As early as 2016, a number of calls and statements have been released by a number of NGOs calling The Global Fund to take action to continue the provision of support through The Global Fund despite the ongoing crisis in the country. In 2017, a comprehensive report was published calling the Global Fund Board to instruct the Secretariat to take actions including convening NGOs in Venezuela to assist developing of a fund request. The report also called on the Global Fund Board to review its existing eligibility country to focus more on the the key and vulnerable populations disproportionately affected by the epidemics.
A Committee was formed within The Global Fund Board to review its eligibility policy. At the 39th Global Fund Board, this Committee’s recommendation via a new policy was approved.
- The Board acknowledges that a health crisis may emerge in an ineligible non-highincome country that could have an adverse impact on the global response against HIV/AIDS, tuberculosis, and/or malaria, and that the health crisis may be of such a magnitude that the Global Fund should consider providing support; and
- Based on the recommendation of the Strategy Committee, the Board requests the Secretariat, in consultation with relevant partners, to present potential investment cases meeting the criteria described in the Revision 1 to the Strategy Committee Policy for review and recommendation to the Board. Any such proposals shall also include options for how the proposed investment should be funded.
Budgetary implications: This decision is likely to have future budgetary implications for country funding and/or Secretariat operational expenses, but the actual amounts will depend on specific size of the crisis and potential response. These will be detailed in any proposals that result from this decision.
- An evidence-based approach is proposed to evaluate (without further depth or delay) and potentially finance non-eligible countries in crisis based on epidemiology, economic capacity, implementation arrangements, and cost options.
- The Strategy Committee determined that the evaluation process to examine the potential funding of a non-eligible country in crisis could be activated by the Secretariat or by the Technical Partners, or at the request of the Strategy Committee. Under a focus endorsed by this committee, the Global Fund with technical partners will examine the epidemiological situation of the country in crisis. The importance of considering the contributions of civil society and nongovernmental stakeholders in the evaluations was pointed out.
- The policy also considers the issue of the resurgence of malaria that may occur in countries that have eliminated malaria or in middle-high income countries that are not eligible. The process to advise non-eligible countries facing resurgence of malaria will be based on the principles of WHO’s Emergency Response Framework (ERM).
- Implementing arrangements are unlikely to follow traditional Global Fund agreements (eg, CCM, request for funds, revision of the TRP, granting of grants, etc.) due to the uniqueness of the crises, the likely absence of Global Fund’s implementing partners in the country and the need for quick responses.
- It is expected that this response will be supported, if there is sufficient capacity, by the Technical Partners in the countries with implementation arrangements that provide sufficient and responsible oversight of funding and impact, taking due account of the specific political situation and circumstances of the crisis, including the participation of civil society, multilateral actors or other non-governmental actors, as the main funding channels, when the national government does not recognize a health crisis in HIV, tuberculosis or malaria. Considering that there is currently no specific reserve, the Global Fund’s Secretariat will determine what sources of resources may be available to finance this need.