4. ANALYSIS
24 Feb 2020
Mozambique, India, and Nigeria received the largest allocations for HIV, TB and malaria

The Global Fund has increased funding by an overall 23% to all countries in the coming 2020-2022 cycle compared to the 2017-2019 cycle. (See recent GFO article describing the new allocations.) The Global Fund allocates funds to eligible countries using a formula that accounts for two main variables: the burden of disease and the income per capita. The Global Fund’s formula therefore favors low-income countries with high burdens of each disease.

This article highlights countries with increases in their total allocations of 50% or more, as well as the top 20 countries with the largest allocations for each of the three diseases in this 2020-2022 cycle. The data comes from the Global Fund’s data service.

Twenty countries with increased total allocations of 50% and higher

We first focus on countries with an increased total allocation of 50% or more in the 2020-2022 funding cycle, compared to the 2017-2019 cycle, as this represents a substantial increase in available funds to fight those three diseases.

For this section,  the data from the following countries/grants were not locatable within the Global Fund’s data service: Bulgaria, Fiji, Iraq, Multicountry Americas (an HIV grant for activities in 11 countries in Latin America), Palestine, Russian Federation, Syrian Arab Republic, and Yemen.

Albania received the highest increase in its total allocation, of 490%. Seven countries’ allocations have doubled between the two funding cycles (increases of at least 100%) (See Table 1, beneath Figure 1 below). Interestingly, most of those countries have relatively small portfolios: six countries received less than $10 million, nine others received between $10- and $100 million. Only two of these 20 countries (Mali and South Africa) are defined by the Global Fund as ‘high impact” – with a “very large portfolio, mission-critical disease burden”.

Figure 1: Countries with allocations higher by at least 50% compared to 2017-2019

 

Source: The Global Fund

Top 20 largest HIV/AIDS allocations

For this section, Aidspan could not locate the data from Bulgaria, Gabon, Multi-country Americas (CRN+), Palestine, Russian Federation, Syrian Arab Republic and Yemen on the Global Fund’s data-service website.

The 20 top HIV/AIDS grants

We rank the top 20 countries in terms of their 2020-2022 HIV/AIDS allocations, excluding catalytic funds, if any.

Among the top 20 countries with the largest HIV/AIDS grants, 17 are African, two are Asian (India and Indonesia) and one is Caribbean (Haiti; see Table 1). Mozambique and South Africa have received the highest absolute allocations in this cycle, of $496.4 million and $491.2 million, respectively. The allocations are in line with their disease burdens, as South Africa has the largest HIV epidemic in the world, with prevalence at 20.4% in 2017. Mozambique is a neighbor to South Africa with an HIV prevalence among adults of 12.6% in 2017, according to UNAIDS. Interestingly, Tanzania and Rwanda, despite a reduction in their HIV allocations by 11% and 21% respectively, are still in the top 20 in terms of allocations. The allocations for India and Myanmar remained essentially the same over the two periods, at $155 million and $123 million respectively.

Table 1: The top 20 highest HIV/AIDS allocations in the 2020-2022 allocation cycle ranked by the amount of the 2020-2022 allocations

Country Grant Management Division regions Allocation  2020-2022 US$ Allocation   2017-2019 US$

