GFO Issue 462, Article Number: 7
ABSTRACT
The article summarizes the Global Fund Board discussions held in Geneva from 7 to 9 May 2025 on the Seventh Grant Cycle. Discussions covered progress in grant decisions and spending—96% of proposals reviewed, 241 grants approved, and 95% of allocations had been used up by April 2025. Despite gains, a $5.7 billion funding gap remains for interventions listed in the unfunded quality demand register and delays in catalytic investments persist. Although there have been great improvements in Country Coordinating Mechanisms management, challenges remain in relation to both ethical oversight and monitoring of co-financing. Partners are clamoring for increased transparency, simplified process and deeper engagement.
The Global Fund has made significant progress in Grant Cycle 7 (GC7), which is the ongoing Global Fund grant cycle spanning from 2023 to 2025, particularly in grant implementation, private sector engagement, and strategic investments. These issues were discussed at the 53rd Global Fund Board meeting in Geneva from 7 – 9 May 2025. According to the Secretariat report, proposals, approved 241 grants, and begun their execution by April 2025. This is an improvement when compared to the preceding country funding update from the Global Fund. Despite the Global Fund utilizing 95% of the country allocations and 94% of matching funds, the organization faced challenges such as delays in catalytic investments, governance deficiencies, and a $5.7 billion unfunded quality demand (UQD) funding shortfall.
To maintain advancement and reinforce the groundwork for Grant Cycle 8 (GC8), the Global Fund needs to enhance resource use, improve governance, and broaden partnerships with the private sector. For sustainability, the organization should focus on timely implementation of catalytic investments, strengthening Country Coordinating Mechanism (CCM) governance, and secure additional funding.
Management of country allocations
According to the Secretariat report, t. This shows an improved alignment of country funding proposals with the Global Fund’s technical guidelines, thereby lessening the necessity for alterations or adjustments.
The Secretariat report indicated that by mid-February 2025, the Board had approved $12.45 billion of the country allocations, representing 95% of the $13.128 billion designated for this purpose. The allocation of funds consists of $5.97 billion for HIV/AIDS, $4.17 billion for malaria, and $2.31 billion for tuberculosis. The Board approved 241 grants, all of which are now in the implementation stage, while 21 more grants are still being reviewed and are pending approval in 2025.
Catalytic Investments
The Global Fund operates special funds, known as catalytic investments, to enhance health initiatives that go beyond the regular country allocations. There are three categories of catalytic investment: Matching Funds, Multicountry Programs, and Strategic Initiatives. However, the Secretariat report noted that for GC7 these funds experienced delays compared to country allocations because of longer approval and distribution processes.
Also, the Secretariat report noted that so far, the Global Fund has approved 94% of the Matching Funds, exhibiting strong financial commitment. However, the Multicountry Programs have encountered challenges, as only 72% of the intended $110 million has been approved. One significant problem is that applications for Multicountry Programs funds often come late in the funding cycle, leading
to
delays in
allocating
financial
resources
to
areas
of
need. This is especially true for HIV-related programs, where approvals have been slow. The first HIV-focused Multicountry investment for Eastern Europe and Central Asia was approved in Window 6, with the rest at the negotiation stage. These delays make it harder to plan and provide critical health services in high-need areas.
On the brighter side, participation of the private sector involvement in GC7 has risen, contributing
an
additional
$71 million for
essential
health
initiatives. A major highlight is the Climate and Health catalytic fund, announced at the World Economic Forum in Davos, which has already garnered $50 million commitments from the private sector. This initiative aims to strengthen health systems against climate-related challenges by helping countries integrate climate adaptation into their healthcare strategies. This
effort
seeks
to
bolster
health systems
in
response
to climate-related
issues
by
assisting
countries
in
incorporating
climate adaptation into their healthcare
plans.
According to the Secretariat report to the Board, strategic initiatives have gained from timely disbursements, as 16% of allocated funds were used in the first year, with commitments reaching 43%. These numbers exceed GC6 results, showcasing enhanced financial management. Nonetheless, maintaining this momentum into GC8 demands continuing resource mobilization. The Global Fund has effectively incorporated private sector financing, dedicating $71 million to five key priorities approved by the Board. The Climate and Health catalytic fund is assisting countries in improving their readiness for risks associated with climate change.
Despite these advancements, challenges in operations remain. The mid-cycle distribution for Climate and Health necessitates distinct country prioritization and prompt implementation to enhance effectiveness. Moreover, elements of Strategic Initiatives, including digital health acceleration and regional manufacturing, are advancing more slowly than anticipated. Addressing these obstacles is essential for fostering innovation, bolstering health systems, and achieving quantifiable health results.
