GFO Issue 467, Article Number: 5
ABSTRACT
This article analyzes how the Dakar meeting marked a turning point in the Global Fund's strategy in Francophone Africa by shifting from parallel financial mechanisms to gradually integrating its grants into national public financial management systems. The article demonstrates that this alignment, conceived as a means of achieving health sovereignty and transitioning away from external aid, presents substantial opportunities, yet it also poses political and social risks if communities and civil society are not fully engaged at the local level in this new "shared risk contract."
In early November 2025, the Global Fund and fifteen Francophone African countries met in Dakar to discuss single treasury accounts, spending chains, public audits, and transition pathways. This was quite revealing at a time when health budgets are shrinking and donor fatigue is becoming palpable. In other words, budgetary power. Behind the polished language of "public financial management" (PFM), the very concept of health sovereignty is being redefined, and Francophone Africa has become the strategic testing ground.
Why Francophone Africa has become the front line of the GFP
Dakar is more than just another meeting on "sustainability." The figures presented in the room explain why Francophone Africa was chosen as a priority area. Over the last three funding cycles, the region received $2.6 billion (Grant Cycle 5), $3.2 billion (Grant Cycle 6), and $2.8 billion (Grant Cycle 7) for HIV, tuberculosis, and malaria. In comparison, the rest of Africa received $6.3 billion, $7.2 billion, and $6.6 billion. In other words, it received barely a third of the total African funding, even though the burden of disease remains high.
Even more striking is who manages this money. In Francophone Africa, governments account for approximately half of the grant budgets (54%, 49%, and 52%, respectively, across the three cycles), while the remainder goes to multilateral agencies and international NGOs (31%-36%) and local organizations (12%-16%). In the rest of Africa, governments manage an average of two-thirds of the funds (65%-68%), with local organizations receiving a slightly higher share than in Francophone Africa. The data confirm a long-held, intuitive diagnosis: Francophone countries are less "bankable" than their Anglophone or Lusophone neighbors for the Global Fund and are more dependent on international intermediaries (Figure 1).
Figure 1:
The information shared in Dakar (Figure 2) further illustrates this discrepancy objectively. It compares the role of Global Fund resources in five key areas of public financial management (PFM).
The Single Treasury Account (STA): Only 18% of Francophone countries have integrated it into their portfolios, compared to 35% of non-Francophone countries. Barely 18% of Francophone countries fully utilize the STA, compared to 35% of non-Francophone countries.
Computerized budget management systems: Nearly two-thirds of Francophone countries do not use national systems to track subsidy expenditures, while one in five non-Francophone countries already do so completely.
Public internal and external audits: The difference is even more pronounced for external audits. One hundred percent of Francophone portfolios rely on parallel mechanisms, while 65 percent of non-Francophone countries use their supreme audit institutions to audit at least some of the funds.
Figure 2:
Finally, the "GFP maturity" typology places countries into three groups: 18% are at high maturity (with nearly full use of national systems), 39% are at medium maturity, and 43% are at low maturity. No Francophone country is in the first group. Five are at medium maturity, and eight are at low maturity (Figure 3). Thus, the Dakar agenda begins with the clear observation that if the Global Fund truly wants to align its grants with national systems, the Francophonie represents both the weakest link and the greatest potential for progress.
Figure 3:
This assessment aligns with the GFP strategy adopted by the Board in 2024, which explicitly links alignment with national systems to the "3 ONEs" vision — one plan, one budget, and one report — championed by the Lusaka Agenda. This assessment is also part of a broader partnership with IFAC, Gavi, AFROSAI-E, CREFIAF, and other African professional accounting organizations. The partnership aims to strengthen audit and financial management capacities in the public sector.
A graduated approach to PFM in a constrained macroeconomic context
Dakar is not arriving in a vacuum. The Global Fund points out that, in an environment of climate shocks, soaring food prices, slowing growth, and rising debt service costs, public financial management (PFM) is becoming a matter of survival. World Bank projections show downward revisions to growth prospects in all developing regions, with public debt remaining above pre-pandemic levels and official development assistance (ODA) for health declining, particularly in sub-Saharan Africa and fragile states.
