Prior to the implementation of the Global Fund, eradication programs and funding for diseases like AIDS, TB, and malaria were inadequate and incapable to meet the pressing needs of global health. With an annual death toll of 6 million people, these three diseases contributed to the highest mortality rates for developing countries by the end of the 1990’s. As an effort to combat the spread of disease, UNAIDS, WHO foundation, and donor countries relied on major support systems of bilateral aid agencies and development banks to disperse funds to governments. But the dispersion of funds was too slow and the “old model” did not enable enough country ownership to even be effective. Due to inappropriate political support and mismanagement of funds, recipient countries like Zimbabwe had high prevalences of HIV ( Zimbabwe 25% of population). The “old model” of funding also largely ignored the fragile states that had ineffective governments and were structurally unable to adequately implement programs. This stagnated the global progress in eradication, since the highest burden of AIDs, TB, and malaria reside in the poorer populations of these states (90%).

At the end of the 1990s, global leaders of the G8 countries (France, Germany, Italy, Japan, United Kingdom, United States, Canada, and Russia) recognized these inadequacies and developed the Monterrey Consensus. It argued that international stakeholders and donor countries must increase funding by contributing at least .7 percent of GNP as Official Development Assistance (ODA) to developing countries. To reach the target ODA and meet the MDGs, the consensus stressed the importance of collaboration among the public and private actors for funding. But it wasn’t till the Paris Declaration/Accra Agenda of Action was the effectiveness of these funds measured. The Paris Declaration/Accra Agenda for Action was an international agreement committed to increase the global efforts in “harmonization, alignment and managing aid for results with a set of monitarable actions and indicators.” The declaration emphasized ownership, where developing countries created their own programs for the disease eradication. After the Monterrey Consensus and the Paris Declaration came to play, UN Secretary General Kofi Annan called for the creation of a “war chest” that spends $7-10 billion annually on the campaign against AIDs. His efforts paid off in June 2002 when the Global Fund was established, providing grants to its first 36 countries for AIDS, TB and malaria.The Global Fund burrowed much of its principles from the Paris Declaration by creating a more flexible funding mechanism. It did not become an implementing entity because it allows country ownership of its own programs. To funding these programs, the the Global Fund burrowed principles from the Monterrey Consensus to select its stakeholders. The Fund relies not only on the consultation of the government, but also the private sector, nongovernmental organizations (NGOs), and the civil society. By collaborating the efforts of both public and private sectors the Global Fund maximizes its financial input by complimenting it with other funding programs. This public/private partnership is unique from the “old model” of bilateral agencies and world banks. The Fund is also the first to implement the Early Alert and Response System (EARS), which assists “fragile states” to build infrastructure to implement their programs.

Although the Global Fund is a significant improvement from the “old model,” there are still problems in reaching significant funds to maintain projects. 85 percent of the $17 billion annual target donation come from the G8 countries. With this heavy reliance on the G8, cutbacks in funding from these countries drastically affect the progress of the Global Fund. But many argue that emerging countries (now part of G20) should be contributors to the Global Fund, despite being recipients of the Fund. For example, China, with a $2.5 trillion foreign currency reserve, is the fourth largest recipient of Global Funds. Because it is a middle income country, it is eligible to receive many grants. But this forces donor countries to allocate less funds to lower income countries. This loophole of eligibility creates an obscure line between countries that are donors and those that are recipients. There has also been much controversy over whether the Global Funds should focus on health systems rather than disease-specific causes. Margaret Chan, director of the World Health Organization, claims that weak health systems are major setbacks to reaching global health goals. Yet, most of the Fund’s money goes towards disease-specific programs, which reflect the priorities of donor not recipient countries. Donor countries prefer the disease-specific approach because the eradication is simpler and more cost effective than approaching broad-scale health care problems.

In order to provide the most effective approach in improving global health, the global fund must increase the flexibility of its funds. Although the Fund believes in “country ownership” and national freedom to choose any program, the freedom is significantly limited to HIV/AIDs, malaria, and TB. Having funds confined to these diseases ultimately ignores other, more prevalent health concerns in specific countries. To highlight the point, China receives a total of 149 million for eradicating malaria, which only causes 38 deaths a year. Instead the Fund should allocate this money towards reducing the most prevalent diseases in that country. But the Fund’s most pressing concern is the global dispersion of its financial resources. China submits compelling proposals for programs related to the goals of the Global Fund, which pool in significant grant donations. Meanwhile, African nations that do not have the resources to submit compelling proposals are getting less funds yet suffering more from diseases like malaria. So the question remains-who really deserves the money? Logically it is the “fragile states” of the African nations because they have the most need. And that is exactly what the Global Fund promised through its EARs program. Yet the Fund still fails to represent the “fragile states.” Donor countries continue to invest in countries like China to safeguard success in programs rather aiding countries that need the funds the most. To combat the Fund’s weaknesses, there must be a reassessment of the dispersion of resources. Rather than focusing on the strength of a country’s grant proposals, donor countries should concentrate funds on “fragile states” that have the highest disease prevalence. There must also be different levels of monitoring programs among recipient countries. The fund should be more hands-off for recipients that have sound practices and show a trend of success. But there should be heavier monitoring for countries with poorer performance in programs. This approach is more effective because the Global Fund focuses on countries that need the most management. Another direction that was proposed by the British Journal of General Practice is to shift the funding from specific-disease programs to programs for health care improvements. Although health care systems is the biggest threat against reaching global health goals, there is no universal equation to measure progress of healthcare programs. The problem is too wide-scale and complicated to implement effective programs. In addition, resources are limited. How do donor countries prevent a brain drain of health professionals in developing countries? And how do developed countries maintain healthcare systems with a limited budget? These questions highlight big factors that currently deter donor countries from taking this approach. Therefore, the most effective form of funding is to allocate funding for diseases that countries feel are the most prevalent and act as a monitoring/support system whenever assistance is needed.