The Global Fund to Fight AIDS, Tuberculosis, and Malaria: Background and Current Issues

Publication Date: March 2005

Publisher: Library of Congress. Congressional Research Service

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Research Area: International relations

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Abstract:

The Global Fund to Fight AIDS, Tuberculosis, and Malaria, headquartered in Geneva, Switzerland, is an independent foundation intended to attract and rapidly disburse new resources in developing countries for the struggle against infectious disease. The Fund is a financing vehicle, not a development agency, and its grants are intended to complement existing efforts rather than replace them.

The origins of the concept of an independent funding mechanism to fight AIDS and other diseases lie partly in a French proposal made in 1998, in ideas developed in the 106th Congress, and in recommendations made by U.N. Secretary General Kofi Annan in April 2001. President Bush made the "founding pledge" of $200 million for a disease fund in May 2001. The Global Fund was established in January 2002, following negotiations involving donor and developing country governments, nongovernmental organizations (NGOs), the private sector, and the United Nations.

Through four rounds of grant awards, the Global Fund has approved 313 projects in 127 countries. Proposals are submitted to the Global Fund by Country Coordinating Mechanisms (CCMs) based in the recipient countries and including representatives of the public and private sectors, NGOs, people living with the diseases, and others. Grants are made to Principal Recipients (PRs), which may be NGOs or government agencies, and their operations must be audited. PRs are also monitored by Local Funding Agents (LFAs), which may be accounting firms or other independent organizations, and which report to the Global Fund. Contributions to the Fund to date total $3.4 billion, and the Fund has disbursed just over $1 billion. The Fund estimates that it needs $2.2 billion in 2005 to cover grant renewals and new grants, while $1.4 billion has been pledged to date.

The Administration has requested $300 million for a U.S. contribution to the Global Fund in FY2006. Appropriations for FY2005 provided $435 million, including $87.8 million carried over from FY2004 due to a legal requirement limiting U.S. contributions to 33% of total contributions. Many supporters of the Fund advocate a larger U.S. contribution, but others respond that the United States is already doing a great deal through the bilateral President's Emergency Plan for AIDS Relief (PEPFAR).

Critics of the Fund have raised concerns about programs in Burma and other authoritarian countries, an allegedly slow pace of disbursements, and other issues. Supporters respond that the Fund has instituted a number of safeguards to assure accountability and is taking steps to enhance its capabilities. They regard the Fund as an innovator in malaria treatment and other areas. The Global Fund notes that it is required to maintain a large financial reserve in order to assure that treatment programs already approved are not interrupted. This report will be updated as needed. For further information, see CRS Report RS21181, HIV/AIDS International Programs: Appropriations, FY2003-FY2005; CRS Issue Brief IB10050, Aids in Africa; and CRS Report RL32252, AIDS Orphans and Vulnerable Children (OVC): Problems, Responses, and Issues for Congress.