GFO Issue 462, Article Number: 9
ABSTRACT
This article analyses the Global Fund’s 2024 OIG Annual Report, which was presented at the 53rd Board Meeting, from May 7 to 9, 2025, in Geneva. The report highlights the Global Fund’s progress amid global uncertainty, identifies key governance-related risks, and calls for bold operational reforms to maximize efficiency and safeguard billions in the fight against HIV, tuberculosis, and malaria.
Introduction
The Global Fund to Fight AIDS, Tuberculosis and Malaria has transformed global health outcomes since 2002, saving an estimated 65 million lives through targeted interventions. Last year alone, its programs delivered essential services to 59 million people across 100+ countries. As the independent oversight body, the Office of the Inspector General (OIG) conducted 21 comprehensive reviews in 2024 to ensure these investments achieve maximum impact through rigorous audits and real-time monitoring systems.
Fig1: The Global Fund 2024 results
Design : AIDSPAN
For your information, the Office of the Inspector General (OIG) plays a key role in safeguarding the Global Fund’s assets, investments, and reputation while ensuring that the fight against AIDS, tuberculosis, and malaria remains effective, transparent, and sustainable. Its annual report, to be presented at the 53rd Board Meeting from May 7 to 9, 2025, highlights the OIG’s critical work over the past year, as well as the challenges identified and strategic directions for the years ahead.
Impressive gains amidst persistent global health threats
The Global Fund partnership’s 2024 results report underscores significant achievements in the fight against HIV, TB, and malaria worldwide. The Global Fund improves health outcomes in many countries, driven by strong political leadership, country ownership, and effective partnerships with governments, civil society, and technical agencies.
HIV Impact: New HIV infections have been at their lowest level since the mid-1990s. In several countries audited during the year, including Malawi, Eswatini, Zimbabwe, Rwanda, Cambodia, and Indonesia, the OIG noted an impressive 75% reduction in new HIV infections, with many on track to meet the ambitious 90% reduction target by 2030. Some African countries, such as Eswatini, Zimbabwe, Namibia, Zambia, and Cambodia, have even surpassed global HIV 95-95-95 targets, demonstrating that elimination is within reach with sustained investment and strong national health systems.
Tuberculosis (TB) Trends: After setbacks during the COVID-19 pandemic, TB notification and treatment success rates have stabilised. Countries like Indonesia and the Greater Mekong subregion nations have achieved notable improvements, such as a 42% increase in TB case notifications and DS-TB treatment success rates near or above 87%. However, despite progress in the region, some gaps remain, from weak sub-recipient monitoring in Bangladesh to flawed procurement, weak community outreach, and uneven care access.
Malaria Programs: Although malaria programs face operational and environmental challenges, including climate change, rising incidence in some regions, and lower-than-expected bed net utilization, significant progress has been made. According to the report, the Global Fund-aided programs averted over 177 million malaria cases and more than one million deaths worldwide in 2023, with countries such as Eswatini demonstrating success in reducing malaria incidence and deaths, positioning them as “Elimination 8” countries committed to malaria elimination by 2030.
A continent at the epicenter: Africa
Africa remains critical to the Global Fund’s mission given its disproportionate burden of HIV, TB, and malaria. The OIG report confirms that African countries continue to deliver significant health improvements, though challenges persist that threaten the sustainability and effectiveness of these programs.
Encouraging progress
Several African countries are leading in progress against HIV. Eswatini, Zimbabwe, Namibia, and Zambia have surpassed the 95-95-95 targets, referring to the proportion of people living with HIV who know their status, are on treatment, and have viral suppression. Malawi has shown availability of key commodities under Global Fund grants at all levels, while Rwanda’s adoption of the Result-Based Financing (RBF) model has allowed alignment of incentives with program outcomes, leading to sustained progress in HIV and malaria targets.
The collaborative efforts between the Global Fund’s OIG and African Supreme Audit Institutions (SAIs) such as AFROSAI-E and CREFIAF point to strengthening governance and oversight. OIG’s involvement with initiatives like the "Conquering Corruption in Africa" event would, according to the report, reflect a sustained commitment to strengthening accountability mechanisms, an essential factor in protecting donor investments and ensuring the integrity of programs.
Systemic challenges that need immediate action
Despite these successes, the OIG identified critical vulnerabilities threatening program sustainability. Persistent supply chain failures caused essential medicine stockouts in Angola and Malawi, while only 26% of planned corrective actions met implementation deadlines. The report particularly highlights concerning gaps in prevention tool utilization, with Zimbabwe's bed net programs demonstrating how distribution doesn't guarantee usage without proper community engagement. Data collection systems require urgent upgrades to properly track marginalized populations often missed by current reporting methods.