Difference in allocations between the two cycles

Percentage change %
Mozambique High Impact Africa 2 496,359,122 289,889,134 206,469,988 71%
South Africa High Impact Africa 1 491,237,860 317,721,470 173,516,390 55%
Zimbabwe High Impact Africa 2 425,034,567 406,518,928 18,515,639 5%
Malawi Southern and Eastern Africa 393,004,813 370,804,766 22,200,047 6%
Tanzania (United Republic) High Impact Africa 2 364,840,423 408,487,081 -43,646,658 -11%
Nigeria High Impact Africa 1 329,107,978 239,781,871 89,326,107 37%
Uganda High Impact Africa 2 289,203,023 255,632,244 33,570,779 13%
Ethiopia High Impact Africa 2 278,315,505 194,160,288 84,155,217 43%
Kenya High Impact Africa 2 271,649,197 246,899,292 24,749,905 10%
Zambia High Impact Africa 2 233,545,183 184,377,140 49,168,043 27%
Congo (Democratic Republic) High Impact Africa 1 174,093,362 122,678,456 51,414,906 42%
India High Impact Asia 155,000,000 155,063,624 -63,624 0%
Cameroon Western Africa 149,772,367 94,644,534 55,127,833 58%
Myanmar High Impact Asia 122,408,561 123,102,465 -693,904 -1%
Rwanda Southern and Eastern Africa 121,349,916 154,462,907 -33,112,991 -21%
Indonesia High Impact Asia 102,717,937 91,934,562 10,783,375 12%
Côte d'Ivoire High Impact Africa 1 90,998,410 70,216,292 20,782,118 30%
Ghana High Impact Africa 1 88,833,024 66,436,395 22,396,629 34%
Mali Western Africa 80,322,830 49,083,927 31,238,903 64%
Haiti Latin America and Caribbean 72,959,840 66,216,854 6,742,986 10%
Source: The Global Fund data service

 

Twenty-four countries received allocations increased by at least 50% to fight HIV/AIDS

Eleven countries’ allocations have at least doubled (increases of at least 100%). Among these countries, Egypt received the highest allocation increase, of 740%, while Paraguay’s allocation increased by 52%. Countries with the highest percentage increases are not the ones with the largest HIV/AIDS grants. For instance, Egypt’s HIV/AIDS grant in this cycle is $4.2 million, while that of Paraguay is $6.7 million.

Top 20 Largest TB allocations

For the TB allocations’ analysis, we did not have adequate data from the following countries/grants: Bulgaria, Fiji, Iraq, Multicountry Americas (CRN+), Palestine, Syrian Arab Republic and Yemen.

We rank the top 20 countries in terms of their 2020-2022 TB allocations. Among the top 20 countries with the largest TB allocations, 18 are High-Impact Asia and Africa (See Table 2). India and Pakistan have the two largest TB allocations at $280 million and $171.9 million, respectively. India, with a population of 1.4 billion, is home to more than a quarter of the global TB burden, according to the Global Fund. The country also has the world's highest incidence of TB, with 2.7 million cases annually. India has set a goal of ending TB in the country by 2025, five years ahead of the Sustainable Development Goal (SDG) target year. Pakistan, its neighbor, has an estimated 562 000people with TB.

Table 2: The top 20 highest TB allocations in the 2020-2022 allocation cycle ranked by the amount of the 2020-2022 allocations

Country Grant Management Division regions Allocation  (USD Equivalent) 2020-2022 Allocation funds

Amount

%
India High Impact Asia 280,000,000 279,929,924 70,076 0%
Pakistan High Impact Asia 171,981,709 130,163,215 41,818,494 32%
Indonesia High Impact Asia 150,456,123 102,416,537 48,039,586 47%
Nigeria High Impact Africa 1 143,595,962 107,495,151 36,100,811 34%
Philippines High Impact Asia 119,096,167 78,543,887 40,552,280 52%
Bangladesh High Impact Asia 115,770,502 97,935,663 17,834,839 18%
Myanmar High Impact Asia 93,126,255 82,947,503 10,178,752 12%
Congo (Democratic Republic) High Impact Africa 1 76,950,962 56,656,946 20,294,016 36%
Viet Nam High Impact Asia 59,771,812 47,281,094 12,490,718 26%
Kenya High Impact Africa 2 56,694,297 45,507,072 11,187,225 25%
Mozambique High Impact Africa 2 55,152,849 45,122,235 10,030,614 22%
Ethiopia High Impact Africa 2 50,893,976 51,599,381 -705,405 -1%
Ukraine Eastern Europe and Central Asia 48,644,568 48,646,090 -1,522 0%
South Africa High Impact Africa 1 45,528,766 35,599,651 9,929,115 28%
Tanzania (United Republic) High Impact Africa 2 43,068,093 25,849,887 17,218,206 67%
Uganda High Impact Africa 2 29,773,958 21,101,922 8,672,036 41%
Somalia Middle East and North Africa 29,018,030 22,110,931 6,907,099 31%
Uzbekistan Eastern Europe and Central Asia 26,150,623 21,640,400 4,510,223 21%
Haiti Latin America and Caribbean 25,422,056 17,896,075 70,076 0%
Zimbabwe High Impact Africa 2 23,771,855 23,775,807 41,818,494 32%
Source: The Global Fund

