United Nations Secretary-General Kofi Annan at the African Summit on HIV/AIDS in Abuja, Nigeria, in April 2001, who called for the creation of a global trust fund for the three diseases.

As of July 2003, total pledges by donors to the Fund amounted to US$4.7 billion. Forty governments have pledged 98 percent of the funds, and 2 percent come from the private sector. By February 2004, a total of US$245 million in Global Fund resources had been disbursed to about 120 countries. In the first two rounds of grants, 21 percent went for malaria programs (59 percent for HIV/AIDS, 19 percent for tuberculosis). Over the first three rounds, a minority of funding was destined for purchase of ACTs—less than US$20 million, and less than the amount allocated for purchases of chloroquine and SP (Attaran et al., 2004). This reflects the requests of countries to the Global Fund, which does not dictate how countries should approach malaria control. However, the international health financing community—of which the Global Fund is a major part—has significant influence on what countries plan by way of disease control and what they ask for. Given the level of funding of the Global Fund itself, countries have made realistic requests, which may not include large quantitites of ACTs, because the price would make such requests nonviable. Countries also are concerned about how sustainable a system built on ACTs would be after Global Fund grants run out (if not renewed).

A principle by which the Global Fund operates is that their grants are not fungible: they must augment existing funding for the three diseases and not supplant them. Evidence that allocations for malaria from other sources are being reduced is grounds for the Global Fund to terminate a malaria grant. This principle acknowledges the historic underinvestment in malaria and the other diseases. Strictly speaking, it also can be seen as limiting the endemic countries’ ability to freely allocate resources according to their own priorities, while signalling the global acceptance—of both donor and recipient countries—that only with greater resources is there hope of making progress against these diseases. With continued and increasing donor contributions, the Global Fund has the potential to be a major positive force for malaria control.

REFERENCES

Ahorlu CK, Dunyo SK, Afari EA, Koram KA, Nkrumah FK. 1997. Malaria-related beliefs and behaviour in Southern Ghana: Implications for treatment, prevention and control. Tropical Medicine and International Health 2(5):488-499.

Attaran A, Barnes KI, Curtis C, d’Alessandro U, Fanello CI, Galinski MR, Kokwaro G, Looareesuwan S, Makanga M, Mutabingwa TK, Talisuna A, Trape JF, Watkins WM. 2004. WHO, the Global Fund, and medical malpractice in malaria treatment. Lancet 363(9404):237-240.



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