advocacy statement on 55% rule issued in advance to the 28th gf board meeting

7/30/2019 Advocacy statement on 55% rule issued in advance to the 28th GF Board meeting

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Mr. Simon Bland

Chair of the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria

Dr. Mphu Ramatlapeng

Vice-Chair of the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria

13.11.2012

Dear colleagues,

In advance of the 28th meeting of the Global Fund Board, which will take place in Geneva on 14-15

November 2012, we, representatives of civil society groups, including communities of people living with

HIV, most vulnerable populations, and non-governmental organizations from the Eastern Europe and

Central Asia (EECA) and other regions, consider it necessary to inform members of the Board about our

position regarding the imperative need to revoke the so-called 55% rule approved by the Board a year

ago and formulated in Annex 1 to GF/B25/DP16. We call to eliminate this rule for the following reasons:

1. The 55% rule would have a serious negative impact on the response to concentrated HIVepidemics around the world because such epidemics are ongoing mostly in middle-income countries

(MICs) in EECA and other regions including East and South Asia, Latin America and the Caribbean,

and the, Middle East and North Africa. The consequences would be especially devastating in EECA,

the only region in the world where the HIV epidemic continues to grow, mainly due to limitedpolitical will to respond adequately and the reluctance of national governments to make evidence-

based HIV services available for the individuals most affected by the epidemic, people who inject

drugs. If the Global Fund decreases funding, governments are therefore unlikely to take over

funding and fill the gap. This potential impact has already been realized in Russia, where the

government refuses to support vital HIV prevention interventions for people who inject drugsand

the absence of Global Fund support means there is little or no money to bridge the gap.1 If it is

unfrozen and reinstated, the 55% rule would particularly affect the EECA region since more than 95

percent of people living with HIV there live in middle-income countries (only two EECA countries,

Kyrgyzstan and Tajikistan, are still classified as low income).

2. The 55% rule would reduce funding available through existing grants in most countries withconcentrated HIV epidemics even while limiting their opportunities to obtain new funding. Most

countries in the EECA region are now classified as middle income, with several having graduated

from lower income status. As a result, the share of funding in the region that went to low-income

countries (LICs) was 56 percent in Round 8, but had fallen to 0 percent by Round 10. (Some, but far

1Stuikite R, Votyagov S, Pinkham S (2012). Quitting while not ahead: the Global Funds retrenchment and the

looming crisis for harm reduction in Eastern Europe & Central Asia. Available atwww.harm-reduction.org/library(accessed 22 October 2012).
http://www.harm-reduction.org/libraryhttp://www.harm-reduction.org/libraryhttp://www.harm-reduction.org/libraryhttp://www.harm-reduction.org/library


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from all, of the shortcoming was covered by single-stream funding, of which LICs had a share of 21

percent of the regions funding in 2011.) Because it penalizes and restricts MICs, regardless of the

epidemic-related realities and needs, the 55% rule would force nearly all countries in the EECA to

cut 25 percent of already approved budgets when negotiating grant renewals. Such concerns are

heightened by worries that the new funding model will place additional challenges on MICs access

to funding should it over-prioritize country income levels.

The axe from a re-imposed 55% rule would undoubtedly fall on HIV prevention programming

targeting most-at-risk populations such as people who inject drugs. That likely impact has already

been seen already in Armenia and Belarus, both of which negotiated grant renewals before the 55%

rule was frozen. The majority of cuts concerned community systems strengthening activities such as

NGO development and building service capacity. Such cuts and others imperil the effectiveness andreach of critical harm reduction interventions that need more, not less, support, including those

focused on programme quality, innovation to address changing drug-use practices and the needs of

different sub-populations, technical support, drug user participation, community mobilisation,

advocacy and legal services.

3. Earmarking of resource allocations solely based on income level contradicts strategic objectives ofthe Global Fund Strategy 2012-2016: Investing for Impact. The five-year strategy envisages

investing more strategically in order to maximize impact, an overarching focus that prioritizes value

for money and closer integration with countries national strategies.2

Resource allocation must take

into account disease burden, epidemiology patterns and counterpart financing commitments and

other criteria of quality (country-level performance, effectiveness and impact).

4. The shift in the Global Funds strategy from emergency to sustainability funding should entailmore targeted, focused, cost-effective and epidemiologically sound interventions, and not just

focus on the poorest. As the report of Global Funds High-Level Independent Review Panel on

Fiduciary Controls and Oversight Mechanisms pointed out in 2011, [T]o be effective, the Global

Fund should be more targeted. A one-size-fits-all approach to approving and managing grants is no

longer appropriate nor effective [...] It should take a more global look at the disease burden and

better determine who needs the money most.3 Given this recommendation, preferentially

allocating resources based on income status alone, without taking into consideration the disease

burden and various epidemic patterns, seems inappropriate and simplistic.