 

Malaria allocation

We ranked the top 20 countries in terms of their 2020-2022 malaria allocations. The top 20 countries in terms of amount of malaria allocations are in Africa (Table 3). India is 21st (not shown in the table). Nigeria has received the largest malaria allocation at about $417.8 million, followed by Democratic Republic of Congo at $393.9 million.  Malaria is endemic in these two large countries, which have populations of 206 million and 89 million, respectively. These two countries accounted for 37% of all malaria cases globally in 2018 (See WHO’s Malaria report of 2019:).

Table 3: Top 20 countries with highest allocations for malaria ranked by the amount of the 2020-2022 allocations

Country Grant Management Division regions Allocation 2020-2022 US$ Allocation 2017-2019 US$

Difference in Allocations between the two cycles

%
Nigeria High Impact Africa 1 417,893,727 313,409,111 104,484,616 33%
Congo (Democratic Republic) High Impact Africa 1 393,891,463 347,651,023 46,240,440 13%
Uganda High Impact Africa 2 260,024,950 188,322,878 71,702,072 38%
Mozambique High Impact Africa 2 200,001,211 167,870,339 32,130,872 19%
Tanzania
(United Republic)
High Impact Africa 2 179,362,012 145,258,808 34,103,204 23%
Burkina Faso Central Africa 155,188,287 94,868,155 60,320,132 64%
Côte d'Ivoire High Impact Africa 1 145,592,530 118,139,717 27,452,813 23%
Ghana High Impact Africa 1 119,665,794 111,531,421 8,134,373 7%
Ethiopia High Impact Africa 2 115,344,133 129,849,218 -14,505,085 -11%
Cameroon Western Africa 111,670,203 69,591,080 42,079,123 60%
Sudan High Impact Africa 1 110,314,123 98,522,995 11,791,128 12%
Niger Western Africa 107,446,514 53,763,719 53,682,795 100%
Malawi Southern and Eastern Africa 99,984,069 70,670,374 29,313,695 41%
Mali Western Africa 90,096,464 53,055,381 37,041,083 70%
Kenya High Impact Africa 2 86,966,676 63,225,487 23,741,189 38%
Guinea Western Africa 72,670,272 56,663,302 16,006,970 28%
Burundi Central Africa 70,849,593 36,656,018 34,193,575 93%
Sierra Leone Central Africa  68,353,985 43,960,771 24,393,214 55%
Chad Western Africa 67,614,009 39,986,124 27,627,885 69%
Zambia High Impact Africa 2 65,131,160 69,000,000 -3,868,840 -6%
Source: The Global Fund

 

As with HIV/AIDS and TB allocations, countries that received the highest increases in malaria allocations are not among the top 20 in terms of the total allocation in the 2020-2022 cycle. Sao-Tome and Principe, and Congo received the highest increases – of 198% (total allocation $11 million) and 156% (total allocation $34 million), respectively.

All countries that received allocation letters must submit their requests for funding to the Global Fund during the three windows for application during 2020. Increases in allocations are associated with an increase in the countries’ co-financing commitments – in other words, with an obligation for countries to increase their domestic funding for their respective health sectors and programs for the three diseases. (See separate article in this GFO on co-financing in the latest allocations.)

 

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