GFO Issue 462, Article Number: 3
ABSTRACT
This article highlights the key points of the Global Fund’s 2023-2028 Strategic Performance Summary Report, which will be presented at the 53rd Board Meeting, scheduled to take place from May 7 to 9, 2025, in Geneva, Switzerland. Without excessive pessimism, the prevailing feeling is a mix of hope and deep concern.
The Global Fund’s 2023-2028 Strategic Performance Summary Report will be presented for information at the 53rd Board Meeting, to be held from May 7 to 9, 2025. This report aims to provide Board members and various stakeholders with an assessment of the progress made in the fight against HIV, tuberculosis, and malaria, highlighting the achievements of 2024 and the challenges ahead.
Supported countries have achieved a combined 11% reduction in mortality and a 4% reduction in incidence of these diseases compared to 2021, reflecting collective efforts across partners, implementers, and communities. However, these gains are tempered by emerging global health threats and macro-fiscal constraints, which require adaptive strategies to sustain and accelerate impact.
Rising socio-economic inequalities, conflicts, and forced displacement continue to challenge equitable access to prevention and treatment services, particularly for key and vulnerable populations. The Global Fund is prioritizing the reduction of equity gaps by designing grants and deploying resources that enhance social protection mechanisms, mitigate financial barriers, and reduce the risk of catastrophic health spending. Despite these efforts, community satisfaction with engagement in grant processes remains below targets, emphasizing the need for strengthened collaboration and responsiveness to community feedback.
Financial sustainability remains a critical concern, with the 7th Replenishment pledge amount falling below target, prompting renewed focus on realistic co-financing commitments and accountability mechanisms to safeguard national financing for health programs. Concurrently, investments continue to support critical program areas such as expanded HIV prevention tools and human rights programming, while efforts to improve health facility services and community systems are underway. These multifaceted approaches underscore the Global Fund’s commitment to maximizing impact and moving closer to its strategic goal of ending AIDS, TB, and malaria by 2028.
Progress in disease reduction and program implementation
By the end of 2023, countries supported by the Global Fund experienced an 11% combined reduction in mortality rates from HIV/AIDS, tuberculosis, and malaria compared to the 2021 baseline, with AIDS mortality dropping by 15%, TB by 13%, and malaria by a more modest 6%. According to the Global Fund, these gains underscore the efficacy of intensified antiretroviral therapy (ART) coverage, targeted TB treatment, and tailored malaria interventions. The projected combined reduction by 2028 falls between 30% under conservative and 58% under optimistic scenarios. However, the more conservative projection does not meet the Global Fund Strategy’s low target of 35%, highlighting the risk of stagnation without enhanced efforts.
The advances reflect successful interventions such as expanded access to quality malaria case management (including subnational tailored strategies), increased ART and prevention tool rollouts in HIV programs, and improvements in community and health systems. The promotion of Multiple first-line therapies to tackle emerging drug resistance in malaria and initiatives to scale up long-acting injectable Prep for HIV demonstrate adaptive responses to evolving epidemiological landscapes.
However, some stakeholders warn that the fight against malaria faces unprecedented threats, an alarming convergence of climate change, growing resistance to insecticides and treatments, the spread of new mosquito vectors in East and Southern Africa, and persistent diagnostic limitations. These challenges emerge in a context of chronic underfunding, creating a perfect storm that jeopardizes decades of progress.
Challenges in funding and health financing
Again, according to the summary report, financial sustainability remains a central challenge. Domestic resource mobilization has lagged expectations, with only 70% of co-financing commitments realized against an 85% target in the 6th Replenishment (GC6), and mitigating actions for 7th Replenishment (GC7) co-financing shortfalls are partially completed (29%). Although the Global Fund has achieved an 87% pledge quality rate and secured US$8 billion in cash by the end of 2024 (59% of the adjusted pledge), financial flexibility is constrained, evidenced by 99% corporate asset utilization surpassing the target range.
Innovative financing mechanisms are promising developments that can address funding gaps. The Secretariat’s exploration of debt swaps (Debt2Health) and blended finance partnerships, such as the prequalification of the Asian Development Bank and new agreements with Mongolia and Indonesia (the latter at EUR 75 million, the largest ever) illustrates strategic diversification of resources. Given the global economic uncertainties and competing priorities threatening health investments, these mechanisms are essential.
Strengthening oversight, accountability, and community systems
The report insists on the importance of robust financial oversight and accountability in recipient countries to maximize investment impact. In 2024, 80% of countries submitting grant audit reports met timeliness and quality benchmarks, a significant improvement from 47% in the previous year. Strengthening Supreme Audit Institutions (SAIs) is pivotal to this progress.
Moreover, community systems strengthened incrementally, with 28% of countries showing maturing or strong community system capacity for delivering health services, though policy and strategic dimensions lag behind. The integration of community-level data into national health information systems is improving and critical for sustained health outcomes.
Addressing equity, human rights, and operational maturity
While significant progress has been made in scaling up human rights programming to reduce barriers to TB and malaria services, efforts for HIV lag, with only 41% of countries meeting targets related to human rights scale-up compared to a 50% target. This shortfall is compounded by the challenging context of anti-rights and anti-gender movements, which can hinder access for vulnerable and key populations.
