles and Equipment
The acquisition of new vehicles, as well as IT, laboratory, and other types of equipment, will be paused. This measure affects procurement plans for assets that support program operations, including transport and technology infrastructure necessary for service delivery. Delaying such purchases helps reduce non-critical spending during this period of uncertainty.
3. Certain Trainings, Conferences, and Publications:
Some training sessions, conferences, and related publications will be deferred. These activities often contribute to capacity building, knowledge sharing, and dissemination of information but may be considered less urgent compared to frontline service provision. Scaling back on these activities allows resources to focus on critical interventions.
4. Surveys, Studies, Assessments, and Reviews:
Planned surveys, studies, program assessments, and evaluations will be put on hold. These activities are important for monitoring, evaluation, and evidence gathering but can be temporarily postponed without compromising immediate service delivery. This pause provides flexibility to concentrate efforts on sustaining essential health services.
5. Certain Program Management Elements
: Some elements of program management will also be deferred. This could include administrative or oversight activities considered non-essential or less time-sensitive at this moment. By reducing these expenditures,
Global Fund intends to streamline program operations and prioritize core activities directly impacting health outcomes.
6. Certain Less Time-Critical or Essential Disease-Specific Activities:
Where appropriate, specific activities related to individual diseases (HIV/AIDS, tuberculosis, malaria) that are deemed less critical or not immediately essential may be deferred. These decisions will reflect country-specific contexts and be coordinated with the Country Team, ensuring that crucial interventions remain uninterrupted.
The Global Fund, however, reaffirms its commitment to what it considers ‘priority’ investments in the fight against the three diseases. But what exactly do this entail?
Fig 1: Three core priorities for HIV investments
Fig 2: Three core priorities for Tb investments
Fig 3: Three core priorities for malaria investments
Worth mentioning, all activities related to the COVID-19 Response Mechanism (C19RM) are exempt from these deferrals and are expected to proceed as approved to maintain momentum in responding to the ongoing health emergency.
While the need for adjustments may be understandable, these unprecedented measures could carry serious consequences.
Several Principal Recipients (PRs) have signed annual or multi-year contracts. Abruptly suspending or terminating these agreements risks triggering legal repercussions, exposing both PRs and governments to judicial challenges and reputational damage
for the already on going contract at country level. At the same time, certain activities scheduled for future quarters - or even the next implementation year - have already been initiated in anticipation of programmatic needs. In this context, the Global Fund Secretariat must provide clear, timely guidance on how to manage these risks and must ensure that such expenditures will not be retroactively deemed ineligible under the new rules.
Moreover, several key performance indicators (KPIs) are directly tied to activities now facing delays or disruptions. It is essential to clarify whether this revised guidance will lead to adjustments in KPIs and grant performance expectations, to avoid unfairly penalizing implementers for decisions beyond their control.
Adding to the concern, at no point does anyone say whether this unprecedented turnaround in the Global Fund's operations, and we are entitled to wonder whether the Board was consulted and whether its opinion was required on the matter.
Another area of concern, this critical situation is expected to be addressed during the 53rd Board Meeting, but only in an executive session, excluding many delegations. This is regrettable. All stakeholders deserve to be included in the conversation. Their field experience and practical insight are invaluable and should help guide decision-making at this pivotal moment.
Nevertheless, the Technical Review Panel (TRP) consists of experts in HIV, tuberculosis, malaria, human rights and gender, health systems, and sustainable financing. Beyond ensuring the funding of effective programs, it also plays a key advisory role in maximizing the impact of Global Fund investments and aligning them with the objectives outlined in the Global Fund Strategy. Given the TRP’s critical function within the Global Fund’s governance structure, one must ask: were its members consulted?
Conclusion
A slowdown in implementation could disproportionately affect civil society organizations (CSOs) and community systems, many of whom operate with limited financial buffers. These actors are often closest to the populations most in need and play a vital role in program continuity. To minimize disruption, Global Fund should establish clear and responsive communication channels to ensure that frontline implementers are not left in uncertainty.
The Global Fund’s recent adjustments may reflect necessary measures, but they will be challenging to implement in an uncertain financial ecosystem, especially while striving to maintain essential health services for HIV, tuberculosis, and malaria. By postponing certain investments, procurements, non-urgent trainings, and programmatic activities, the Global Fund states its intent to prioritize life-saving interventions amid significant budgetary constraints.
However, these deferrals are not without consequences: they pose substantial operational and legal risks, particularly for Principal Recipients with ongoing contracts, pre-committed expenditures, or key performance indicators directly tied to the affected activities.
The success of these interim measures depends on proactive risk management, adaptive implementation, and unwavering commitment to protecting the most vulnerable populations. At a time when we talk about country ownership, it’s important to advocate for more domestic resources and ask country to be the one who should be prioritizing and come up with feasible measures and key priorities.
In a recent communication, the Global Fund informed countries, principal recipients, Country Coordinating Mechanism (CCM) members, and Board members of a major shift with significant implications. In response to an increasingly unstable global financial landscape, the institution has decided to implement swift and substantial adjustments to ensure the continued operation of essential programs against HIV, tuberculosis, and malaria.
As a temporary measure, the partnership is introducing transitional actions aimed at preserving core services. According to the Global Fund, these adjustments are intended to maximize available resources while maintaining life-saving interventions. As stated in the letters sent to stakeholders, which we were able to review: “Our aim is to work together to maximize your country’s ability to adapt its Global Fund grants to the rapidly evolving external context, and thus to ensure we continue to optimize the impact of our investments, protecting the gains and sustaining our progress.”
