Over the last couple of weeks we’ve witnessed two key events that will shape global health and the HIV response over the next five years. I’ve closely followed the recent developments and outcomes at the MDG Summit and the 3rd Voluntary Replenishment of the Global Fund to Fight AIDS, TB and Malaria. For those of us working in the field of HIV the importance of the Global Fund Replenishment could not be overstated. I waited for the outcome of the replenishment meeting with cautious optimism.  After almost a decade of increased financial support for the Global HIV/AIDS response, this past year has been marked by funding flat lining. Donor countries have blamed the economic crisis for reductions in development aid, however there are growing concerns that the tide has turned away from AIDS funding and that political will in taking the HIV/AIDS response to the next level has waned.  The disappointing outcome of the Global Fund Replenishment Meeting reinforces my concerns. More...

The outcomes of last week’s Global Fund Board meeting brought relief and joy. Many people, fearful that planned discussions about prioritizing and financing for the next round of funding could damage the Global Fund’s collaborative spirit, went into the meeting thinking it could be the toughest yet.

Against a tough back drop of financial uncertainty, the Board’s decision to launch Round 10 on 20 May with an innovative new fund to support programmes for marginalized populations proved to be an important step forward in the Global Fund’s maturation.

As usual, the Board meeting made for an intensely busy week with late-night gatherings proving key to working through the issues at hand. Global Fund Chair, Ethiopian Health Minister Tedros, agreed that IAS could attend the meeting as an Observer. We hope this role will continue, given the importance of the Fund’s work to our membership, who play a central role reviewing applications on the Technical Review Panels, serving on Country Coordinating Mechanisms and delivering programmes supported by the Global Fund.

Setting funding priorities is inherently about choices. In the lead-up to the meeting it looked as though the Board would face tough choices that could pit low- and middle-income countries against one another, knowing that resolution on prioritization was key to deciding whether, when and how 10 would be launched. With a cap? With a waiting list? And who would be first on that list? These questions are most acute now because with the Replenishment process kicking off, no one knows how much money will be in the bank at the start of next year – and the Fund is only allowed to make grants up to the amount of real cash it holds. More...

I’m still not really sure what came out of the Global Fund Replenishment meeting in The Netherlands last week. I sat through two days of donors delivering their talking points, chatted in several corridors during coffee breaks, have read the rather bland Chair’s summary several times, and the big question remains: will there be more money?

The people round the table in Den Haag were the Fund’s friends. These are donor representatives who will encourage their Ministers and bosses to find the money. Through most of the meeting they seemed to accept the case for the Fund to think big and aim for its top scenario to fundraise $20 billion for the next three years (2011-2013). This is the top level that would put a total of 7.5 million people on ARVs and provide annual care for 4.4 million orphans and vulnerable children, and access to PMTCT for 1.1 million women. This is the track to universal access. And as the civil society representatives at the meeting said – this is the minimum requirement.

But by the end of the second day, as the donor representatives settled back in to familiar routines negotiating the Chair’s summary, these ambitious goals seemed to fade. More...