In mid-February 2026, the Global Fund Secretariat presented an update to its Board during a meeting held on 12–13 February in Geneva. The discussion focused on how the organization plans to improve access to lifesaving health products and prepare countries for the future as more nations increasingly rely on domestic financing for health programs.

The Secretariat explained that it has been working on what it calls a “NextGen Market Shaping” approach. In simple terms, this means using the Global Fund’s position as a major global purchaser to negotiate lower prices, ensure quality, and help new technologies reach countries faster. The update looked at what has worked so far and what needs to evolve as the organization moves into the next grant cycle, known as Grant Cycle 8 (GC8).

Looking back: what has already been achieved

The Secretariat reminded the Board why market shaping remains essential. Many countries depend on affordable medicines, diagnostics, and prevention tools to fight HIV, tuberculosis, and malaria. When prices rise or supply is delayed, treatment programs suffer and patients are directly affected. Over the last few years, the Global Fund has sought to shape the market through its purchasing power. It buys large quantities of health products in various countries, hence in a position to bargain for low prices while at the same time demanding high quality from the suppliers.

One specific example that the Secretariat gave is that of new insecticide-treated nets. The new nets, unlike the old ones, possess two active ingredients instead of one. This is done to safeguard against mosquitoes that are now resistant to insecticides. Through its procurement systems and financing mechanisms, the Global Fund helped countries access the new nets quickly and at prices close to earlier models.

Another example was in facilitating access to a long-acting HIV prevention medicine. This medication was able to protect individuals from HIV for a long time even after taking it once. The Global Fund supported its rollout in several countries soon after approval. Normally, new medicines first appear in high-income countries and only reach poorer countries years later. In this case, the Global Fund helped speed up access so that people at high risk in lower-income countries could benefit sooner.

The Secretariat also described how it helped countries diversify malaria treatments. Drug resistance is a major threat. When parasites stop responding to a single treatment, patients need alternatives. By supporting multiple first-line therapies, the Global Fund helped countries reduce the risk of treatment failure and save money through better procurement.

Building local strength in Africa and beyond

The Secretariat stressed that one of its goals is to help regions become more self-reliant. In the past, many African countries depended heavily on imported medicines and health products. This then made them susceptible to any global disruption in their supply. To this end, the Global Fund worked to reinforce regional manufacturing with partners. It supported training for local manufacturers and assisted them in meeting international standards of quality. Very recently, companies based in Africa began supplying some of the medicines used to treat HIV, tuberculosis and malaria.

For example, some African manufacturers have begun producing HIV treatment medicines that meet global standards. These medicines have already been delivered to countries in the region through the Global Fund’s procurement system. The Secretariat said the advantages of local production extend beyond reducing reliance on international trade and supply. Regional supply can provide job and skills benefits as well. In case of a crisis that disrupts worldwide transportation, countries with a regional supplier will be able to access vital items.

Strengthening supply chains

The Secretariat also spoke about improvements in supply chains. A supply chain is the system that moves products from factories to health facilities and then to patients. If this system breaks down, medicines can sit in warehouses while clinics run out. To solve this problem, the Global Fund has supported countries in modernizing how they track and manage stocks. Some countries are now using digital systems to monitor how many medicines are available at different locations. This helps health officials know when to reorder supplies before they run out.

In some places, the Global Fund also supported new delivery approaches. For example, private pharmacies and local drug shops are sometimes used to help distribute health products. This makes it easier for people in remote areas to get what they need. The Secretariat emphasized that reliable supply chains are as important as securing affordable products.

Why change is needed now

After reviewing past achievements, the Secretariat turned to the future. The global health environment is shifting rapidly. Funding is tighter in many parts of the world. Governments face economic pressure, and donors are also dealing with competing priorities. At the same time, geopolitical tensions and trade disruptions can affect how products move across borders. In addition, some countries are preparing to transition away from heavy reliance on Global Fund grants. This means they will start using more of their own money to buy medicines and health products.

The Secretariat told the Board that these changes make it necessary to evolve the market-shaping approach. The goal is not only to keep introducing new tools but also to ensure that systems remain strong and sustainable over time.

Four priorities for the next phase

The Secretariat identified four main priorities for the next grant cycle. First, it wants to continue to invest in innovation: new medicines, diagnostics, and prevention tools are in constant development. The Global Fund wishes to continue helping to introduce those tools into countries as quickly and at as lower cost. For instance, new diagnostic technologies for fighting tuberculosis could help patients be diagnosed closer to home, instead of sending samples to distant labs.

Second, the Secretariat wants to expand regional cooperation in procurement. When countries buy together instead of separately, they can negotiate lower prices. This is similar to buying in bulk at a wholesale shop. The Global Fund plans to help countries and regional organizations work together to place joint orders, share information and harmonize standards.