Capacity building within Country Coordinating Mechanisms (CCMS) shows encouraging trends, especially in engagement and oversight functions, but continued investment is necessary to bolster operational maturity across all core areas. Some countries advocate improving all the functions of CCMS and taking a holistic approach. CCM could play a more prominent strategic role than it currently does.
Critical analysis and recommendations
All in all, the Global Fund's 2024 report shows a cautiously optimistic picture but highlights several critical vulnerabilities:
- Slower-than-needed disease incidence reduction: The modest malaria incidence reduction (6%) and the failure to hit low Strategy targets under conservative projections betray underlying funding and programmatic challenges. The fight against drug and insecticide resistance remains precarious, necessitating accelerated innovation and regional tailoring.
- Fragile financial sustainability: Despite improvements in pledges and innovative financing, the persistent lag in domestic financing and co-financing mitigation reflects structural and economic constraints within countries. The Secretariat’s efforts to diversify funding sources are commendable but will require scaling and closer integration with domestic health financing reforms.
- Equity and human rights challenges: The marginal progress on HIV-related human rights programming, coupled with societal pushback against vulnerable groups, threatens equitable access to services, critical to controlling the epidemic. This calls for enhanced advocacy, resource allocation, and protective policy environments. For one stakeholder, the lack of a clear definition for "lifesaving interventions" creates a troubling ambiguity that risks sidelining critical prevention and outreach programs, particularly those led by civil society organizations. This oversight becomes especially dangerous in environments where civic space is shrinking and key populations face criminalization, leaving already marginalized groups with even fewer protections.
- Community systems and data gaps: Lagging policy and strategy frameworks for community systems risk underutilization of community health providers in service delivery, a missed opportunity in the Global Fund’s Disease Investment Case. Integrating community feedback and data must advance to optimize program reach and quality.
Conclusion
The Global Fund's Strategic Performance Summary for 2024 acknowledges commendable strides in reducing disease burden and expanding programmatic reach under challenging circumstances. However, it signals a warning that gains may decrease unless domestic financing, human rights programming, and community system strengthening accelerate in pace and scale. Innovative financing, reinforced oversight, and committed multi-stakeholder engagement remain central to overcoming these complexities toward the 2030 global health goals.
In a rapidly evolving global health ecosystem marked by economic uncertainty and sociopolitical challenges such as the rise, and in some cases radicalization, of far-right movements, combined with a significant decline in international aid; the Global Fund’s adaptive and inclusive approach will be crucial. However, it must be accompanied by strengthened country-level ownership and resources optimization on priorities and impactful activities.
The Global Fund’s 2023-2028 Strategic Performance Summary Report will be presented for information at the 53rd Board Meeting, to be held from May 7 to 9, 2025. This report aims to provide Board members and various stakeholders with an assessment of the progress made in the fight against HIV, tuberculosis, and malaria, highlighting the achievements of 2024 and the challenges ahead.
Supported countries have achieved a combined 11% reduction in mortality and a 4% reduction in incidence of these diseases compared to 2021, reflecting collective efforts across partners, implementers, and communities. However, these gains are tempered by emerging global health threats and macro-fiscal constraints, which require adaptive strategies to sustain and accelerate impact.
Rising socio-economic inequalities, conflicts, and forced displacement continue to challenge equitable access to prevention and treatment services, particularly for key and vulnerable populations. The Global Fund is prioritizing the reduction of equity gaps by designing grants and deploying resources that enhance social protection mechanisms, mitigate financial barriers, and reduce the risk of catastrophic health spending. Despite these efforts, community satisfaction with engagement in grant processes remains below targets, emphasizing the need for strengthened collaboration and responsiveness to community feedback.
Financial sustainability remains a critical concern, with the 7th Replenishment pledge amount falling below target, prompting renewed focus on realistic co-financing commitments and accountability mechanisms to safeguard national financing for health programs. Concurrently, investments continue to support critical program areas such as expanded HIV prevention tools and human rights programming, while efforts to improve health facility services and community systems are underway. These multifaceted approaches underscore the Global Fund’s commitment to maximizing impact and moving closer to its strategic goal of ending AIDS, TB, and malaria by 2028.
Progress in disease reduction and program implementation
By the end of 2023, countries supported by the Global Fund experienced an 11% combined reduction in mortality rates from HIV/AIDS, tuberculosis, and malaria compared to the 2021 baseline, with AIDS mortality dropping by 15%, TB by 13%, and malaria by a more modest 6%. According to the Global Fund, these gains underscore the efficacy of intensified antiretroviral therapy (ART) coverage, targeted TB treatment, and tailored malaria interventions. The projected combined reduction by 2028 falls between 30% under conservative and 58% under optimistic scenarios. However, the more conservative projection does not meet the Global Fund Strategy’s low target of 35%, highlighting the risk of stagnation without enhanced efforts.