Unfunded Quality Demand
Even with considerable funding approvals, a substantial financing gap continues to exist in key interventions listed under the UQD register. This register contains interventions that countries have sought but are still unfunded because there aren’t enough resources. The Globa Fund’s Technical Review Panel (TRP) determines which of these interventions should be prioritized for possible funding via grant-making efficiencies or extra financing.
According to the Secretariat report, the TRP has allocated $6.8 billion worth of prioritized unfunded programs so far. Nonetheless, the Global Fund has succeeded in obtaining just $1.1 billion via cost savings and efficiencies, leaving a $5.7 billion funding shortfall. Relatively, this gap is wider than that of the previous cycles (GC5 and GC6), calling for more fundraising efforts and better financial management.
To close this funding gap, the Global Fund is looking for ways to optimize its funding, increase private sector involvement, and explore new financing strategies. Without securing additional resources, many high-impact interventions will stay without funding, limiting efforts to fight diseases and strengthen health systems.
Country Coordinating Mechanisms
The Global Fund has been strengthening CCMs in four key areas: oversight, engagement, positioning, and operations. Oversight address obstacles in program execution. Engagement focusses on key population representation, enhanced information sharing, and greater involvement in meetings, with decisions progressively driven by data. Positioning emphasizes the development of resilient and inclusive health governance that extends past Global Fund initiatives. Operations aim to enhance governance frameworks, leadership, and Secretariat roles.
The Secretariat report noted the by the end of 2024, among the various CCM categories, High Impact CCMs—tasked with managing 75% of Global Fund resources—saw the most significant improvements, especially in engagement (14%) and operations (12%), while also achieving considerable advancements in positioning (9%) and oversight (8%). For Core CCMs, that control 20% of Global Fund resources, operations and oversight improved by 12% each, whereas their positioning and engagement increased by 10% and 8%. For Focus CCMs, which control 5 % of Global Fund assets, engagement increased by 8 % while incremental steps for oversight (6 %), positioning (5 %) and operations (5 %) lagged behind.
Despite these developments, there are still governance gaps. The Secretariat noted that while 90% of CCMs have made strides in transparency, only 65% have operational ethics officers, committees or staff to support a point of contact. That leaves 35% of CCMs that still find it difficult to make ethical decisions, concern that demands immediate action. Another large challenge is monitoring co-financing. At this moment, 26% of CCMs are doing an incomplete job of tracking their country’s co-financing commitments. This diminishes the alignment of GlobalFund investments with national health objectives and raises sustainability concerns.
Stakeholder feedback
Stakeholders were concerned that funding cuts are threatening the future of health provision in many countries. These cuts are either likely or bound to precipitate countries scaling back of their health budgets by a substantial factor with serious implications for essential services. Even before these new reductions to health spending, Pakistan as well as Kenya, for example, had already laid off large numbers of community health workers and cut financing for community-run programs. These are setbacks that undermine local responses and increasing the vulnerability of communities.
When resources are constrained, programs targeting key populations and the most marginalized -including LGBTQ+ people, people who use drugs and children living with HIV - are often the first to face reductions. This has devastating effects. Many of these groups already experience stigma in government-run health institutions, and without community-led services, they go untreated. For instance, some fear that early infant HIV testing, preventions, and drugs essential for children could run short in some countries, with potentially lethal results.
Stakeholders acknowledge that the Global Fund has made important contributions to investments in health systems strengthening through its Resilient and Sustainable Systems for Health programs (RSSH). But they emphasize, there must be better monitoring of how those resources are used - and whether they are truly making a difference, particularly to the most vulnerable communities. Support for health systems has to mean more than equipment and infrastructure — it must ensure that people actually receive the services they need.
They also highlighted issues with the Global Fund’s structure. More countries are ready to transition away from donor support, but need help to do so well. The resources - tools like the Debt2Health program and catalytic funding - that could be used to bridge these gaps aren’t being used sufficiently. They also often lack technical assistance once their programs are underway to troubleshoot and spend the money well.
Furthermore, there is a lack of harmonization of country and regional investments. Regional projects may also not be consistent with the national strategy and thus wastes or duplication may occur. A more connected approach is required to ensure all activities are in line with country priorities.
While the next round of funding (GC8) is on the horizon, some insist that they don’t want to see a repeat. The Global Fund needs to bridge that resource gap. That will involve not just coming up with more money, but also creating a system that is more flexible and responsive. Key areas of focus include protecting locally led initiatives, enhancing monitoring of RSSH investments, and using novel instruments to help transition countries. Without these measures, the hard-fought gains won in the battles against HIV, TB, and malaria are at risk of reversal.
