11 Mar 2015
The $2 billion register so far includes $44 million in key population-specific programs

Under the new funding model (NFM), the Global Fund created a system to maintain an inventory of unmet needs identified by countries, the funding for which exceeds their allocation for the period 2014-2017. The register of Unfunded Quality Demand (UQD) was designed in response to deliberations within the Board that sought to encourage countries to develop their full expressions of demand: a comprehensive inventory of all of the interventions that would help countries in their fight against the three diseases, if there were no financial limitations on the size of the resource envelope available.

In a first look at the register, made available on 11 February on the Fund's website here, there are some $2 billion in provisional requests for technically sound interventions from across the countries eligible for Global Fund support. This amount represents all UQD from the 126 concept notes submitted to the Global Fund from May to October 2014 (Windows 1-4). Eligible requestsfor unfunded quality demand from the 16 regional concept notes and 33 disease-specific concept notes that were submitted in January 2015 (Window 5) will be included in the next version of the UQD register.

Most of the requests are related to joint HIV/TB (52%) or malaria (34%) programs. Single disease concept notes for HIV (7%) and TB (5%) comprise the majority of the rest, with just 1% of provisional requests made to support health system strengthening programming. The register is likely to grow as more concept notes are submitted.

The vast majority of the register is populated with requests from sub-Saharan Africa: some $1.5 billion from the region that is also the largest beneficiary of NFM funding. Uganda's request for an additional $188 million to further scale-up anti-retroviral treatment constitutes the largest single unmet need, representing roughly half of its $365 million UQD ask. Nigeria, which was allocated $1.1 billion under the NFM, has the second-largest composite UQD ask, for some $329 million.

Beyond the big-ticket items, the UQD register also provides insight into where the gaps are. Programming targeting key affected populations was championed as the NFM was in development, and evidence is emerging that countries have conformed to the requirements that the groups most vulnerable to infection are at the center of planned interventions. Nevertheless, the UQD register shows a $44.37 million funding gap for KAPs across 11 countries, as shown by Table 1.

Table 1: Unfunded Quality Demand for Key Affected Populations



 Amount (USD)


Additional 14,300 MSM and 1,277 TG to be covered by HIV prevention programs, including condoms, HTC and STI screening.


Two new Opioid Substitution Treatment centers for prevention among PWID


Additional 9,600 sex workers to be covered by HIV prevention programs



TB case detection, diagnosis and prison outreach



Behavioral change as part of HIV prevention programs for MSM and TGs



Condoms as part of programs for MSM and TGs



Increase the target coverage of behavior change programs from 37% to 50% for MSM, and 43-64% for TG


Behavioral change as part of HIV prevention programs for PWID and their partners


Behavioral change as part of HIV prevention programs for sex workers and their clients



Behavioral change as part of HIV prevention programs for MSM and TG


Needle Exchange Program and Opioid Substitution Treatment for PWID



Behavioral change as part of HIV prevention programs for sex workers and their clients


HIV Prevention programs for other vulnerable populations, including reaching 45% of 39,521 miners.



Behavioral change as part of HIV prevention programs for PWID and their partners



MSM behavior change, condoms, HTC and STI treatment to increase national coverage to 49% by 2017


Sex worker client programs, condoms, HTC, STI treatment to increase national coverage to 35% by 2017


Behavior change, HTC and STI for internally displaced persons



Condoms as part of programs for MSM and TGs


HIV testing and counseling as part of programs for sex workers and their clients



Expand interventions to national scale for PWID


Equipment, training and resources to expand HTC for key populations nationwide plus operational pilot for HIV self-testing and linkage to service





HIV interventions make up the largest KAP-related gap included in the register. Within the key populations, activities targeting people who inject drugs comprise the largest deficit, with some $21.4 million led by Vietnam's request for $18.7 million to scale existing activities. Interventions focused on sex workers represent a $10.1 million gap, followed by interventions that target men who have sex with men (MSM) and transgender (TG) individuals ($6.1 million).

Sudan follows Vietnam with the second-largest unmet need for KAPs, with a gap of $10.6 million. Sudan’s UQD includes the largest gap in funding for sex workers, internally displaced people, MSM and TG.  

How can these gaps be addressed?

All of the interventions in the UQD register, including the ones in Table 1, will have a “shelf life” of up to three years. This transparency around unmet country need means that the UQD register may be a useful tool for additional resource mobilization. Already, resources from private donors -- including pledges of $30 million from Product (RED)™ and $12 million from the M∙A∙C AIDS Fund, GoodBye Malaria and Comic Relief -- are being committed to these requests. High-net-worth individuals from Indonesia, the Philippines and Vietnam have also expressed interest in making commitments towards funding UQD in their countries.

It is also possible for program needs to be addressed through synergies with regional applications that focus on KAPs. Rising domestic investment could also go towards bridging these gaps.

Shaun Mellors, associate director at the International HIV/AIDS Alliance, emphasizes the importance of developing a plan of action for the unfunded demand. “This pool is steadily growing and we need concrete proactive strategies from the Global Fund and other partners to address this increasing need,” he said. "If not, it is going to impact on countries' willingness to express ambitious demand in future, especially for KAP programming."

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