The slides presented in Dakar (Figure 4) clearly illustrate the causal chain: a decline in public revenue, a reallocation of spending that harms health, a lack of planning certainty, increased pressure on health systems, and a deterioration of household financial protection.
Figure 4:
In this context, the question is no longer just "How much money should be allocated to health?" but also "How can we protect the health budget and use every dollar more intelligently?"
The Global Fund summarizes its response in five points (Figure 5).
1. More money for health: helping countries mobilize public and private resources.
2. Spend better: Improve the efficiency of existing spending.
3. Align with national systems: Integrate programs into budgetary frameworks, treasury systems, and expenditure chains.
4. Less dependence on external resources by preparing the transition of Fund-financed components to domestic financing.
5. Improve results and financial sustainability by linking the GFP, programmatic results, and universal health coverage.
Figure 5:
This matrix is linked to the "PFM Accelerator" initiative, which was launched in Geneva in 2024. The initiative brings together ministries of finance and health, supreme audit institutions, and partners to co-construct national pathways for public financial management (PFM) alignment.
In a sense, Dakar is territorializing this agenda within the Francophone space. The official communiqué emphasizes three objectives: consolidating political will, addressing the underrepresentation of Francophone countries in the GFP maturity cohorts, and seizing an "impactful opportunity." By targeting the GFP in these countries, the Fund hopes to align financing with national systems sustainably, reduce aid dependency, and accelerate program transitions.
The discourse is not purely rhetorical. Since its inception, the Global Fund has supported the transition of 52 disease programs in 38 countries to domestic financing. In the current cycle, an additional 12 programs in eight countries are undergoing this transition — the largest wave to date. GFP alignment is thus becoming the backbone of this transition. Countries can only assume recurring costs (e.g., personnel, medicines, and prevention) if these expenditures are integrated into the national budget, are subject to regular monitoring, and are backed by sustainable revenues.
From "zero tolerance" to a shared risk contract
For the Global Fund, the Francophone PFM agenda represents a significant change to its model. Its "zero tolerance" policy toward fraud has historically resulted in the proliferation of parallel mechanisms, such as dedicated bank accounts, trustees, private audits, and specific procurement procedures. While this structure has reassured donors, it has also fostered distrust of national oversight institutions.
The new approach is to transition from insurance "against" national systems to insurance "with" them. In concrete terms, this means:
Shared risk acceptance: By integrating more funds into the CUT and national computerized systems, the Fund loses granular control but gains overall transparency and budgetary coherence. Rather than preventing it, the GFP maturity assessments and graduated trajectories (30–40%, 75–85%, and 100% system utilization) guide this transition.
The focus is on supreme audit institutions. The challenge is to transition from private audits commissioned by Geneva to public audits carried out by the Courts of Auditors. Technical partnerships with IFAC, professional organizations, and joint programs will support these institutions in strengthening their capacities in performance auditing and monitoring health programs.
Linking co-financing to finance laws: Budgetary integration of subsidies makes it harder to engage in "double-speak" by promising domestic benefits on paper without including them in finance laws. This also gives parliaments and citizens additional leverage to monitor the executive branch's commitments.
For Francophone governments, the GFP agenda presents both opportunities and constraints. It is an opportunity because it supports ongoing reforms (e.g., program-based budgeting, harmonization of public finance rules within the EU, and digitalization of budgetary systems) and provides access to targeted support from the Global Fund on issues traditionally handled by international financial institutions. It is also a constraint because it requires clear choices. Integrating grants into national budgeting processes makes them more visible and therefore more exposed to competition from other political priorities.