If the Global Fund is to remain a strong partner for countries with health problems, it needs to change. It must listen to community voices, address structural shortcomings and ensure that resources flow to the places and programs that need them most.
The Global Fund has made significant progress in Grant Cycle 7 (GC7), which is the ongoing Global Fund grant cycle spanning from 2023 to 2025, particularly in grant implementation, private sector engagement, and strategic investments. These issues were discussed at the 53rd Global Fund Board meeting in Geneva from 7 – 9 May 2025. According to the Secretariat report, proposals, approved 241 grants, and begun their execution by April 2025. This is an improvement when compared to the preceding country funding update from the Global Fund. Despite the Global Fund utilizing 95% of the country allocations and 94% of matching funds, the organization faced challenges such as delays in catalytic investments, governance deficiencies, and a $5.7 billion unfunded quality demand (UQD) funding shortfall.
To maintain advancement and reinforce the groundwork for Grant Cycle 8 (GC8), the Global Fund needs to enhance resource use, improve governance, and broaden partnerships with the private sector. For sustainability, the organization should focus on timely implementation of catalytic investments, strengthening Country Coordinating Mechanism (CCM) governance, and secure additional funding.
Management of country allocations
According to the Secretariat report, t. This shows an improved alignment of country funding proposals with the Global Fund’s technical guidelines, thereby lessening the necessity for alterations or adjustments.
The Secretariat report indicated that by mid-February 2025, the Board had approved $12.45 billion of the country allocations, representing 95% of the $13.128 billion designated for this purpose. The allocation of funds consists of $5.97 billion for HIV/AIDS, $4.17 billion for malaria, and $2.31 billion for tuberculosis. The Board approved 241 grants, all of which are now in the implementation stage, while 21 more grants are still being reviewed and are pending approval in 2025.
Catalytic Investments
The Global Fund operates special funds, known as catalytic investments, to enhance health initiatives that go beyond the regular country allocations. There are three categories of catalytic investment: Matching Funds, Multicountry Programs, and Strategic Initiatives. However, the Secretariat report noted that for GC7 these funds experienced delays compared to country allocations because of longer approval and distribution processes.
Also, the Secretariat report noted that so far, the Global Fund has approved 94% of the Matching Funds, exhibiting strong financial commitment. However, the Multicountry Programs have encountered challenges, as only 72% of the intended $110 million has been approved. One significant problem is that applications for Multicountry Programs funds often come late in the funding cycle, leading
to
delays in
allocating
financial
resources
to
areas
of
need. This is especially true for HIV-related programs, where approvals have been slow. The first HIV-focused Multicountry investment for Eastern Europe and Central Asia was approved in Window 6, with the rest at the negotiation stage. These delays make it harder to plan and provide critical health services in high-need areas.
On the brighter side, participation of the private sector involvement in GC7 has risen, contributing
an
additional
$71 million for
essential
health
initiatives. A major highlight is the Climate and Health catalytic fund, announced at the World Economic Forum in Davos, which has already garnered $50 million commitments from the private sector. This initiative aims to strengthen health systems against climate-related challenges by helping countries integrate climate adaptation into their healthcare strategies. This
effort
seeks
to
bolster
health systems
in
response
to climate-related
issues
by
assisting
countries
in
incorporating
climate adaptation into their healthcare
plans.
According to the Secretariat report to the Board, strategic initiatives have gained from timely disbursements, as 16% of allocated funds were used in the first year, with commitments reaching 43%. These numbers exceed GC6 results, showcasing enhanced financial management. Nonetheless, maintaining this momentum into GC8 demands continuing resource mobilization. The Global Fund has effectively incorporated private sector financing, dedicating $71 million to five key priorities approved by the Board. The Climate and Health catalytic fund is assisting countries in improving their readiness for risks associated with climate change.
Despite these advancements, challenges in operations remain. The mid-cycle distribution for Climate and Health necessitates distinct country prioritization and prompt implementation to enhance effectiveness. Moreover, elements of Strategic Initiatives, including digital health acceleration and regional manufacturing, are advancing more slowly than anticipated. Addressing these obstacles is essential for fostering innovation, bolstering health systems, and achieving quantifiable health results.
Unfunded Quality Demand
Even with considerable funding approvals, a substantial financing gap continues to exist in key interventions listed under the UQD register. This register contains interventions that countries have sought but are still unfunded because there aren’t enough resources. The Globa Fund’s Technical Review Panel (TRP) determines which of these interventions should be prioritized for possible funding via grant-making efficiencies or extra financing.
