Analysis of Global Fund Allocation Letters 2023-2025 Cycle
Context
The Global Fund (GF) provides funding to countries to support HIV, tuberculosis (TB) and malaria (HTM) programs and build Resilient and Sustainable Systems of Health (RSSH) following a three-year cycle. The total amount available for allocation to a country depends on the funds raised during the cycle replenishment and the Global Fund processes to allocate those funds. Allocations to countries are calculated using formulas based primarily on the disease burden and Gross National Income (GNI) of each country followed by a qualitative adjustment. Then, through an allocation letter, the Global Fund notifies each country of available funding and the conditions for accessing it.
As a think-tank of the African Constituencies, the African Constituency Bureau (ACB) analyzed West and Central Africa (WCA) and East and Southern Africa (ESA) countries’ allocations for the GF Grant Cycle 2023-2025. This brief presents the findings of the allocation letters.
The findings and recommendations presented in this summary brief are those of the authors alone.
Methodology
A desk review of documentation was undertaken. A standard form in Excel format was developed to standardize the extraction of the required financials from the 2023-2025 Global Fund Allocations and other relevant allocation reports including allocation letters and the official qualitative adjustments report. These sources were later updated by the website as the Global Fund Secretariat published the allocation amounts without publishing all allocation letters. Quantitative variables were reported by frequencies as appropriate.
Summary of Findings
2023-2025 Allocation funds
Overview
The Global Fund’s allocation of US$13,088,000,000 towards five regions, including Africa, represents a positive step in addressing the major health challenges faced by various nations globally. The allocation towards Africa is particularly significant and highlights the recognition of the pressing need for support in this region. The amount of US$10,008,934,155 (76.47 per cent of the total amount) earmarked for Africa is substantial and could potentially make a significant impact on the health and well-being of the population.
Results also show that the top five African countries receiving the largest amounts of funding are Nigeria, Mozambique, Democratic Republic of Congo (DRC), United Republic of Tanzania, and Uganda with US$933 Million (Mn), US$770 Mn, US$700 Mn, US$602 Mn, and US$587 Mn respectively. This demonstrates GF’s commitment to these nations.
HIV, TB, and Malaria
The allocation of resources towards tackling HTM exhibits an interest in addressing the health challenges prevalent in numerous nations worldwide. The focus on HTM is a step in the right direction and will mitigate the impact of these diseases. The Global Fund has allocated US$13,088,000,000 towards the three infectious diseases for 104 countries including 52 countries in Africa, according to the information on the website. Of this amount, HIV received 49.6 per cent of the funds available for allocation (about US$6,488 Mn), followed by malaria with 31.89 per cent (US$4,178 Mn) and TB with 18.54 per cent (US$2,422 Mn) (Table 1).
Table 1: 2023-2025 Global Fund Allocation for Africa by Components
| Components | Total amount in USD Mn | Percentage (%) |
| HIV | 6,488 | 49.57 |
| TB | 2,422 | 18.51 |
| Malaria | 4,178 | 32.46 |
| Total | 13,088 | 100 |
Source: (Global Fund, 2023)
In addition, a significant amount of funds is allocated towards the African (AFR) region compared to other regions such as Oceania (OCE), Asia and the Middle East (AM), Europe (EUR) and (ASI). For HIV (Figure 1), the African constituencies represent the region with the most allocated funds (70%). This is consistent with the allocation methodology as 67 per cent of people living with HIV are in Africa (ESA and WCA) and this part of the world has the highest concentration of low-income countries (UNAIDS, 2022).
Figure 1: 2023-2025 Global Fund Allocation for HIV by Region
For malaria (Figure 2), the region represents 90 per cent of the total amount allocated. The World Health Organization (WHO) reports a disturbing increase in malaria cases and deaths in the African Region from 2019 to 2020. Specifically, the estimated number of cases rose from 218 million to 232 million, and deaths climbed from 544,000 to 599,000. It’s worth noting that the African region bears the brunt of the global malaria burden, accounting for a staggering 95 per cent of all cases and 96 per cent of all deaths (WHO, 2022a).
Figure 2: 2023-2025 Global Fund Allocation for Malaria by Region
Regarding TB (Figure 3), 41 per cent of the total amount of US$2,422,000,000 is allocated to Africa. However, in 2021, there were 2,460 reported tuberculosis cases worldwide with the African region accounting for 23 per cent of the total cases. The African countries that carried the highest burden of tuberculosis were Nigeria and Congo (WHO, 2022b).