The advances reflect successful interventions such as expanded access to quality malaria case management (including subnational tailored strategies), increased ART and prevention tool rollouts in HIV programs, and improvements in community and health systems. The promotion of Multiple first-line therapies to tackle emerging drug resistance in malaria and initiatives to scale up long-acting injectable Prep for HIV demonstrate adaptive responses to evolving epidemiological landscapes.
However, some stakeholders warn that the fight against malaria faces unprecedented threats, an alarming convergence of climate change, growing resistance to insecticides and treatments, the spread of new mosquito vectors in East and Southern Africa, and persistent diagnostic limitations. These challenges emerge in a context of chronic underfunding, creating a perfect storm that jeopardizes decades of progress.
Challenges in funding and health financing
Again, according to the summary report, financial sustainability remains a central challenge. Domestic resource mobilization has lagged expectations, with only 70% of co-financing commitments realized against an 85% target in the 6th Replenishment (GC6), and mitigating actions for 7th Replenishment (GC7) co-financing shortfalls are partially completed (29%). Although the Global Fund has achieved an 87% pledge quality rate and secured US$8 billion in cash by the end of 2024 (59% of the adjusted pledge), financial flexibility is constrained, evidenced by 99% corporate asset utilization surpassing the target range.
Innovative financing mechanisms are promising developments that can address funding gaps. The Secretariat’s exploration of debt swaps (Debt2Health) and blended finance partnerships, such as the prequalification of the Asian Development Bank and new agreements with Mongolia and Indonesia (the latter at EUR 75 million, the largest ever) illustrates strategic diversification of resources. Given the global economic uncertainties and competing priorities threatening health investments, these mechanisms are essential.
Strengthening oversight, accountability, and community systems
The report insists on the importance of robust financial oversight and accountability in recipient countries to maximize investment impact. In 2024, 80% of countries submitting grant audit reports met timeliness and quality benchmarks, a significant improvement from 47% in the previous year. Strengthening Supreme Audit Institutions (SAIs) is pivotal to this progress.
Moreover, community systems strengthened incrementally, with 28% of countries showing maturing or strong community system capacity for delivering health services, though policy and strategic dimensions lag behind. The integration of community-level data into national health information systems is improving and critical for sustained health outcomes.
Addressing equity, human rights, and operational maturity
While significant progress has been made in scaling up human rights programming to reduce barriers to TB and malaria services, efforts for HIV lag, with only 41% of countries meeting targets related to human rights scale-up compared to a 50% target. This shortfall is compounded by the challenging context of anti-rights and anti-gender movements, which can hinder access for vulnerable and key populations.
Capacity building within Country Coordinating Mechanisms (CCMS) shows encouraging trends, especially in engagement and oversight functions, but continued investment is necessary to bolster operational maturity across all core areas. Some countries advocate improving all the functions of CCMS and taking a holistic approach. CCM could play a more prominent strategic role than it currently does.
Critical analysis and recommendations
All in all, the Global Fund's 2024 report shows a cautiously optimistic picture but highlights several critical vulnerabilities:
- Slower-than-needed disease incidence reduction: The modest malaria incidence reduction (6%) and the failure to hit low Strategy targets under conservative projections betray underlying funding and programmatic challenges. The fight against drug and insecticide resistance remains precarious, necessitating accelerated innovation and regional tailoring.
- Fragile financial sustainability: Despite improvements in pledges and innovative financing, the persistent lag in domestic financing and co-financing mitigation reflects structural and economic constraints within countries. The Secretariat’s efforts to diversify funding sources are commendable but will require scaling and closer integration with domestic health financing reforms.
- Equity and human rights challenges: The marginal progress on HIV-related human rights programming, coupled with societal pushback against vulnerable groups, threatens equitable access to services, critical to controlling the epidemic. This calls for enhanced advocacy, resource allocation, and protective policy environments. For one stakeholder, the lack of a clear definition for "lifesaving interventions" creates a troubling ambiguity that risks sidelining critical prevention and outreach programs, particularly those led by civil society organizations. This oversight becomes especially dangerous in environments where civic space is shrinking and key populations face criminalization, leaving already marginalized groups with even fewer protections.
- Community systems and data gaps: Lagging policy and strategy frameworks for community systems risk underutilization of community health providers in service delivery, a missed opportunity in the Global Fund’s Disease Investment Case. Integrating community feedback and data must advance to optimize program reach and quality.
Conclusion
The Global Fund's Strategic Performance Summary for 2024 acknowledges commendable strides in reducing disease burden and expanding programmatic reach under challenging circumstances. However, it signals a warning that gains may decrease unless domestic financing, human rights programming, and community system strengthening accelerate in pace and scale. Innovative financing, reinforced oversight, and committed multi-stakeholder engagement remain central to overcoming these complexities toward the 2030 global health goals.
In a rapidly evolving global health ecosystem marked by economic uncertainty and sociopolitical challenges such as the rise, and in some cases radicalization, of far-right movements, combined with a significant decline in international aid; the Global Fund’s adaptive and inclusive approach will be crucial. However, it must be accompanied by strengthened country-level ownership and resources optimization on priorities and impactful activities.
