GFO Issue 463, Article Number: 3
ABSTRACT
This article describes the "GC7 reprioritization" process currently taking place, which will involve deferring certain activities and revising country grants to fit lower funding envelopes. While the Global Fund has emphasized the need for community engagement and to protect community-focused programs, there are risks of community priorities being disproportionately impacted and that civil society will face difficulties engaging in the rapid decision-making process. The article describes the guidance from Global Fund, outlines strategies for community engagement and advocacy, explains how to request support, and provides escalation pathways to address any challenges that arise during the process.
What is the “GC7 reprioritization” and why is it happening?
The Global Fund is funded by public and private donors on a three-year replenishment cycle. After pledges are made, they must then transfer the funds to the Global Fund Secretariat so they may be spent. This process is called “pledge conversion.” Since the beginning of the Global Fund, the pledge conversion rate has never fallen below 93%.
However, the funding landscape has changed significantly, with donors signalling an interest in pulling back from supporting global health programs. For the Global Fund, there is a risk that some donors will either delay transferring the funds that were pledged, or that they will not pay at all. As of May 17, 2025, the Secretariat has received US$ 9.05 billion from its donors. About 43%, or US$ 6.74 billion, is still waiting to be received.
This situation is creating a serious financial risk for the Global Fund. In order to avoid running out of funds, the Global Fund is pursuing two strategies:
- Deferral of activities: Countries have been requested to “pause” the implementation of certain parts of grants.
- Reprioritization: The funding available for Grant Cycle 6 and 7 grants will be reduced, and countries will be asked to reprioritize and revise grants under the new funding envelope. Currently approved C19RM-related activities are expected to continue given the need to maintain the pace of execution within the C19RM implementation period.
The process of deferring activities has already taken place in most countries. According to the Global Fund guidance, countries were requested to immediately pause several specific activities. The details of these activities are on page 7 of the Global Fund’s “GC7 Programmatic Reprioritization Approach.”
The reprioritization process is separate from the implementation slow-down process. According to the Global Fund’s communication on June 6, the reprioritization process will take place in two phases: first, the revised funding envelopes for each grant will be approved, and secondly, grant revisions will be processed (Fig. 2).
Phase 1: Approval of revised grant budgets (mid-May to mid-July 2025)
- Mid-May to end-June: Secretariat will calculate how much each grant will be cut.
- By the end of June: Secretariat will contact the Principle Recipients (PRs) and Country Coordinating Mechanisms (CCMs) with the amount each grant will be cut. For countries with only one grant, they will proceed immediately to grant revisions. For countries with more than one grant, a two-week review period for the CCM will begin.
- Mid-July: At the end of the two-week review period, the CCM will be asked to endorse the revised grant amounts or escalate to the Secretariat if changes are proposed. To ensure meaningful engagement of stakeholders, CCMs are advised to hold at least one meeting with CCM members before mid July.
Phase 2: Revision of grant activities, detailed budgets, and targets (mid-July to 28 September)
- Mid-July: The PRs, CCMs and the Global Fund will work to formally revise the grants. This will mean making changes to the detailed budgets and performance frameworks, to comply with the reduced grant budgets.
- At completion of the grant revisions, PRs will send the Grant Revision Request to the CCM. The CCM will have a two week period to review and discuss and provide endorsement of the final Grant Revisions Request, after which the PR can submit to the Global Fund.
- 28 September: all grant revisions completed.
Figure 2. Timelines for deferral and reprioritization of GC7 grants. Published 6 June 2025.
Which activities can be cut during the GC7 reprioritization?
The Global Fund has released specific guidance about the reprioritization approach. These details are described on pages 11-69 of the Global Fund’s “GC7 Programmatic Reprioritization Approach.” While the decisions about what to preserve or deprioritize will be made by the countries, the Global Fund recommends the following activities be prioritized for continued funding:
- Community-focused programs should not be disproportionately reduced, as compared to other activities in the grants. Any cuts made to community activities must avoid negative impacts or consequences for vulnerable populations.
- Interventions to reduce barriers to health services (related to equity, human rights, and gender) should be prioritized, so that the most affected populations can access HIV, TB, and malaria services.
- Countries must maintain and strengthen community systems, including peer- and community-led service delivery, community-led monitoring (CLM) and community accountability mechanisms, and linkage and referrals between community-based services and public health facilities.
