WHO report 2008
Global tuberculosis control
3.7 Global Fund financing
3.7.1 High-burden countries
The Global Fund is the single most important source of external financing in HBCs, with 11 countries (Bangladesh, Cambodia, the Democratic the Congo, Ethiopia, India, Indonesia, Mozambique, Pakistan, the Philippines, Uganda and Zimbabwe) relying on it to fund more than 25% of their NTP budgets. Only one HBC (Myanmar) lacks a Global Fund grant. After seven rounds of proposals, the total value of approved proposals in the HBCs is US$ 1.4 billion and the amounts in the Phase 1 grant agreements (i.e. the grants that cover the first two years of the proposal) total US$ 547 million (data not shown).
By the end of 2007, US$ 502 million had been disbursed. Across all grants and countries, the actual disbursement rate is very similar to the expected rate,1 though there is variation among countries with disbursements higher than those expected in 30 out of 53 grants and less than expected in 23 (data not shown). Countries for which disbursements are particularly low in relation to the expected disbursement of funds include Bangladesh (for one of the two principal recipients in round 5), Brazil (for one of the principal recipients in round 5), India (rounds 3 and 4), Indonesia (round 5, possibly linked to a temporary cessation of funding in 2007) and Kenya (round 2). The main delay in the initial flow of funds to countries is the time taken to sign the grant agreement after proposal approval; the median time is 11 months, which is in line with Global Fund expectations that it takes about one year to prepare and finalize the Phase 1 grant agreement and related documentation once proposals are approved by the Board. Once grant agreements are signed, disbursements are usually made within two months.
3.7.2 All countries
In seven funding rounds between 2002 and 2007, the Global Fund approved proposals worth a total of US$ 2.5 billion for TB control in 108 countries, out of total commitments for HIV, TB and malaria of around US$ 10 billion.2 The African Region has the single largest share, at 37% (Figure 3.16), which is higher than its share of the global burden of TB (31%). The South-East Asia and Western Pacific regions have the second and third highest funding in absolute terms, but less than might be expected given their share of the global burden of TB. The share of total funding approved for the Eastern Mediterranean Region and the European Region (13% and 11% respectively) is double these regions’ share of the global burden of TB (6% and 5%), while the share of funding for the Region of the Americans is in line with its share of the global burden of TB.
The value of approved proposals for TB control was relatively high in rounds 5 and 6 compared with rounds 1–4, as was the proposal approval rate (Figure 3.17), but fell in round 7.3 The approval rate for TB proposals submitted to the Global Fund was 50% in round 5 and 64% in round 6, up from 37–40% in rounds 1–4, but fell to 51% in round 7.
1 The expected rate assumes that disbursements should be spread evenly over the two- or five-year period of the grant agreement following the programme start date.
2 The Global Fund has committed US$ 10 billion in rounds 1–7; in round 7, US$ 1.1 billion was committed for a two-year period. See www.theglobalfund.org/en/media_center/press/pr_071112.asp
3 Calculated as the number of proposals approved divided by the number of proposals reviewed by the Global Fund’s Technical Review Panel.