On 11 January 2019 the Global Fund released a summary of their Investment Case which will be released in full in the next few weeks.  We shared our concern with the numbers presented and that the $US14 billion funding target set for the Global Fund’s Sixth Replenishment will not be enough. This target is significantly lower than the need calculated in our Get Back On Track Report published in July 2018 in which we made a strong case for significant increases in funding to the Global Fund with a replenishment target of US$16.8 to 18 billion.

Matthew Kavanagh (HealthGap US and Georgetown U Visiting Professor & Director, Global Health Policy & Governance Initiative at the O’Neill Institute for National and Global Health Law) published the thread below and his analysis echoed some of our concerns with the US$ 14 billion ask.  

We worked with Matt to delve into the details and source the data:

First: GF is one of the most effective, powerful #GlobalHealth (or #development) mechanisms in history. Creates country-driven model of health aid w active multi-stadholder power embedded in #Governance. Imperfect in practice, but reflects remarkable progress in real world. 2/10

— Matthew Kavanagh (@kavanaghmm) January 15, 2019

Evidence for Effective and Powerful Organization:

• The Global Fund Results Report 
• Integrated Evaluations from the Global Fund
• Multilateral Aid Reviews 

Evidence for Country Driven Model:

• Country Ownership and Stewardship of Health Programs: The Global Fund Experience
• The Global Fund : Funding model 

Evidence for Global Fund as active, multi-stakeholder power embedded in governance: 

• WHO – Interactions Between Global Health Initiatives 
• GFAN –  Key Populations Report 
• The Global Fund and the re-configuration and re-emergence of ‘civil society

Last replenishment (’17-19) in Canada raised $12.2b or $11.9b depending on how u count plus was some carry-forward from previous funding + plus-up from UK. [at time GF Sec. played games w/exchange rates to declare it was 12.9 billion… but let’s leave that aside] 4/10 pic.twitter.com/FZdjdsGA7X

— Matthew Kavanagh (@kavanaghmm) January 15, 2019

Evidence for Millions of Lives Saved: 

• The Global Fund Results Report 

Evidence for Replenishment Numbers:

• Money raised by country in the 5th Replenishment 

And that is supposed to achieve this graph. 6/10 pic.twitter.com/U7LeDKb2vc

— Matthew Kavanagh (@kavanaghmm) January 15, 2019

Source for Graphs:

• Investment Case Summary 

But this is VERY misleading.
To reach these targets TOTAL gap in financing for AIDS, TB, Malaria: around $18.5 billion.
Global Fund additional contribution: just $0.6 billion, up 15%
LMICs would have to DOUBLE their spending in 2020.
Not a serious proposition. 7/10

— Matthew Kavanagh (@kavanaghmm) January 15, 2019

Evidence for Funding Gap:

• GFAN:  Get Back on Track Report

Meanwhile the simple reality of inflation + increasing healthcare costs eat up nearly all of GF proposed increase. 2019 projected rise in costs:
Malawi, Uganda: 20%
India: 9%
Guatemala: 10%
LAC: 13.2%
DRC: 13.7%
South Africa lucky at 11% https://t.co/kgso4SZK2q 8/10

— Matthew Kavanagh (@kavanaghmm) January 15, 2019

Source for numbers: 

• 2019 Global Medical Trend Rates Report 

And as a reminder 0.25% of US budget goes to all of global health. Americans, meanwhile, spend $3 billion buying bags of ice each year and $4.6 playing fantasy football. Don’t tell me there isn’t enough money to #EndAIDS #EndTB #EndMalaria 10/10 pic.twitter.com/TlV6evLUF6

— Matthew Kavanagh (@kavanaghmm) January 15, 2019

Evidence for US Budget money spent on Global Health:

• How Does the U.S. Spend Its Foreign Aid?

Evidence for US expenditures on ice and Fantasy Football:

• ice
• fantasy football