January 10, 2025
Driving Transition and Sustainability in Global Health Financing: Key Decisions from 2024 Global Fund Board Meeting
Helping countries build sustainable health finance systems and transition away from donor assistance is a major objective of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). This includes helping countries develop national health plans, requiring domestic co-financing of grants and accelerating the efforts of middle-income countries to move away from Global Fund assistance.
At its 52nd Board Meeting, held in Lilongwe, Malawi in November 2024, the Global Fund Board approved significant policy changes that will further increase the Global Fund’s ability to make the HIV, TB and malaria response more sustainable, mobilize new resources from implementing countries and help more countries transition to self-sufficiency:
Eligibility: A country’s eligibility for Global Fund grants is based mainly on income level and disease burden. The Global Fund offers support to countries to transition away from global health assistance as they move towards a higher income classification or their disease burdens decline. The board reinforced the transition planning process by clarifying that countries will not receive additional transition assistance after a change in eligibility. New policies also introduced flexibilities for transitioning countries experiencing crisis and conflict.
Allocation methodology: The Board approved new policies that will allocate a greater proportion of funding to low- and lower-middle-income countries rather than middle-income countries. This will help the most vulnerable countries invest more in the fight against epidemics, while encouraging middle-income countries to accelerate their own sustainability and transition efforts.
Catalytic investments: For the next grant cycle, the Global Fund will use new catalytic investments to help countries achieve sustainability and transition away from donor assistance. The NextGen Market Shaping initiative will bring innovations to scale more quickly and make supply chains more sustainable. Other catalytic investments will help countries plan for transitions, improve public financial management, invest in health workforces and disease surveillance, and set up an emergency fund to continue providing services during conflicts and natural disasters as roadblocks in the path the transition.
Sustainability, Transition and Co-financing (STC) policy: The Global Fund honed its STC policy by requiring countries’ mandated co-financing be devoted to specific programs depending on their income level. For example, 100% of co-financing for upper-middle-income countries must go towards sustainability and transitions programs. All countries are required to progressively finance program costs, with requirements differentiated by income level.