According to the Secretariat report, the TRP has allocated $6.8 billion worth of prioritized unfunded programs so far. Nonetheless, the Global Fund has succeeded in obtaining just $1.1 billion via cost savings and efficiencies, leaving a $5.7 billion funding shortfall. Relatively, this gap is wider than that of the previous cycles (GC5 and GC6), calling for more fundraising efforts and better financial management.
To close this funding gap, the Global Fund is looking for ways to optimize its funding, increase private sector involvement, and explore new financing strategies. Without securing additional resources, many high-impact interventions will stay without funding, limiting efforts to fight diseases and strengthen health systems.
Country Coordinating Mechanisms
The Global Fund has been strengthening CCMs in four key areas: oversight, engagement, positioning, and operations. Oversight address obstacles in program execution. Engagement focusses on key population representation, enhanced information sharing, and greater involvement in meetings, with decisions progressively driven by data. Positioning emphasizes the development of resilient and inclusive health governance that extends past Global Fund initiatives. Operations aim to enhance governance frameworks, leadership, and Secretariat roles.
The Secretariat report noted the by the end of 2024, among the various CCM categories, High Impact CCMs—tasked with managing 75% of Global Fund resources—saw the most significant improvements, especially in engagement (14%) and operations (12%), while also achieving considerable advancements in positioning (9%) and oversight (8%). For Core CCMs, that control 20% of Global Fund resources, operations and oversight improved by 12% each, whereas their positioning and engagement increased by 10% and 8%. For Focus CCMs, which control 5 % of Global Fund assets, engagement increased by 8 % while incremental steps for oversight (6 %), positioning (5 %) and operations (5 %) lagged behind.
Despite these developments, there are still governance gaps. The Secretariat noted that while 90% of CCMs have made strides in transparency, only 65% have operational ethics officers, committees or staff to support a point of contact. That leaves 35% of CCMs that still find it difficult to make ethical decisions, concern that demands immediate action. Another large challenge is monitoring co-financing. At this moment, 26% of CCMs are doing an incomplete job of tracking their country’s co-financing commitments. This diminishes the alignment of GlobalFund investments with national health objectives and raises sustainability concerns.
Stakeholder feedback
Stakeholders were concerned that funding cuts are threatening the future of health provision in many countries. These cuts are either likely or bound to precipitate countries scaling back of their health budgets by a substantial factor with serious implications for essential services. Even before these new reductions to health spending, Pakistan as well as Kenya, for example, had already laid off large numbers of community health workers and cut financing for community-run programs. These are setbacks that undermine local responses and increasing the vulnerability of communities.
When resources are constrained, programs targeting key populations and the most marginalized -including LGBTQ+ people, people who use drugs and children living with HIV - are often the first to face reductions. This has devastating effects. Many of these groups already experience stigma in government-run health institutions, and without community-led services, they go untreated. For instance, some fear that early infant HIV testing, preventions, and drugs essential for children could run short in some countries, with potentially lethal results.
Stakeholders acknowledge that the Global Fund has made important contributions to investments in health systems strengthening through its Resilient and Sustainable Systems for Health programs (RSSH). But they emphasize, there must be better monitoring of how those resources are used - and whether they are truly making a difference, particularly to the most vulnerable communities. Support for health systems has to mean more than equipment and infrastructure — it must ensure that people actually receive the services they need.
They also highlighted issues with the Global Fund’s structure. More countries are ready to transition away from donor support, but need help to do so well. The resources - tools like the Debt2Health program and catalytic funding - that could be used to bridge these gaps aren’t being used sufficiently. They also often lack technical assistance once their programs are underway to troubleshoot and spend the money well.
Furthermore, there is a lack of harmonization of country and regional investments. Regional projects may also not be consistent with the national strategy and thus wastes or duplication may occur. A more connected approach is required to ensure all activities are in line with country priorities.
While the next round of funding (GC8) is on the horizon, some insist that they don’t want to see a repeat. The Global Fund needs to bridge that resource gap. That will involve not just coming up with more money, but also creating a system that is more flexible and responsive. Key areas of focus include protecting locally led initiatives, enhancing monitoring of RSSH investments, and using novel instruments to help transition countries. Without these measures, the hard-fought gains won in the battles against HIV, TB, and malaria are at risk of reversal.
If the Global Fund is to remain a strong partner for countries with health problems, it needs to change. It must listen to community voices, address structural shortcomings and ensure that resources flow to the places and programs that need them most.