- When services are integrated into government-run clinics, these services must be made accessible and acceptable to the most affected populations. This means the government must provide training and other competency-building activities to ensure that services are inclusive, respectful, stigma-free, gender-responsive and age-appropriate.
What does this mean for Global Fund-supported community programs?
The Global Fund has clearly stated that the GC6 - GC7 reprioritization should prioritize funding for reducing equity-, human rights-, and gender-related barriers to services, community systems interventions, community-led service delivery, community-led monitoring, and linkages between community-based health delivery and the formal public health sector. This is because without these community-focused activities, services will not reach the key, vulnerable and underserved populations who need them.
However, the reprioritization process creates several risks to communities. These include:
- Exclusion from decision-making process. The very fast timelines mean that decision-making could happen quickly and without communities being able to properly engage.
- Community priorities disproportionately cut from grants. In some cases, community-focused programs may be cut more than other programs. This could be because grants are highly commoditized, meaning that there is very little funding that can be cut without defunding medicines. In other contexts, government PRs may be hostile toward key and vulnerable populations and use this exercise to cut these programs.
- Integration of programs for key and vulnerable populations. The Global Fund is promoting the use of domestic resources as a source of funding for HIV, tuberculosis, and malaria programs. In some cases, government funding can be an important strategy for filling the gaps. However, in other cases, community programs may be transferred to the Ministry of Health with the intention of integrating key and vulnerable population-focused programs into public clinics.
- Accelerated and poorly planned transition of community programs from Global Fund’s support. As the reprioritization process will be taking place in a very tight time period there is a risk that some programs of a key priority for communities might just be cut without receiving any support from domestic resources.
How can communities engage in this process?
First, the Global Fund Country Teams (CT) will reach out to the PRs to share the revised funding envelope for the remainder of GC7. This will be calculated for each country separately and will take into account how much funding has already been spent. The CT will also make suggestions about which activities should be deprioritised. The PRs will work together with the CT to develop a proposal for how to reprioritise the remaining funds in the grant.
At the end of June, the PRs will communicate the proposal to the CCM. For countries with only one grant, they will proceed immediately to grant revisions. For countries with more than one grant, the CCM will then have two weeks to review, feedback, and endorse. The Global Fund will use standard grant revision procedures when revising grants, which means that although the Global Fund has suggested that the full CCM meet to discuss, the Global Fund has not required for every member of the CCM to formally sign off on grant revisions. Because of this, there is a high risk that decisions will be made quickly and without input from communities.
Communities must proactively and regularly reach out to their CCM and the Secretariat to provide feedback and input (Fig. 3). The Global Fund suggests that CCMs plan for at least one meeting with all CCM members to take place during the first half of July to discuss reprioritization of interventions and align on and confirm the final grant budgets amounts to the Global Fund, where relevant. CCM members and communities should approach the CCM Secretariat in their country on this matter as soon as possible. Finally, for those who are CCM members, the Global Fund suggests reaching out to the CCM Focal Point to ensure that their contact information is recorded and up-to-date. This will increase the likelihood that all CCM members receive communications from the Global Fund.
Figure 3. Pathways for community engagement in the GC7 Reprioritization.
When advocating around GC7 reprioritization, it is important to first understand which activities are currently funded in the grants. Since the GC7 reprioritization exercise is designed to reduce country funding envelopes, this is unlikely to be an opportunity to advocate for new activities. Instead, communities will need to advocate to protect the community-focused activities that are already funded in grants. Detailed data on grants are available on the Global Fund’s Data Explorer or the CCM Dashboard. Communities should review the grant budgets and identify the highest priority activities to protect from cuts.
When advocating to the Global Fund, PRs, and CCMs, it is important to use the same language that the Global Fund uses. Communities may find it useful to advocate for community-focused programs by clearly explaining how community-led and community-focused programs are:
- Life-saving: Community-led organisations are responsible for delivering life-saving services to the people most affected by HIV, tuberculosis, and malaria. Without them, drugs and commodities will sit unused in warehouses and clinics. If we stop funding community programmes, we will lose these trusted implementers, and our most vulnerable populations will lose the care they need to stay alive.
