Global Fund Is $6-Billion Short and May Have to Cut Life-Saving Programmes

For decades the Global Fund to Fight AIDS, TB and Malaria and the US PEPFAR programme have funded public health across the world. Both programmes are now short of money following US funding cuts.

The Global Fund to Fight AIDS, TB and Malaria (Global Fund) has told its recipients that it is cutting funding amidst “significant disruptions” in the “financing landscape for global health programs”.

Earlier this month, the Global Fund informed its recipient countries that it was going to revise its current grant cycle by mid-June due to funding shortfalls. Over 200 grants will be revised.

The Global Fund was set up in 2002 and provides funding for HIV, TB, and malaria programmes in over 100 countries. Most of the funding has gone towards sub-Saharan Africa (72% from 2021 to 2024), according to its 2024 Results Report. It is the largest international funder of malaria programs.

This comes after the withdrawal of PEPFAR funding from the US Agency for International Development (USAID) earlier this year, leading to the loss of billions of rands in funding for HIV programmes. This has led to clinics closing down, health staff getting retrenched, and HIV treatment and prevention services collapsing in sub-Saharan African countries.

HIV activists have raised concerns in Parliament about the effects of the funding cuts on the ground. Most aid from USAID was effectively cancelled by the US government earlier this year. The Global Fund cuts will worsen an already bad situation.

At a board meeting earlier this month, the Global Fund indicated that its mid-cycle grants (referred to as GC7) would be revised, “fairly” deallocated, and then readjusted based on country and grant contexts.

“The external financing landscape for global health programs is undergoing significant and rapid change. The Global Fund is both subject to these forces and supporting countries and communities to respond,” the Global Fund said in a letter to its recipients. The main objective was to “slow down non-critical expenses to ensure life-saving services can be prioritised,” it said in another letter from April.

Numbers from The Global Fund show that as of 17 May, it had a shortfall of over $6-billion for the grant cycle of 2023-2025, which means that about half of the money pledged by national governments has not yet been received.

More than $4-billion of the shortfall is from the United States. There is also a lack of clarity from other donors whether their pledges will be honoured.

Statistics from UNAIDS show that in South Africa, the Global Fund covered between 3% and 5% of the annual HIV spending over the last few years. PEPFAR funded about 20% of South Africa’s HIV spending.

Data shows that Global Fund money in South Africa goes primarily to the National Department of Health and non-profit organisations such as the AIDS Foundation of South Africa (AFSA), the Networking HIV & AIDS Community of Southern Africa (NACOSA), and Beyond Zero.

CHANGE (Community Health and HIV Advocates Navigating Global Emergencies) is a coalition of civil society organisations from around the world, established in January this year, to respond to the global health funding crisis. It has expressed concern about the decision to “slow down” the current grant cycle and deallocate funds which would “carry extremely high risks to the lives of the people whom the Global Fund serves”.

CHANGE’s statement also criticised the lack of “specificity” in communication with countries. It called on the Global Fund to release “clear guidance” about the deallocations.

Similarly, a webinar meeting between civil society organisations from across the globe on Friday discussed the importance of coming up with solutions and “non-negotiables” to minimise harm from the funding cuts.

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