5. The new funding model aims to invest the worlds money more strategically and for greaterimpact; the 55% rule, however, contradicts this goal. Under the new approach, countries will be

2The Global Fund Strategy 2012-2016: Investing for Impact. Available at

www.theglobalfund.org/en/about/strategy/(accessed 24 October 2012).3

Report of the High-Level Independent Review Panel on Fiduciary Controls and Oversight Mechanisms of the

Global Fund to Fight AIDS, Tuberculosis and Malaria (2011). Available at

www.theglobalfund.org/en/highlevelpanel/ (accessed 25 October 2012).
https://www.google.com/url?q=http://www.theglobalfund.org/documents/highlevelpanel/HighLevelPanel_IndependentReviewPanelOnFiduciaryControlsAndOversightMechanisms_Report_en/&sa=U&ei=yBWJUPHYJNSxhAeoloDoAw&ved=0CAgQFjAA&client=internal-uds-cse&usg=AFQjCNGj-0https://www.google.com/url?q=http://www.theglobalfund.org/documents/highlevelpanel/HighLevelPanel_IndependentReviewPanelOnFiduciaryControlsAndOversightMechanisms_Report_en/&sa=U&ei=yBWJUPHYJNSxhAeoloDoAw&ved=0CAgQFjAA&client=internal-uds-cse&usg=AFQjCNGj-0http://www.theglobalfund.org/en/about/strategy/http://www.theglobalfund.org/en/about/strategy/http://www.theglobalfund.org/en/about/strategy/https://www.google.com/url?q=http://www.theglobalfund.org/documents/highlevelpanel/HighLevelPanel_IndependentReviewPanelOnFiduciaryControlsAndOversightMechanisms_Report_en/&sa=U&ei=yBWJUPHYJNSxhAeoloDoAw&ved=0CAgQFjAA&client=internal-uds-cse&usg=AFQjCNGj-0https://www.google.com/url?q=http://www.theglobalfund.org/documents/highlevelpanel/HighLevelPanel_IndependentReviewPanelOnFiduciaryControlsAndOversightMechanisms_Report_en/&sa=U&ei=yBWJUPHYJNSxhAeoloDoAw&ved=0CAgQFjAA&client=internal-uds-cse&usg=AFQjCNGj-0


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grouped in bands, to ensure focus is placed on countries with the highest disease burden and least

ability to pay. The criteria determining the composition of those bandsand the funding allocation

formula for themare to be discussed at the November Board meeting, yet it seems that

maintaining the 55% rule, which gives more weight to income status than disease burden,

contradicts the goal of the new funding model.

6. Middle-income countries have higher absolute burdens of HIV and TB than low-income countries.Three of the top five countries with the highest HIV burdens are middle income and eight of the ten

countries with the highest TB burdens are middle income. In fact, only 30 percent of HIV-positive

people lived in LICs in 2009.4

7. Resource allocation based on income level fails to acknowledge differences between epidemicpatterns and customized epidemic responses. HIV epidemic patterns and disease responses differ

between epidemics concentrated among MARPs (in EECA and other regions including East and

South Asia, Latin America and the Caribbean, and the Middle East and North Africa) and generalized

epidemics (mostly in sub-Saharan Africa). Therefore, conditionalities for counterpart financing

should take into account governments commitment in these two different epidemic contexts and

impose minimum government thresholds for HIV prevention community-based activitiesrather

than restrict eligibility and reduce funding altogether.

8. Poverty is not necessarily related to countries income status.About 60 percent of the worlds poorlive in five populous countries currently classified as middle income: Pakistan, India, Nigeria, China

and Indonesia. Of the top 10 countries by contribution to global poverty, only four are low income.As of 2011, there were only 35 countries classified as low income that were receiving Global Fund

support. The comparable number for middle-income countries was 110, and in them collectively

was concentrated the greatest burden by far for all three priority diseases (HIV, TB and malaria).5

Given this situation and ongoing trends, allocating more than half of funds to a decreasing number

of LICs, where the disease burden is not necessarily the highest, seems inequitable and inadequate

from a disease-response point of view.

9. Resource allocations solely based on country income level is a short-sighted developmentobjective and will not serve LICs best interest. Some 15 of the worlds 20 most aid-dependent

countries are on the list of LICs likely to receive even more official development assistance through

4Glassman A, Duran D, Sumner A (2011). Global health and the new bottom billion: what do shifts in global

poverty and the global disease burden mean for GAVI and the Global Fund?CGD working paper 270. Washington,D.C.: Center for Global Development, p. 2.5

Developed Country NGO Delegation (May 2012). The Global Fund to Fight AIDS, Tuberculosis and Malaria and

support for middle-income countries. Discussion paper, available at

www.aidsalliance.org/includes/Document/Uploaded/News%20stories%20links/GF%20support%20for%20MICs%2

0Devd%20C%20NGO%20deln%2023may.pdf(accessed 22 October 2012).
http://www.aidsalliance.org/includes/Document/Uploaded/News%20stories%20links/GF%20support%20for%20MICs%20Devd%20C%20NGO%20deln%2023may.pdfhttp://www.aidsalliance.org/includes/Document/Uploaded/News%20stories%20links/GF%20support%20for%20MICs%20Devd%20C%20NGO%20deln%2023may.pdfhttp://www.aidsalliance.org/includes/Document/Uploaded/News%20stories%20links/GF%20support%20for%20MICs%20Devd%20C%20NGO%20deln%2023may.pdfhttp://www.aidsalliance.org/includes/Document/Uploaded/News%20stories%20links/GF%20support%20for%20MICs%20Devd%20C%20NGO%20deln%2023may.pdfhttp://www.aidsalliance.org/includes/Document/Uploaded/News%20stories%20links/GF%20support%20for%20MICs%20Devd%20C%20NGO%20deln%2023may.pdf


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Ivan Vodnev

hairperson

International NGO "Social Assistance''

Anna Liubinskaya

Chair Person

BPA "Positive Movement" (Belarus)

Natalia Vasilieva

General Director

Open Health Institute

Moscow, Russian Federation

Anya Sarang

President

Andrey Rylkov Foundation for Health and Social

Justice, Russia

Anahit Harutyunyan

President

NGO "Positive People Armenian Network",

Armenia

Lasha Zaalishvili

Executive Director

Georgian Harm Reduction Network

advocacy statement on 55% rule issued in advance to the 28th gf board meeting

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