- Sustainable: Community leadership is a core pillar of country ownership and long-term sustainability: by building community ownership, health programs can be durable and impactful over the long-term. Public healthcare facilities are a key part of service delivery. However, the evidence from our community is that key population clients have been turned away from care and face abuse from clinic staff. We must continue to fund community-based services for those who will otherwise stop receiving life-saving care.
- Offer value for money: According to the Global Fund, there are five facets of value for money: effectiveness, efficiency, economy, equity, and sustainability. When defending these priorities, explain the impact of these programs, to demonstrate effectiveness. Explain how without community distribution and engagement, the efficiency of programs will drop, since the people who need services won’t be reached. You may explain how community programs are economical since they make up very small parts of grants, yet have big impacts on program impact. Without community programs, service delivery cannot be equitable and reach all populations. Finally, community leadership is a core pillar of country ownership and long-term sustainability: by building community ownership, health programs can be durable and impactful over the long-term.
What support is available for communities to engage?
There is only a limited amount of support available for community engagement and technical assistance. This is because the Global Fund is in its second year of implementing the three-year cycle, and no new resources have been provided for the Secretariat, the CCMs, or the Learning Hubs to support the re-prioritization. However, several sources of support may be available to help communities prepare and advocate during the GC7 reprioritization.
The CRG Learning Hubs are hosted by community and civil society organizations across the six regions. These Hubs share information and good practices on engagement in Global Fund and related processes, and work to improve access to technical assistance. The CRG Learning Hubs have been working to engage and support communities during these processes.
Since the issuing of guidance around the “slow down” and the reprioritization exercise, the Learning Hubs proactively stepped in to clarify confusion regarding the reprioritization process at the country level, conducting webinars, distributed information through newsletters, facilitating small grants, and delivering virtual technical assistance, where needed. While the selection of countries for direct support from the Learning Hubs and the CRG has already taken place, some virtual technical assistance and information-sharing activities may be available. The contact information for the six Regional Learning Hubs is available here.
Although there are very limited resources available, CCM members and their community delegations are encouraged to reach out for any support needs as soon as possible. CCM members are encouraged to contact their CCM Secretariats, to request support from the CCM budgets to conduct consultations and engage in the re-prioritization process. Contact information for CCMs and Fund Portfolio Managers in Geneva can be found on the Global Fund’s Data Explorer or the CCM Dashboard.
In addition, there are several resources and tools available to help communities engage. These include:
- Global Fund’s guidance on the GC7 Programmatic Reprioritization Approach.
- Resources are available from the CRG Learning Hubs.
- A community FAQ on the GC7 reprioritization process is available here.
- Detailed data on grant budgets can be found on the Global Fund’s Data Explorer or the CCM Dashboard.
What to do if there are challenges engaging with the CCM?
The process of advocating for community priorities during the GC7 reprioritization process will be challenging. There is a high risk of community priorities being deprioritized and CCM representatives not being fully engaged in the process. In the case of any challenges, the most important strategy is to speak up quickly. Any delays increase the risk that major decisions are made without community engagement.
There are several pathways for escalating challenges:
- Contact the Learning Hubs. Part of their role is to gather real-time updates on the reprioritization process and any emerging issues, which they can relay directly to the Global Fund, which can prompt the Country Portfolio Manager to ensure the CCM's process is inclusive at the country level. The contact information for the six Regional Learning Hubs is available here.
- Use the escalation platform. A web platform has been created by civil society where CCM members and communities can ask questions about the process, request support, and escalate any challenges or barriers. Submissions are immediately responded to and support is provided to escalate to the right teams or people, either anonymously or not.
- Contact the Secretariat in Geneva. Since decisions will be taken very quickly, challenges should be escalated as soon as possible to Geneva. The Learning Hubs and the civil society platform can provide support in understanding who to reach out to, and the community FAQ includes templates for contacting Geneva.
Authors : Chinmay Modi, (Asia Pacific Regional Learning Hub hosted by Seven Alliance Asia Pacific), Karon Lama (Asia Pacific Regional Learning Hub), Anuar Luna (Via Libre, Latin America and Caribbean Learning Hub), Grace Ngulube (EANNASO, Anglophone Africa Learning Hub), Lesley Odendal (independent consultant), Alana Sharp (Data Etc), Jennifer Sherwood (amfAR), Taline Torikian (MENA Rosa, MENA Learning Hub), Ivan Varentsov (Eurasian Harm Reduction Association, Eastern Europe and Central Asia Learning Hub), Ida Yugbaré (RAME, Francophone Africa Learning Hub)
What is the “GC7 reprioritization” and why is it happening?
