Although the Global Fund is committed to promoting harm reduction, serious concerns have been raised that the new funding model poses a threat to investments in harm reduction. This is one of the main findings of an article published in the International Journal of Drug Policy on 15 August.
The article was based on a study conducted by a group of experts representing different universities and international organizations.
The study analyzed Global Fund investments in harm reduction from 2002 until the start of the new funding model in 2014. The study found that 151 grants for 58 countries, plus one regional proposal, contained activities targeting people who inject drugs, and that this constituted a total investment of $620 million. The authors said that this was far short of what was needed. They said that an estimated $2.3 billion was needed for harm reduction in 2015 alone. More than 90% of the Global Fund investments in harm reduction in 2002-2013 were for Eastern Europe and Central Asia.
But the article focused primarily on concerns about the future. “There are widespread concerns regarding the withdrawal from middle-income countries where harm reduction remains essential and unfunded through other sources: for example, 15% of the identified investments were for countries which are now ineligible for Global Fund support,” the authors said.
Of the 58 countries previously funded for harm reduction by the Global Fund, 11 countries had become ineligible by the time the NFM allocations were determined; three countries were eligible only under the ”NGO rule” (which has certain restrictions); more than half of the eligible countries were included Band 4 under the allocation methodology, which restricts the amounts they can receive; and 26 countries were labelled as “over-allocated” or “significantly over-allocated,” meaning that they will receive less funding over in 2014-2017 than they had been receiving.
Of the 11 countries that became ineligible, six are in the EECA. All three countries eligible under the NGO rule are in the EECA.
According to the article, in recent years harm reduction programs in the EECA that had been funded by the Global Fund have already closed in Romania and Serbia, where there is no sustainable alternative funding available.
The article said that the criteria used to calculate allocations under the NFM are too blunt. “Using only national disease burden data may not adequately reflect concentrated HIV epidemics among people who inject drugs, or in specific regions or cities within a country,” the authors said. “Using country income categorisations from the World Bank overlooks vast wealth inequalities within countries.”
Furthermore, the article said, the vast majority of poor people now live in middle income countries, “as do the majority of people living with HIV and the majority of people who inject drugs.” According to the Global Fund’s own analysis, the authors said, “upper-middle-income countries account for 18% of the disease burden, yet receive just 8% of the new funding model allocations.”
The authors applauded the fact that under the new funding model, some funding has been set aside for regional proposals, that the Eurasian Harm Reduction Network was invited to apply as an early applicant, and that harm reduction proposals have been developed for East Africa and Asia. “This is a welcome avenue for greater funding for the critical enablers such as advocacy and community systems strengthening,” the article said.
The authors recommended that “as a matter of urgency,” the Global Fund should further measure and analyze the impact of the NFM on harm reduction programs and that this analysis should inform the development of the Fund’s new strategy for 2017-2021.