Despite these gains, numerous challenges undermine the effectiveness and sustainability of programs in Africa:
-
Commodity stock-outs and supply chain gaps: OIG’s audits highlighted critical stock-outs of essential commodities, disrupting prevention and treatment services across diseases. For example, Angola continues to experience material stock-outs despite progress in co-financing verification and sub-recipient data monitoring. Malawi, although having commodities available, has delayed supply chain integration efforts that limit efficiency.
-
Low utilization of prevention tools: High coverage but low utilization of bed nets in countries such as Zimbabwe illustrates a critical gap in translating access into effective preventive behavior. Cultural and behavioral barriers, and limited funding for social and behavior change communication programs, have been identified as key barriers.
-
Targeting vulnerable populations: A recurring theme across African countries is the insufficient reach of programs to key populations such as adolescents, young women, pregnant women, refugees, and vulnerable children. Inadequate tailoring of interventions and limited disaggregated data hinder precise targeting and reporting, observed particularly in Zimbabwe, Guinea, and Guinea-Bissau.
-
Sustainability concerns: The OIG’s audit of regional initiatives such as the Regional Artemisinin-resistance Initiative (RAI) highlights a lack of sustainability planning and preparedness in programs, warning that without stronger plans, gains in malaria elimination could be reversed.
However…
While the Global Fund's achievements to date are undeniable, the 2024 OIG Annual Report paints a nuanced picture that calls for critical reflection and urgent action.
- Governance and risk management must improve
The report reveals inconsistent governance and oversight, leading to avoidable risks such as commodity stock-outs, delays in fund utilization, and reporting inaccuracies. These issues erode donor confidence and program effectiveness. The OIG’s efforts to collaborate with African SAIs represent a significant step forward. However, strengthening these relationships, ensuring regular independent audits, and embedding robust governance practices at all levels remain imperative.
Critically, there is a tension between the Global Fund’s ambitious programmatic reach and the varying capacity of countries (especially Challenging Operating Environments(COE)to manage complex grants. Enhancing local capacity and deploying more in-country resources to support implementers could mitigate many risks. The report suggests that while the OIG has increased staffing, in-country technical support has not grown proportionally, a gap that requires urgent addressing.
2. Programmatic focus and data quality
The gap between availability and utilization of prevention tools, such as insecticide-treated nets, underlines a problematic disconnect between supply chains and community engagement strategies. This, coupled with weak data collection and limited disaggregation, restricts understanding of who is being left behind.
To address these challenges, according to the IGO report, more investments are needed in social and behavior change programs and strengthening data systems to facilitate targeted interventions. Programs must be designed for coverage, acceptance, and behavioral uptake.
3. Sustainability vs donor dependence
A significant concern across African programs is the sustainability of successes amid shifting donor priorities and economic pressures. The lack of exit strategies and country ownership plans, especially for malaria programs and regional initiatives like RAI, threatens to reverse hard-won gains.
According to the Report, the Global Fund must work more closely with countries to develop realistic transition plans, including diversified financing, integration into national health systems, and capacity building, to ensure lasting impact. Continuous failure to plan for sustainability may saddle recipient countries with unmanageable programmatic dependencies.
4. Moving into political and economic uncertainties
2024 OIG annual report
The report notes the increasing complexity of the global health ecosystem, with political, economic, and security challenges complicating grant implementation. The cancellation of the Middle East multi-country audit due to security issues illustrates the growing reality that regions may become inaccessible due to instability, requiring agile and innovative approaches to oversight and programming.
As funding environments tighten, there is a risk that the Global Fund and its partners will need to “do more with less.” Efficiency gains and prioritisation will be critical but may require difficult trade-offs, potentially affecting vulnerable populations that often require sustained and sometimes costly interventions.
In this context, the OIG's recommendations for enhancing the Global Fund model present actionable opportunities to increase operational efficiency and optimize resource utilization. We believe such improvements will and could help with the resources optimization.
A Model of Accountability in Global Health
Financial management remains exemplary, with fraud cases constituting just 0.3% of total expenditures - a testament to the OIG's robust oversight systems. Their investigative work recovered $28 million in misused funds while implementing preventive controls at 120 high-risk implementation sites. These efforts have strengthened partnerships with key allies like Gavi and national health ministries.