The Global Fund is funded by public and private donors on a three-year replenishment cycle. After pledges are made, they must then transfer the funds to the Global Fund Secretariat so they may be spent. This process is called “pledge conversion.” Since the beginning of the Global Fund, the pledge conversion rate has never fallen below 93%.
However, the funding landscape has changed significantly, with donors signalling an interest in pulling back from supporting global health programs. For the Global Fund, there is a risk that some donors will either delay transferring the funds that were pledged, or that they will not pay at all. As of May 17, 2025, the Secretariat has received US$ 9.05 billion from its donors. About 43%, or US$ 6.74 billion, is still waiting to be received.
This situation is creating a serious financial risk for the Global Fund. In order to avoid running out of funds, the Global Fund is pursuing two strategies:
- Deferral of activities: Countries have been requested to “pause” the implementation of certain parts of grants.
- Reprioritization: The funding available for Grant Cycle 6 and 7 grants will be reduced, and countries will be asked to reprioritize and revise grants under the new funding envelope. Currently approved C19RM-related activities are expected to continue given the need to maintain the pace of execution within the C19RM implementation period.
The process of deferring activities has already taken place in most countries. According to the Global Fund guidance, countries were requested to immediately pause several specific activities. The details of these activities are on page 7 of the Global Fund’s “GC7 Programmatic Reprioritization Approach.”
The reprioritization process is separate from the implementation slow-down process. According to the Global Fund’s communication on June 6, the reprioritization process will take place in two phases: first, the revised funding envelopes for each grant will be approved, and secondly, grant revisions will be processed (Fig. 2).
Phase 1: Approval of revised grant budgets (mid-May to mid-July 2025)
- Mid-May to end-June: Secretariat will calculate how much each grant will be cut.
- By the end of June: Secretariat will contact the Principle Recipients (PRs) and Country Coordinating Mechanisms (CCMs) with the amount each grant will be cut. For countries with only one grant, they will proceed immediately to grant revisions. For countries with more than one grant, a two-week review period for the CCM will begin.
- Mid-July: At the end of the two-week review period, the CCM will be asked to endorse the revised grant amounts or escalate to the Secretariat if changes are proposed. To ensure meaningful engagement of stakeholders, CCMs are advised to hold at least one meeting with CCM members before mid July.
Phase 2: Revision of grant activities, detailed budgets, and targets (mid-July to 28 September)
- Mid-July: The PRs, CCMs and the Global Fund will work to formally revise the grants. This will mean making changes to the detailed budgets and performance frameworks, to comply with the reduced grant budgets.
- At completion of the grant revisions, PRs will send the Grant Revision Request to the CCM. The CCM will have a two week period to review and discuss and provide endorsement of the final Grant Revisions Request, after which the PR can submit to the Global Fund.
- 28 September: all grant revisions completed.
Figure 2. Timelines for deferral and reprioritization of GC7 grants. Published 6 June 2025.
Which activities can be cut during the GC7 reprioritization?
The Global Fund has released specific guidance about the reprioritization approach. These details are described on pages 11-69 of the Global Fund’s “GC7 Programmatic Reprioritization Approach.” While the decisions about what to preserve or deprioritize will be made by the countries, the Global Fund recommends the following activities be prioritized for continued funding:
- Community-focused programs should not be disproportionately reduced, as compared to other activities in the grants. Any cuts made to community activities must avoid negative impacts or consequences for vulnerable populations.
- Interventions to reduce barriers to health services (related to equity, human rights, and gender) should be prioritized, so that the most affected populations can access HIV, TB, and malaria services.
- Countries must maintain and strengthen community systems, including peer- and community-led service delivery, community-led monitoring (CLM) and community accountability mechanisms, and linkage and referrals between community-based services and public health facilities.
- When services are integrated into government-run clinics, these services must be made accessible and acceptable to the most affected populations. This means the government must provide training and other competency-building activities to ensure that services are inclusive, respectful, stigma-free, gender-responsive and age-appropriate.
