Start the countdown for the Global Fund’s Seventh Replenishment
Article Number: 7
Preparatory Meeting for the Global Fund's Seventh Replenishment to be held 23-24 February 2022
ABSTRACT The Global Fund has just officially launched its Seventh Replenishment (‘Fight for What Counts: The Launch of the Seventh Replenishment’) with an invitation to the first Preparatory Meeting which will be held virtually towards the end of this month. It will be hosted by the Presidents of five African countries and brings the Global Fund partnership together to review its impact to date and lay the groundwork for a successful Seventh Replenishment campaign. At the same time, the Global Fund Advocates Network asks if the Investment Case “Ask” is adequate for the task in hand?
‘Fight for What Counts: The Launch of the Seventh Replenishment’ kicks off next week. The Preparatory Meeting for the Global Fund’s Seventh Replenishment 2023-2025, co-hosted by the Presidents of the Democratic Republic of the Congo, Kenya, Rwanda, Senegal and South Africa, will be convened virtually on 23-24 February 2022.
The Preparatory Meeting for the Sixth Replenishment was held in India in 2019, prior to the Pledging Conference in France in October that year. The theme during the last Replenishment was to ‘Step Up the Fight’ and the Investment Case for that Replenishment focused on the risk of losing momentum and on the reality that the world was already off-track to meet the 2030 objectives of ending the epidemics. At that time the Global Fund wanted to raise at least $14 billion for the next three years to help save 16 million lives, cut the mortality rate from HIV, tuberculosis (TB) and malaria in half, and build stronger health systems by 2023. The Sixth Replenishment was successful, in the sense that the goal was met. However, as the Global Fund Advocates Network (GFAN) point out in its Sign On Letter of 10 February signed by 142 signatories from around the world, ‘7 Asks for the 7th Replenishment’, the Ask had not been ambitious enough — that $14 billion would be insufficient to get back on track. Is the Seventh Replenishment Investment Case asking for sufficient funds to tackle the three diseases in the context of health systems where progress has been derailed by the COVID-19 pandemic?
Global Fund replenishments take place every three years, but this will be the first of its kind to be held against the backdrop of a fourth, deadly epidemic. COVID-19, the uninvited guest at the wedding, will affect all replenishment discussions and decisions.
Shrewd and successful health investments through the Global Fund have saved 44 million lives to date, including 5.4 million in 2020 alone. Through collective global commitment, the Fund has demonstrated that when the world comes together, it can result in astounding success against the world’s most deadly infectious diseases. This year, the Global Fund celebrates its 20th Anniversary. For two decades, this unique partnership has made significant inroads in the fight against HIV/AIDS, TB, and malaria. Since 2002, deaths caused by the three diseases have dropped by 46% in countries where the Global Fund invests. It is hard to imagine where the fight against these deadly diseases might be without the Global Fund partnership.
However, the impact of the COVID-19 pandemic eroded many hard-won gains made against these diseases. With only eight years to go to achieve the Sustainable Development Goals (SDGs), COVID-19 has pushed countries further away from achieving SDG 3: health and well-being for all, and the target of ending AIDS, TB and malaria by 2030. It has strained health systems to the breaking point and exposed inequities in health in terms of unequal access to health services and commodities, exacerbating pre-existing inequalities, as well as undermining progress.
In response to the crisis, in 2020 and 2021 the Global Fund reacted swiftly by deploying more than $4 billion to help countries fight COVID-19 through its special COVID-19 Response Mechanism grants.
Nonetheless, unless the Global Fund and partners can significantly scale up funding, more lives will be lost, together with decades of headway. The Seventh Replenishment takes place during unprecedented times in global health, and in a very different global health environment from that of earlier replenishments.