But what do these letters actually say? And what do they reveal about the Global Fund’s current strategy?
What does it cover and how?
1. Capital Investments:
The implementation of capital investments will be deferred until further notice. This category typically includes expenditures on fixed assets such as infrastructure projects or major physical improvements related to the health programs. By postponing these investments, the Global Fund aims to conserve financial resources while prioritizing essential, ongoing program activities.
2. Purchase of New Vehicles and Equipment
The acquisition of new vehicles, as well as IT, laboratory, and other types of equipment, will be paused. This measure affects procurement plans for assets that support program operations, including transport and technology infrastructure necessary for service delivery. Delaying such purchases helps reduce non-critical spending during this period of uncertainty.
3. Certain Trainings, Conferences, and Publications:
Some training sessions, conferences, and related publications will be deferred. These activities often contribute to capacity building, knowledge sharing, and dissemination of information but may be considered less urgent compared to frontline service provision. Scaling back on these activities allows resources to focus on critical interventions.
4. Surveys, Studies, Assessments, and Reviews:
Planned surveys, studies, program assessments, and evaluations will be put on hold. These activities are important for monitoring, evaluation, and evidence gathering but can be temporarily postponed without compromising immediate service delivery. This pause provides flexibility to concentrate efforts on sustaining essential health services.
5. Certain Program Management Elements
: Some elements of program management will also be deferred. This could include administrative or oversight activities considered non-essential or less time-sensitive at this moment. By reducing these expenditures,
Global Fund intends to streamline program operations and prioritize core activities directly impacting health outcomes.
6. Certain Less Time-Critical or Essential Disease-Specific Activities:
Where appropriate, specific activities related to individual diseases (HIV/AIDS, tuberculosis, malaria) that are deemed less critical or not immediately essential may be deferred. These decisions will reflect country-specific contexts and be coordinated with the Country Team, ensuring that crucial interventions remain uninterrupted.
The Global Fund, however, reaffirms its commitment to what it considers ‘priority’ investments in the fight against the three diseases. But what exactly do this entail?
Fig 1: Three core priorities for HIV investments
Fig 2: Three core priorities for Tb investments
Fig 3: Three core priorities for malaria investments
Worth mentioning, all activities related to the COVID-19 Response Mechanism (C19RM) are exempt from these deferrals and are expected to proceed as approved to maintain momentum in responding to the ongoing health emergency.
While the need for adjustments may be understandable, these unprecedented measures could carry serious consequences.
Several Principal Recipients (PRs) have signed annual or multi-year contracts. Abruptly suspending or terminating these agreements risks triggering legal repercussions, exposing both PRs and governments to judicial challenges and reputational damage
for the already on going contract at country level. At the same time, certain activities scheduled for future quarters - or even the next implementation year - have already been initiated in anticipation of programmatic needs. In this context, the Global Fund Secretariat must provide clear, timely guidance on how to manage these risks and must ensure that such expenditures will not be retroactively deemed ineligible under the new rules.
Moreover, several key performance indicators (KPIs) are directly tied to activities now facing delays or disruptions. It is essential to clarify whether this revised guidance will lead to adjustments in KPIs and grant performance expectations, to avoid unfairly penalizing implementers for decisions beyond their control.
Adding to the concern, at no point does anyone say whether this unprecedented turnaround in the Global Fund's operations, and we are entitled to wonder whether the Board was consulted and whether its opinion was required on the matter.
Another area of concern, this critical situation is expected to be addressed during the 53rd Board Meeting, but only in an executive session, excluding many delegations. This is regrettable. All stakeholders deserve to be included in the conversation. Their field experience and practical insight are invaluable and should help guide decision-making at this pivotal moment.
Nevertheless, the Technical Review Panel (TRP) consists of experts in HIV, tuberculosis, malaria, human rights and gender, health systems, and sustainable financing. Beyond ensuring the funding of effective programs, it also plays a key advisory role in maximizing the impact of Global Fund investments and aligning them with the objectives outlined in the Global Fund Strategy. Given the TRP’s critical function within the Global Fund’s governance structure, one must ask: were its members consulted?
Conclusion
A slowdown in implementation could disproportionately affect civil society organizations (CSOs) and community systems, many of whom operate with limited financial buffers. These actors are often closest to the populations most in need and play a vital role in program continuity. To minimize disruption, Global Fund should establish clear and responsive communication channels to ensure that frontline implementers are not left in uncertainty.
The Global Fund’s recent adjustments may reflect necessary measures, but they will be challenging to implement in an uncertain financial ecosystem, especially while striving to maintain essential health services for HIV, tuberculosis, and malaria. By postponing certain investments, procurements, non-urgent trainings, and programmatic activities, the Global Fund states its intent to prioritize life-saving interventions amid significant budgetary constraints.
However, these deferrals are not without consequences: they pose substantial operational and legal risks, particularly for Principal Recipients with ongoing contracts, pre-committed expenditures, or key performance indicators directly tied to the affected activities.
The success of these interim measures depends on proactive risk management, adaptive implementation, and unwavering commitment to protecting the most vulnerable populations. At a time when we talk about country ownership, it’s important to advocate for more domestic resources and ask country to be the one who should be prioritizing and come up with feasible measures and key priorities.