What does this mean for Global Fund-supported community programs?
The Global Fund has clearly stated that the GC6 - GC7 reprioritization should prioritize funding for reducing equity-, human rights-, and gender-related barriers to services, community systems interventions, community-led service delivery, community-led monitoring, and linkages between community-based health delivery and the formal public health sector. This is because without these community-focused activities, services will not reach the key, vulnerable and underserved populations who need them.
However, the reprioritization process creates several risks to communities. These include:
- Exclusion from decision-making process. The very fast timelines mean that decision-making could happen quickly and without communities being able to properly engage.
- Community priorities disproportionately cut from grants. In some cases, community-focused programs may be cut more than other programs. This could be because grants are highly commoditized, meaning that there is very little funding that can be cut without defunding medicines. In other contexts, government PRs may be hostile toward key and vulnerable populations and use this exercise to cut these programs.
- Integration of programs for key and vulnerable populations. The Global Fund is promoting the use of domestic resources as a source of funding for HIV, tuberculosis, and malaria programs. In some cases, government funding can be an important strategy for filling the gaps. However, in other cases, community programs may be transferred to the Ministry of Health with the intention of integrating key and vulnerable population-focused programs into public clinics.
- Accelerated and poorly planned transition of community programs from Global Fund’s support. As the reprioritization process will be taking place in a very tight time period there is a risk that some programs of a key priority for communities might just be cut without receiving any support from domestic resources.
How can communities engage in this process?
First, the Global Fund Country Teams (CT) will reach out to the PRs to share the revised funding envelope for the remainder of GC7. This will be calculated for each country separately and will take into account how much funding has already been spent. The CT will also make suggestions about which activities should be deprioritised. The PRs will work together with the CT to develop a proposal for how to reprioritise the remaining funds in the grant.
At the end of June, the PRs will communicate the proposal to the CCM. For countries with only one grant, they will proceed immediately to grant revisions. For countries with more than one grant, the CCM will then have two weeks to review, feedback, and endorse. The Global Fund will use standard grant revision procedures when revising grants, which means that although the Global Fund has suggested that the full CCM meet to discuss, the Global Fund has not required for every member of the CCM to formally sign off on grant revisions. Because of this, there is a high risk that decisions will be made quickly and without input from communities.
Communities must proactively and regularly reach out to their CCM and the Secretariat to provide feedback and input (Fig. 3). The Global Fund suggests that CCMs plan for at least one meeting with all CCM members to take place during the first half of July to discuss reprioritization of interventions and align on and confirm the final grant budgets amounts to the Global Fund, where relevant. CCM members and communities should approach the CCM Secretariat in their country on this matter as soon as possible. Finally, for those who are CCM members, the Global Fund suggests reaching out to the CCM Focal Point to ensure that their contact information is recorded and up-to-date. This will increase the likelihood that all CCM members receive communications from the Global Fund.
Figure 3. Pathways for community engagement in the GC7 Reprioritization.
When advocating around GC7 reprioritization, it is important to first understand which activities are currently funded in the grants. Since the GC7 reprioritization exercise is designed to reduce country funding envelopes, this is unlikely to be an opportunity to advocate for new activities. Instead, communities will need to advocate to protect the community-focused activities that are already funded in grants. Detailed data on grants are available on the Global Fund’s Data Explorer or the CCM Dashboard. Communities should review the grant budgets and identify the highest priority activities to protect from cuts.
When advocating to the Global Fund, PRs, and CCMs, it is important to use the same language that the Global Fund uses. Communities may find it useful to advocate for community-focused programs by clearly explaining how community-led and community-focused programs are:
- Life-saving: Community-led organisations are responsible for delivering life-saving services to the people most affected by HIV, tuberculosis, and malaria. Without them, drugs and commodities will sit unused in warehouses and clinics. If we stop funding community programmes, we will lose these trusted implementers, and our most vulnerable populations will lose the care they need to stay alive.
- Sustainable: Community leadership is a core pillar of country ownership and long-term sustainability: by building community ownership, health programs can be durable and impactful over the long-term. Public healthcare facilities are a key part of service delivery. However, the evidence from our community is that key population clients have been turned away from care and face abuse from clinic staff. We must continue to fund community-based services for those who will otherwise stop receiving life-saving care.