This is where Dakar's political dimension becomes apparent: the plan presented at the meeting identifies a "turning point" between two extremes: dependence on external funding and rigid administrative controls and inflexible procedures. The ambition is to gradually shift countries toward a system in which the following coexist:
- sustainable health financing, primarily based on national resources;
- A robust GFP, capable of ensuring the sustainability of investments and increased decision-making autonomy;
- Accountable institutional governance, where communities and civil society are at the heart of the Global Fund partnership, not on its periphery.
However, blind spots remain. If not balanced, the increasing influence of finance ministries in health governance can marginalize community actors and national NGOs, despite their status as key recipients of subsidies for two decades. Integration into the state budget does not guarantee that programs aimed at reducing inequalities, combating stigma, or providing community-led services will remain priorities. Similarly, the rhetoric of "sovereignty" can be used to restrict civil society's space or evade transparency requirements.
The Global Fund and Francophone actors must prevent the GFP agenda from becoming a technocratic exercise. This requires linking discussions on cash flow, information systems, and audits to specific issues, such as payment deadlines for health facilities, supply availability, local management autonomy, and community organizations' access to public funding.
Dakar as a credibility test for the "GFP of sovereignty"
The Dakar meeting was intended to lay the groundwork, but it seems more like a credibility test. The national roadmaps that emerge from it will permit the gradual integration of subsidies into the CUT, increased use of public audits, better inclusion of funding in finance laws, and increased transparency. However, these changes will only be worthwhile if they are implemented within the next two to three years of GC7.
For the Global Fund, the success of this endeavor is crucial to the legitimacy of its discourse on "sovereignty." One cannot proclaim alignment with national systems while controlling the majority of flows through parallel channels. For Francophone countries, the challenge is to seize this political opportunity to consolidate often-fragile reforms, strengthen oversight institutions, and establish health as a lasting budgetary priority despite the looming macroeconomic storm.
Finally, for communities, public health management (PHM) must not remain a debate among technical experts. In Dakar, the message was clear: Without transparency regarding budgets, accessible public audits, and informed parliamentary debates, the promise of health sovereignty risks remaining just a slogan. However, if PHM tools become levers for citizen accountability, the Francophonie could transform a historical handicap into a strategic advantage and give the Global Fund partnership new political depth beyond mosquito nets and antiretrovirals.
In early November 2025, the Global Fund and fifteen Francophone African countries met in Dakar to discuss single treasury accounts, spending chains, public audits, and transition pathways. This was quite revealing at a time when health budgets are shrinking and donor fatigue is becoming palpable. In other words, budgetary power. Behind the polished language of "public financial management" (PFM), the very concept of health sovereignty is being redefined, and Francophone Africa has become the strategic testing ground.
Why Francophone Africa has become the front line of the GFP
Dakar is more than just another meeting on "sustainability." The figures presented in the room explain why Francophone Africa was chosen as a priority area. Over the last three funding cycles, the region received $2.6 billion (Grant Cycle 5), $3.2 billion (Grant Cycle 6), and $2.8 billion (Grant Cycle 7) for HIV, tuberculosis, and malaria. In comparison, the rest of Africa received $6.3 billion, $7.2 billion, and $6.6 billion. In other words, it received barely a third of the total African funding, even though the burden of disease remains high.
Even more striking is who manages this money. In Francophone Africa, governments account for approximately half of the grant budgets (54%, 49%, and 52%, respectively, across the three cycles), while the remainder goes to multilateral agencies and international NGOs (31%-36%) and local organizations (12%-16%). In the rest of Africa, governments manage an average of two-thirds of the funds (65%-68%), with local organizations receiving a slightly higher share than in Francophone Africa. The data confirm a long-held, intuitive diagnosis: Francophone countries are less "bankable" than their Anglophone or Lusophone neighbors for the Global Fund and are more dependent on international intermediaries (Figure 1).
Figure 1:
The information shared in Dakar (Figure 2) further illustrates this discrepancy objectively. It compares the role of Global Fund resources in five key areas of public financial management (PFM).