The Preparatory Meeting will lay the groundwork for the Seventh Replenishment and bring the Global Fund partnership together to review impact to date and determine what is needed to achieve a world without HIV, TB and malaria. The Meeting will also discuss how the partnership can contribute to make the world better able to tackle current health challenges and face future pandemics, including how to partner with low- and middle-income countries to prepare for future pandemics
Hosted by a coalition of African Presidents, the Preparatory Meeting will put the spotlight on Africa’s leadership role in global health and demonstrate how 20 years of global solidarity have saved lives and created impact in the region where most of the Global Fund’s investments are focused. It will also serve to highlight the Global Fund’s ability to adapt and be flexible when faced with a new global health threat.
Together with technical partners, the Global Fund will launch the Investment Case for the Seventh Replenishment. The Investment Case kickstarts the Global Fund’s campaign to mobilize the needed resources to achieve its ambitious new Strategy, which will culminate in the Pledging Conference hosted by President Biden in the third quarter of 2022.
The Investment Case is yet to be released. Will it be fit for purpose?
The Investment Case, as GFAN notes, is a significant document since it sets the scene for the Pledging Conference in September. Importantly, it contains the “Ask” of the Global Fund, representing the amount that the Global Fund needs to address the three diseases for the next three years.
GFAN has estimated that $28.5 billion, including $4.5 billion for community-led responses, is the minimum needed by the Global Fund over the next three years and that public and private donors need to ‘step up to the plate’ if we want to improve on the 2021 Results Report. GFAN’s seven “Asks”, or what it wants to see in the Investment Case, are:
- Boldness and ambition: The Investment Case needs to include a bold and ambitious Ask. The Ask is central to the Case and needs to be proportionate to the unprecedented task at hand.
- People-centered approaches: Centralized, top-down responses to COVID-19 have been prominent for the past two years. However, such approaches are not effective in addressing HIV, TB and malaria. Health issues are best addressed holistically, and in a spirit of partnership. This is the ethos that the Global Fund must continue to imbody, even if it means going against global trends. Hence, GFAN advocates for at least $4.5 billion to strengthen community-led responses for the next Replenishment.
- Towards sustainable domestic resource mobilization (DRM): Robust DRM predictions, grounded in realistic and explicit assumptions, are essential for implementing countries facing a triple COVID economic threat – a rise in COVID-related health costs, a COVID-created economic recession, and increased debt burdens. Any DRM projection needs to be cognizant of these stresses. DRM projections were a weakness of the last Investment Case that needs to be addressed in the upcoming one.
- Clarity on pandemic preparedness: The object of the Replenishment is to raise funds to end AIDS, TB and malaria. GFAN says the Investment Case should not include additional funding to help the Global Fund fulfill a dedicated role in the emerging pandemic preparedness and response (PPR) consensus, regardless of how important this role can be. PPR must be funded separately. At the same time, under COVID, the same funds for HIV, TB and malaria are not utilized as effectively as they could be. Service delivery costs have been higher during the pandemic and this challenge must be included in the Investment Case.
- Protect the rights of key and vulnerable populations (KVPs): The strength of the Global Fund is its partnership, which features prominently the Strategy for 2023-2028. Addressing the needs of KVPs is central to the success of the partnership.
- Heightened focus on private sector and foundations: The Investment Case needs to clearly spell out the value-added to the private sector of eliminating infectious diseases; there are many lessons from the last two years to underscore this point. It is critical that existing private sector and foundation partners of the Global Fund step up and face the challenge to raise a much more significant portion of the $28.5 billion. It is also essential that new partners join their ranks.
- Accomplishing the 2030 agenda: The 2023-2028 Strategy discussions highlighted the importance of aligning Global Fund objectives and needs with global plans, reflected by the SDGs and reaffirmed for each of the three diseases in international commitments. Alignment with these plans and objectives needs to be reflected in the Investment Case, which means that the Ask must account for the full need and demand to achieve the goals the Global Fund partnership has set for the three diseases.
Watch this space as the Global Fud Observer reports on arrangements for the Seventh Replenishment over the next few months in the lead up to the Pledging Conference.