- Offer value for money: According to the Global Fund, there are five facets of value for money: effectiveness, efficiency, economy, equity, and sustainability. When defending these priorities, explain the impact of these programs, to demonstrate effectiveness. Explain how without community distribution and engagement, the efficiency of programs will drop, since the people who need services won’t be reached. You may explain how community programs are economical since they make up very small parts of grants, yet have big impacts on program impact. Without community programs, service delivery cannot be equitable and reach all populations. Finally, community leadership is a core pillar of country ownership and long-term sustainability: by building community ownership, health programs can be durable and impactful over the long-term.
What support is available for communities to engage?
There is only a limited amount of support available for community engagement and technical assistance. This is because the Global Fund is in its second year of implementing the three-year cycle, and no new resources have been provided for the Secretariat, the CCMs, or the Learning Hubs to support the re-prioritization. However, several sources of support may be available to help communities prepare and advocate during the GC7 reprioritization.
The CRG Learning Hubs are hosted by community and civil society organizations across the six regions. These Hubs share information and good practices on engagement in Global Fund and related processes, and work to improve access to technical assistance. The CRG Learning Hubs have been working to engage and support communities during these processes.
Since the issuing of guidance around the “slow down” and the reprioritization exercise, the Learning Hubs proactively stepped in to clarify confusion regarding the reprioritization process at the country level, conducting webinars, distributed information through newsletters, facilitating small grants, and delivering virtual technical assistance, where needed. While the selection of countries for direct support from the Learning Hubs and the CRG has already taken place, some virtual technical assistance and information-sharing activities may be available. The contact information for the six Regional Learning Hubs is available here.
Although there are very limited resources available, CCM members and their community delegations are encouraged to reach out for any support needs as soon as possible. CCM members are encouraged to contact their CCM Secretariats, to request support from the CCM budgets to conduct consultations and engage in the re-prioritization process. Contact information for CCMs and Fund Portfolio Managers in Geneva can be found on the Global Fund’s Data Explorer or the CCM Dashboard.
In addition, there are several resources and tools available to help communities engage. These include:
- Global Fund’s guidance on the GC7 Programmatic Reprioritization Approach.
- Resources are available from the CRG Learning Hubs.
- A community FAQ on the GC7 reprioritization process is available here.
- Detailed data on grant budgets can be found on the Global Fund’s Data Explorer or the CCM Dashboard.
What to do if there are challenges engaging with the CCM?
The process of advocating for community priorities during the GC7 reprioritization process will be challenging. There is a high risk of community priorities being deprioritized and CCM representatives not being fully engaged in the process. In the case of any challenges, the most important strategy is to speak up quickly. Any delays increase the risk that major decisions are made without community engagement.
There are several pathways for escalating challenges:
- Contact the Learning Hubs. Part of their role is to gather real-time updates on the reprioritization process and any emerging issues, which they can relay directly to the Global Fund, which can prompt the Country Portfolio Manager to ensure the CCM's process is inclusive at the country level. The contact information for the six Regional Learning Hubs is available here.
- Use the escalation platform. A web platform has been created by civil society where CCM members and communities can ask questions about the process, request support, and escalate any challenges or barriers. Submissions are immediately responded to and support is provided to escalate to the right teams or people, either anonymously or not.
- Contact the Secretariat in Geneva. Since decisions will be taken very quickly, challenges should be escalated as soon as possible to Geneva. The Learning Hubs and the civil society platform can provide support in understanding who to reach out to, and the community FAQ includes templates for contacting Geneva.
Authors : Chinmay Modi, (Asia Pacific Regional Learning Hub hosted by Seven Alliance Asia Pacific), Karon Lama (Asia Pacific Regional Learning Hub), Anuar Luna (Via Libre, Latin America and Caribbean Learning Hub), Grace Ngulube (EANNASO, Anglophone Africa Learning Hub), Lesley Odendal (independent consultant), Alana Sharp (Data Etc), Jennifer Sherwood (amfAR), Taline Torikian (MENA Rosa, MENA Learning Hub), Ivan Varentsov (Eurasian Harm Reduction Association, Eastern Europe and Central Asia Learning Hub), Ida Yugbaré (RAME, Francophone Africa Learning Hub)