The Single Treasury Account (STA): Only 18% of Francophone countries have integrated it into their portfolios, compared to 35% of non-Francophone countries. Barely 18% of Francophone countries fully utilize the STA, compared to 35% of non-Francophone countries.
Computerized budget management systems: Nearly two-thirds of Francophone countries do not use national systems to track subsidy expenditures, while one in five non-Francophone countries already do so completely.
Public internal and external audits: The difference is even more pronounced for external audits. One hundred percent of Francophone portfolios rely on parallel mechanisms, while 65 percent of non-Francophone countries use their supreme audit institutions to audit at least some of the funds.
Figure 2:
Finally, the "GFP maturity" typology places countries into three groups: 18% are at high maturity (with nearly full use of national systems), 39% are at medium maturity, and 43% are at low maturity. No Francophone country is in the first group. Five are at medium maturity, and eight are at low maturity (Figure 3). Thus, the Dakar agenda begins with the clear observation that if the Global Fund truly wants to align its grants with national systems, the Francophonie represents both the weakest link and the greatest potential for progress.
Figure 3:
This assessment aligns with the GFP strategy adopted by the Board in 2024, which explicitly links alignment with national systems to the "3 ONEs" vision — one plan, one budget, and one report — championed by the Lusaka Agenda. This assessment is also part of a broader partnership with IFAC, Gavi, AFROSAI-E, CREFIAF, and other African professional accounting organizations. The partnership aims to strengthen audit and financial management capacities in the public sector.
A graduated approach to PFM in a constrained macroeconomic context
Dakar is not arriving in a vacuum. The Global Fund points out that, in an environment of climate shocks, soaring food prices, slowing growth, and rising debt service costs, public financial management (PFM) is becoming a matter of survival. World Bank projections show downward revisions to growth prospects in all developing regions, with public debt remaining above pre-pandemic levels and official development assistance (ODA) for health declining, particularly in sub-Saharan Africa and fragile states.
The slides presented in Dakar (Figure 4) clearly illustrate the causal chain: a decline in public revenue, a reallocation of spending that harms health, a lack of planning certainty, increased pressure on health systems, and a deterioration of household financial protection.
Figure 4:
In this context, the question is no longer just "How much money should be allocated to health?" but also "How can we protect the health budget and use every dollar more intelligently?"
The Global Fund summarizes its response in five points (Figure 5).
1. More money for health: helping countries mobilize public and private resources.
2. Spend better: Improve the efficiency of existing spending.
3. Align with national systems: Integrate programs into budgetary frameworks, treasury systems, and expenditure chains.
4. Less dependence on external resources by preparing the transition of Fund-financed components to domestic financing.
5. Improve results and financial sustainability by linking the GFP, programmatic results, and universal health coverage.
Figure 5:
This matrix is linked to the "PFM Accelerator" initiative, which was launched in Geneva in 2024. The initiative brings together ministries of finance and health, supreme audit institutions, and partners to co-construct national pathways for public financial management (PFM) alignment.
In a sense, Dakar is territorializing this agenda within the Francophone space. The official communiqué emphasizes three objectives: consolidating political will, addressing the underrepresentation of Francophone countries in the GFP maturity cohorts, and seizing an "impactful opportunity." By targeting the GFP in these countries, the Fund hopes to align financing with national systems sustainably, reduce aid dependency, and accelerate program transitions.
The discourse is not purely rhetorical. Since its inception, the Global Fund has supported the transition of 52 disease programs in 38 countries to domestic financing. In the current cycle, an additional 12 programs in eight countries are undergoing this transition — the largest wave to date. GFP alignment is thus becoming the backbone of this transition. Countries can only assume recurring costs (e.g., personnel, medicines, and prevention) if these expenditures are integrated into the national budget, are subject to regular monitoring, and are backed by sustainable revenues.