Third, the Secretariat will focus on keeping markets healthy. A healthy market means there are enough suppliers, prices are fair, and products remain available. If only one company produces a medicine, prices can rise and supply can become unstable. The Global Fund wants to support competition and monitor risks so that markets remain stable.

Fourth, the Secretariat wants to expand something called non-grant financed procurement. Traditionally, the Global Fund provides grants to countries, and part of that money is used to buy medicines and health products through its pooled procurement system. This system enables countries to take advantage of the lower price levels since the Global Fund procures items in bulk. Non-grant financed procurement gives the countries the advantage of accessing the system when they use their own funding. Under this model, countries can continue using the same system even when they are buying with their own money. This allows them to benefit from negotiated prices and quality-assured products.

In addition, the Secretariat recognizes that there are some challenges in the process. Some member states, prior to receiving goods, need to pay suppliers. The process is called pre-payment. Not all countries can pre-pay. Therefore, to resolve the problem, the Secretariat is considering a pre-financing facility. Pre-financing facility resembles a financial loan or credit system. It enables a country to make an order immediately and settle the payments later. This is important in meeting urgent needs.

Supporting country transition

The Secretariat stressed that many countries are entering a transition phase. With growing economies, these countries are likely to bear their own burden by contributing to their own health programs. This is a positive indicator, but it also poses some level of risk. Countries may face difficulties sustaining or scaling up treatments and prevention programs if they suddenly cannot access affordable products. A smoother transition is what the Global Fund is trying to attain through its collaborative procurement and non-grant purchasing options.

The Secretariat said that countries preparing for transition can continue to access quality products at low prices through the Global Fund’s systems, even when donor support decreases.

Partnerships remain central

The Secretariat also highlighted the importance of working with partners. The Global Fund collaborates with organizations such as the World Health Organization, the World Bank, and regional health bodies to strengthen manufacturing, regulatory systems and supply chains. For instance, in Africa, different regional bodies are collaborating in their efforts to standardize regulations, a move aimed at ensuring products approved in one country can be approved in another country as well. This minimizes time spent as well as spurs further investment in that region.

The Secretariat also collaborates with partners to strengthen regulators and manufacturers' skills, as well as procurement systems and supply and demand information sharing.

Feedback from stakeholders

The topic evoked broad consensus among stakeholders on a number of major directions, as well as specific issues related to implementation, equity, and strategic consistency. First, it is important to note that information from various stakeholders reflects consensus on new financial mechanisms, as well as certain areas of disagreement regarding innovation, sustainability, and regional production.

All the stakeholders felt non-grant financed procurement was strategically urgent, considering the budgetary space available in health systems. All were in strong agreement on the need for the creation of a pre-financing facility as well. They, however, asked for more specific details on eligibility criteria, as well as on risks and repayment, in ensuring the Global Fund is not exposed but making the instrument accessible to eligible countries.

There was also strong support for building existing regional pooled procurement and manufacturing. At the same time, concerns existed on what could be done to ensure that, for example, African manufacturers would have access to adequate orders to enable large-scale manufacturing. Some suggested looking into whether a concept like a vaccine manufacturing accelerator could be leveraged for market entry.

On innovation, stakeholders commended the fast-paced rollout of long-acting HIV prevention. Concerns were, however, raised around equity, including key populations in middle-income countries, who might be priced out. On tuberculosis, stakeholders emphasized better prioritization of new near-point of care tests. New near point of care tests can now enable tuberculosis detection near the patient, instead of central labs. Stakeholders asked if guarantees of volume would indeed bring down prices, considering benefits and risks.

There were also calls for greater clarity on how the Global Fund’s work on market shaping fits with other global mechanisms. There were calls for greater alignment with recognized procurement platforms to prevent duplication of work. Lastly, all stakeholders stressed the role of inclusivity and consultation. As non-grant procurement continues to grow, consultation will play a critical role in ensuring that all stakeholders benefit.

Why this matters for ordinary people

Even though this discussion has highlighted issues of policies and systems, the bottom line for the Secretariat is straightforward: ensuring that people have the tools they need to stay healthy. For an individual living in an area endemic for malaria, it may mean better mosquitoes nets that protect his or her loved ones. An individual living with the threat of HIV can find better access to a new form of prevention. An individual suffering from tuberculosis can find better diagnosis and treatment options. Behind these outcomes are different systems that make commodities accessible, affordable, and consistent. According to the Global Fund, designing these markets, supporting regional production, as well as strengthening these regions, can assist in saving more lives while making these systems stronger.

As the meeting concluded, the Secretariat made clear that the next phase will require strong cooperation, smart investments and careful planning. But it also expressed confidence that the progress made so far provides a strong foundation for the future.