Antoinette E.D. Awaga, GFATM Program management Unit Coordinator, Togo

After 10 years of existence, the GFATM appointed a new director, Dr Dybul, and approved a new funding model (NFM) at the 28th Board of Directors held on 14 and 15 November2012 inGeneva,Switzerland. The first business model with round calls for proposals and two phases had shown its limits in recent years. Enter the new funding model. The NFM will remain demand driven but allows for more flexible processes. It will also provide – in a more effective way – strategic direction to the Fund’s portfolio and increase the ability of the Fund to support national robust programs with a focus on countries with the highest needs and the least ability to pay, while remaining global. The length of each allocation period will be three years, and this will be aligned with the Fund’s three year replenishment cycle. At the beginning of an allocation period, the Fund will determine how much funding is available for the entire period. Applicants may apply for this funding at any time during the period. The length of a grant under the new model will be three years with some flexibility to shorten or extend the length. Countries will be assigned to one of the four bands on the basis of their ability to pay and disease burden. Ability to pay will be measured by gross national income per capita.

An adjustment may be required for bands that contain countries receiving substantial support from other major donors. The funding is split between indicative and incentive funding according to the availability of funds and the quality of the demand. As already mentioned, the allocation to country bands will be determined by the Fund based on the ability to pay and disease burden, but adjustments will be made for qualitative factors such as (a) major sources of external funding, (b) minimum required levels, (c) willingness to pay, (d) past performance and absorptive capacity, (e) risk and (f) increasing rates of new infections in lower prevalence countries.

The big question is whether African countries are ready for the new funding model. This new model will help to strengthen health systems (HSS) and improve the performance of our health systems instead of a merely vertical fight of the three diseases.

The role of technical partners and communities is essential in this new model whereby the fight against AIDS, tuberculosis and malaria can be an opportunity for strengthening – underfunded – health systems. Our expectation is that the new Executive Director, Dr Mark Dybul, will take into account HSS and promote more flexibility during the grant negotiations. HSS must be a part of the future grants.

There is a need for the implementing countries to develop robust health programs, including HSS based on the functions that affect health system performance. The Fund must encourage sub-Saharan African governments to honor theAbujacommitment of allocating at least 15% of their national budgets to health. Populations may then well see their health care “out-of pocket” costs reduced!

Full success to the new funding model and the new director of GFATM!

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