Protecting gains through vigilance
2024 OIG annual report
As the Global Fund enters its next funding cycle, the 2024 OIG report provides both celebration and caution. Celebrating health victories reminds stakeholders that sustained success requires addressing systemic weaknesses in delivery systems, data quality and transition planning. Moving forward, the OIG annual report is a reminder for countries, especially African countries, to improve their leadership and ownership for the well-being of all the stakeholders within the health system.
Introduction
The Global Fund to Fight AIDS, Tuberculosis and Malaria has transformed global health outcomes since 2002, saving an estimated 65 million lives through targeted interventions. Last year alone, its programs delivered essential services to 59 million people across 100+ countries. As the independent oversight body, the Office of the Inspector General (OIG) conducted 21 comprehensive reviews in 2024 to ensure these investments achieve maximum impact through rigorous audits and real-time monitoring systems.
Fig1: The Global Fund 2024 results
Design : AIDSPAN
For your information, the Office of the Inspector General (OIG) plays a key role in safeguarding the Global Fund’s assets, investments, and reputation while ensuring that the fight against AIDS, tuberculosis, and malaria remains effective, transparent, and sustainable. Its annual report, to be presented at the 53rd Board Meeting from May 7 to 9, 2025, highlights the OIG’s critical work over the past year, as well as the challenges identified and strategic directions for the years ahead.
Impressive gains amidst persistent global health threats
The Global Fund partnership’s 2024 results report underscores significant achievements in the fight against HIV, TB, and malaria worldwide. The Global Fund improves health outcomes in many countries, driven by strong political leadership, country ownership, and effective partnerships with governments, civil society, and technical agencies.
HIV Impact: New HIV infections have been at their lowest level since the mid-1990s. In several countries audited during the year, including Malawi, Eswatini, Zimbabwe, Rwanda, Cambodia, and Indonesia, the OIG noted an impressive 75% reduction in new HIV infections, with many on track to meet the ambitious 90% reduction target by 2030. Some African countries, such as Eswatini, Zimbabwe, Namibia, Zambia, and Cambodia, have even surpassed global HIV 95-95-95 targets, demonstrating that elimination is within reach with sustained investment and strong national health systems.
Tuberculosis (TB) Trends: After setbacks during the COVID-19 pandemic, TB notification and treatment success rates have stabilised. Countries like Indonesia and the Greater Mekong subregion nations have achieved notable improvements, such as a 42% increase in TB case notifications and DS-TB treatment success rates near or above 87%. However, despite progress in the region, some gaps remain, from weak sub-recipient monitoring in Bangladesh to flawed procurement, weak community outreach, and uneven care access.
Malaria Programs: Although malaria programs face operational and environmental challenges, including climate change, rising incidence in some regions, and lower-than-expected bed net utilization, significant progress has been made. According to the report, the Global Fund-aided programs averted over 177 million malaria cases and more than one million deaths worldwide in 2023, with countries such as Eswatini demonstrating success in reducing malaria incidence and deaths, positioning them as “Elimination 8” countries committed to malaria elimination by 2030.
A continent at the epicenter: Africa
Africa remains critical to the Global Fund’s mission given its disproportionate burden of HIV, TB, and malaria. The OIG report confirms that African countries continue to deliver significant health improvements, though challenges persist that threaten the sustainability and effectiveness of these programs.
Encouraging progress
Several African countries are leading in progress against HIV. Eswatini, Zimbabwe, Namibia, and Zambia have surpassed the 95-95-95 targets, referring to the proportion of people living with HIV who know their status, are on treatment, and have viral suppression. Malawi has shown availability of key commodities under Global Fund grants at all levels, while Rwanda’s adoption of the Result-Based Financing (RBF) model has allowed alignment of incentives with program outcomes, leading to sustained progress in HIV and malaria targets.
The collaborative efforts between the Global Fund’s OIG and African Supreme Audit Institutions (SAIs) such as AFROSAI-E and CREFIAF point to strengthening governance and oversight. OIG’s involvement with initiatives like the "Conquering Corruption in Africa" event would, according to the report, reflect a sustained commitment to strengthening accountability mechanisms, an essential factor in protecting donor investments and ensuring the integrity of programs.
Systemic challenges that need immediate action
Despite these successes, the OIG identified critical vulnerabilities threatening program sustainability. Persistent supply chain failures caused essential medicine stockouts in Angola and Malawi, while only 26% of planned corrective actions met implementation deadlines. The report particularly highlights concerning gaps in prevention tool utilization, with Zimbabwe's bed net programs demonstrating how distribution doesn't guarantee usage without proper community engagement. Data collection systems require urgent upgrades to properly track marginalized populations often missed by current reporting methods.