From "zero tolerance" to a shared risk contract
For the Global Fund, the Francophone PFM agenda represents a significant change to its model. Its "zero tolerance" policy toward fraud has historically resulted in the proliferation of parallel mechanisms, such as dedicated bank accounts, trustees, private audits, and specific procurement procedures. While this structure has reassured donors, it has also fostered distrust of national oversight institutions.
The new approach is to transition from insurance "against" national systems to insurance "with" them. In concrete terms, this means:
Shared risk acceptance: By integrating more funds into the CUT and national computerized systems, the Fund loses granular control but gains overall transparency and budgetary coherence. Rather than preventing it, the GFP maturity assessments and graduated trajectories (30–40%, 75–85%, and 100% system utilization) guide this transition.
The focus is on supreme audit institutions. The challenge is to transition from private audits commissioned by Geneva to public audits carried out by the Courts of Auditors. Technical partnerships with IFAC, professional organizations, and joint programs will support these institutions in strengthening their capacities in performance auditing and monitoring health programs.
Linking co-financing to finance laws: Budgetary integration of subsidies makes it harder to engage in "double-speak" by promising domestic benefits on paper without including them in finance laws. This also gives parliaments and citizens additional leverage to monitor the executive branch's commitments.
For Francophone governments, the GFP agenda presents both opportunities and constraints. It is an opportunity because it supports ongoing reforms (e.g., program-based budgeting, harmonization of public finance rules within the EU, and digitalization of budgetary systems) and provides access to targeted support from the Global Fund on issues traditionally handled by international financial institutions. It is also a constraint because it requires clear choices. Integrating grants into national budgeting processes makes them more visible and therefore more exposed to competition from other political priorities.
This is where Dakar's political dimension becomes apparent: the plan presented at the meeting identifies a "turning point" between two extremes: dependence on external funding and rigid administrative controls and inflexible procedures. The ambition is to gradually shift countries toward a system in which the following coexist:
- sustainable health financing, primarily based on national resources;
- A robust GFP, capable of ensuring the sustainability of investments and increased decision-making autonomy;
- Accountable institutional governance, where communities and civil society are at the heart of the Global Fund partnership, not on its periphery.
However, blind spots remain. If not balanced, the increasing influence of finance ministries in health governance can marginalize community actors and national NGOs, despite their status as key recipients of subsidies for two decades. Integration into the state budget does not guarantee that programs aimed at reducing inequalities, combating stigma, or providing community-led services will remain priorities. Similarly, the rhetoric of "sovereignty" can be used to restrict civil society's space or evade transparency requirements.
The Global Fund and Francophone actors must prevent the GFP agenda from becoming a technocratic exercise. This requires linking discussions on cash flow, information systems, and audits to specific issues, such as payment deadlines for health facilities, supply availability, local management autonomy, and community organizations' access to public funding.
Dakar as a credibility test for the "GFP of sovereignty"
The Dakar meeting was intended to lay the groundwork, but it seems more like a credibility test. The national roadmaps that emerge from it will permit the gradual integration of subsidies into the CUT, increased use of public audits, better inclusion of funding in finance laws, and increased transparency. However, these changes will only be worthwhile if they are implemented within the next two to three years of GC7.
For the Global Fund, the success of this endeavor is crucial to the legitimacy of its discourse on "sovereignty." One cannot proclaim alignment with national systems while controlling the majority of flows through parallel channels. For Francophone countries, the challenge is to seize this political opportunity to consolidate often-fragile reforms, strengthen oversight institutions, and establish health as a lasting budgetary priority despite the looming macroeconomic storm.
Finally, for communities, public health management (PHM) must not remain a debate among technical experts. In Dakar, the message was clear: Without transparency regarding budgets, accessible public audits, and informed parliamentary debates, the promise of health sovereignty risks remaining just a slogan. However, if PHM tools become levers for citizen accountability, the Francophonie could transform a historical handicap into a strategic advantage and give the Global Fund partnership new political depth beyond mosquito nets and antiretrovirals.
