Reaching the marginalized: EFA global monitoring report, 2010; 2010

0120CHAPTER 4Education for All Global Monitoring ReportMany donors thathave givenlimited backingto the FTI —including France,Germany, Japanand the UnitedStates — haveactivelysupported theGlobal Fundthirty-six countries was approved three monthslater. The fund has supplied anti-retroviral drugsto about 2 million people and tuberculosistreatment to 4.6 million, provided 70 millioninsecticide-treated bed nets and saved around3.5 million lives (Global Fund, 2008a).By the end of 2008, it had disbursed US$7 billion(Global Fund, 2009d). The current target is tocut the average time between commitmentand disbursement from between nine and elevenmonths – around half the post–2007 FTIdisbursement period – to eight months (Sridharand Tamashiro, 2009). In 2008, 96% of the fundingplanned in grants was disbursed, and only 16%of active grants had a disbursement rate of lessthan 75% (Global Fund, 2009d). One reason forsuch rapid disbursement is the development ofrules aimed at strengthening and working throughnational procurement and reporting systems.Another is technical support to countries havingtrouble meeting disbursement conditions.Effective and accountable governance has beencentral to sustained delivery. Detailed accountsof the management and administration systemare available elsewhere (Global Fund, 2008d).For purposes of comparison with the FTI,several distinctive features can be identified:Institutionalized independence. The Global Fundis legally constituted as a Swiss foundation,rather than a multidonor trust fund, receivingadministrative support from the World HealthOrganization (WHO) and fiduciary support fromthe World Bank. The Bank’s role is limited todisbursing funds on instruction from the GlobalFund Secretariat. The secretariat is much largerthan the FTI’s, with about 470 staff, and itanswers to the board as a whole, creatinga very different set of institutional incentivesthan those facing the FTI Secretariat.Broad-based donor support. To provide sustainedand predictable support, the Global Fund workswith a system based on replenishments overtwo year cycles. From 2010, the replenishmentarrangement will move to a three year cycle.Total grants for 2008–2010 are expected to reachUS$9.5 billion (Global Fund, 2009a). Many donorsthat have given limited backing to the FTI –including France, Germany, Japan and the UnitedStates – have actively supported the Global Fund.Notably, United States contributions representedone-quarter of the total (Figure 4.21).Innovative financing. From 2001 to 2009,contributions from private philanthropy andinnovative financing arrangements amountedto US$642 million (Box 4.16). Along with the Billand Melinda Gates Foundation, thirteen majorcompanies have contributed directly or indirectly.Long-term commitment. The Global Fundoperates on a five year grant cycle (comparedwith three years for the FTI). As part of the2007–2010 strategy, a facility was introducedto provide support for high-performingprogrammes for up to six additional years.The new facility reflects a growing commitmentto long-term predictable financing to maintainsupport following investments in thestrengthening of health systems, particularlyfor recurrent expenditure such as salaries.Broad-based global representation. The boardthat oversees the Global Fund sets policypriorities and approves grants. It has twenty-fourmembers, twenty of whom have votes: sevenfrom developing countries, eight from donorcountries, three from civil society, one fromthe private sector and one from the GatesFoundation (Global Health Watch, 2008).This structure gives a far stronger voiceto developing countries than that of the FTI.Strong country ownership. Countries developplans and submit proposals to the Global Fundthrough a Country Coordinating Mechanism,a country-level partnership that usuallyconsists of governments and donors, alongwith representatives of non-governmentorganizations, church groups, the private sector,academics and people affected by the diseases(Global Fund, 2008b). The mechanism appointsone or two organizations to act as PrincipalRecipients, or managers and administratorsof Global Fund grants. About two-thirds ofPrincipal Recipients are government agencies,though in some cases responsibility is split.The mechanism facilitates higher levels ofengagement between a wider range of actorsthan is the case with FTI processes.Transparency in decision-making. Well-definedrules and processes govern endorsementand disbursement. A Technical ReviewPanel assesses proposals and makesrecommendations to the board, setting out itsarguments for approval or rejection (Global Fund,2007). Rejected proposals can be amended and262