Despite these gains, numerous challenges undermine the effectiveness and sustainability of programs in Africa:
-
Commodity stock-outs and supply chain gaps: OIG’s audits highlighted critical stock-outs of essential commodities, disrupting prevention and treatment services across diseases. For example, Angola continues to experience material stock-outs despite progress in co-financing verification and sub-recipient data monitoring. Malawi, although having commodities available, has delayed supply chain integration efforts that limit efficiency.
-
Low utilization of prevention tools: High coverage but low utilization of bed nets in countries such as Zimbabwe illustrates a critical gap in translating access into effective preventive behavior. Cultural and behavioral barriers, and limited funding for social and behavior change communication programs, have been identified as key barriers.
-
Targeting vulnerable populations: A recurring theme across African countries is the insufficient reach of programs to key populations such as adolescents, young women, pregnant women, refugees, and vulnerable children. Inadequate tailoring of interventions and limited disaggregated data hinder precise targeting and reporting, observed particularly in Zimbabwe, Guinea, and Guinea-Bissau.
-
Sustainability concerns: The OIG’s audit of regional initiatives such as the Regional Artemisinin-resistance Initiative (RAI) highlights a lack of sustainability planning and preparedness in programs, warning that without stronger plans, gains in malaria elimination could be reversed.
However…
While the Global Fund's achievements to date are undeniable, the 2024 OIG Annual Report paints a nuanced picture that calls for critical reflection and urgent action.
- Governance and risk management must improve
The report reveals inconsistent governance and oversight, leading to avoidable risks such as commodity stock-outs, delays in fund utilization, and reporting inaccuracies. These issues erode donor confidence and program effectiveness. The OIG’s efforts to collaborate with African SAIs represent a significant step forward. However, strengthening these relationships, ensuring regular independent audits, and embedding robust governance practices at all levels remain imperative.
Critically, there is a tension between the Global Fund’s ambitious programmatic reach and the varying capacity of countries (especially Challenging Operating Environments(COE)to manage complex grants. Enhancing local capacity and deploying more in-country resources to support implementers could mitigate many risks. The report suggests that while the OIG has increased staffing, in-country technical support has not grown proportionally, a gap that requires urgent addressing.
2. Programmatic focus and data quality
The gap between availability and utilization of prevention tools, such as insecticide-treated nets, underlines a problematic disconnect between supply chains and community engagement strategies. This, coupled with weak data collection and limited disaggregation, restricts understanding of who is being left behind.
To address these challenges, according to the IGO report, more investments are needed in social and behavior change programs and strengthening data systems to facilitate targeted interventions. Programs must be designed for coverage, acceptance, and behavioral uptake.
3. Sustainability vs donor dependence
A significant concern across African programs is the sustainability of successes amid shifting donor priorities and economic pressures. The lack of exit strategies and country ownership plans, especially for malaria programs and regional initiatives like RAI, threatens to reverse hard-won gains.
According to the Report, the Global Fund must work more closely with countries to develop realistic transition plans, including diversified financing, integration into national health systems, and capacity building, to ensure lasting impact. Continuous failure to plan for sustainability may saddle recipient countries with unmanageable programmatic dependencies.
4. Moving into political and economic uncertainties
2024 OIG annual report
The report notes the increasing complexity of the global health ecosystem, with political, economic, and security challenges complicating grant implementation. The cancellation of the Middle East multi-country audit due to security issues illustrates the growing reality that regions may become inaccessible due to instability, requiring agile and innovative approaches to oversight and programming.
As funding environments tighten, there is a risk that the Global Fund and its partners will need to “do more with less.” Efficiency gains and prioritisation will be critical but may require difficult trade-offs, potentially affecting vulnerable populations that often require sustained and sometimes costly interventions.
In this context, the OIG's recommendations for enhancing the Global Fund model present actionable opportunities to increase operational efficiency and optimize resource utilization. We believe such improvements will and could help with the resources optimization.
A Model of Accountability in Global Health
Financial management remains exemplary, with fraud cases constituting just 0.3% of total expenditures - a testament to the OIG's robust oversight systems. Their investigative work recovered $28 million in misused funds while implementing preventive controls at 120 high-risk implementation sites. These efforts have strengthened partnerships with key allies like Gavi and national health ministries.
Protecting gains through vigilance
2024 OIG annual report
As the Global Fund enters its next funding cycle, the 2024 OIG report provides both celebration and caution. Celebrating health victories reminds stakeholders that sustained success requires addressing systemic weaknesses in delivery systems, data quality and transition planning. Moving forward, the OIG annual report is a reminder for countries, especially African countries, to improve their leadership and ownership for the well-being of all the stakeholders within the health system.