Figure 3: 2023-2025 Global Fund Allocations for TB by Region
It is important to note that a substantial proportion of the allocation (the estimate is approximately 40 per cent, but it can be as high as 90 per cent for some grants) will be used to purchase health commodities (Global Fund, 2017). It’s worth noting that a substantial portion of the medicines used in Africa, ranging from 70 to 90 per cent, are imported from manufacturers located outside of the continent (Buckholtz, 2021).The Covid-19 pandemic has shown the vulnerability of the global supply chain and the risk of concentrating production of essential commodities far from their consumers. This double complication highlights the need for Africa to increase its production of health commodities. Investing in the production of quality health commodities within Africa, will not only improve its access to essential medicines and supplies, but it will also support local economies and create job opportunities.
Allocation Letters
The desk review has identified a total for 27 allocation letters: 17 for WCA (Burkina Faso, Chad, Congo, Comoros, Cote d’Ivoire, Democratic Republic of Congo, Gambia, Ghana, Guinea, Liberia, Mali, Niger, Nigeria, Sao Tome and Principe, Senegal, Sierra Leone, and Togo) and 11 for ESA (Angola, Kenya, Lesotho, Malawi, Mozambique, Namibia, South Sudan, United Republic of Tanzania, Uganda, Rwanda, Zimbabwe).
The allocation letter consists of various sections from which the most relevant information has been extracted. These include the allocation amount, the co-financing requirements, and funding opportunities beyond the allocated amount (catalytic Matching Funds, and catalytic Strategic Initiatives). Catalytic Matching Funds are primarily interested in priorities such as RSSH Innovation Fund, community systems and responses (CS&R), or for scaling up programs to remove barriers related to fulfillment of human rights and gender equality. Other priorities are HIV prevention for key populations or drug-resistant TB. Catalytic Strategic Initiatives are needed to support the success of country allocations but cannot be funded through country grants.
WCA Countries
While cross-country comparisons are challenging due to the currencies used by the Global Fund, the analysis revealed that some countries received a large allocation. To ease the comparison, we used the following exchange rate (1USD= 0.8756 Euro on 8 February 2023). The top three countries in WCA to receive large allocations were Nigeria, Democratic Republic of Congo, and Burkina Faso with US$946,656,931, US$706,653,867, and €256,551,285 respectively. These amounts included the allocation and the catalytic investments they were eligible to receive. This eligibility resulted in a larger envelope. In addition, the results showed that the final allocation was higher for malaria.
The results of this analysis also showed that co-funding requests in the allocation letters ranged from 15 to 20 per cent. Note that the Sustainability, Transition, and Co-financing Policy (STC Policy) does not list any proportion (Global Fund, 2022). However, all these countries signed the Abuja Declaration where they committed to spending 15 per cent of their State budget for health (Global Fund, 2022). Considering the economic impact of the Covid-19, it is possible that all countries may not meet the stated requirement.
ESA Countries
The three countries with the largest envelopes in ESA were Mozambique, United Republic of Tanzania, and Uganda with US$770,557,490, US$602,881,336, and US$587,140,533 respectively. These envelopes included the allocation and the catalytic Matching Funds. Compared to WCA, allocations for ESA countries were higher.
In contrast to WCA countries, the allocation of ESA countries indicated a different epidemiological profile. Indeed, most of the funds were dedicated to HIV. Final allocation for HIV/AIDS varies from €987,992 (Comoros) to US$506,987,373 (Mozambique). HIV/ AIDS seems to remain a public health issue in these countries.
The results of this analysis also showed that co-funding ranged from 15 to 25 per cent. Similar to WCA countries, meeting the requirements for co-funding might appear challenging in some countries in the post- Covid-19 context at the global level.
Tableau I: Summary Findings for Global Fund Allocation Letters, 2023-2025, WCA Countries
| Countries | Final Allocation (US$ Mn) | Catalytic funds + Final Allocation | Co-financing requirements |
| Burkina Faso | €244,070,685
H 46,051,395 |
€256,551,285 | 15% of Burkina Faso’s total Global Fund allocation
Total minimum co-financing requirement of €132,713,298. |
| Chad | €139823657
H 55,821,073 |
€139,823,657 | 15% of Chad’s total Global Fund allocation
Total minimum co-financing requirement of €39,208,266 |
| Congo | €71,680,023
H 29,825,727 |
€71,680,023.0 | 15% of Congo’s total Global Fund allocation
Total minimum co-financing requirement of €18,476,727 |
| Cote d’Ivoire | €230,588,119
H 82,431,197 |
€238,136,869 | 20% of Côte d’Ivoire’s total Global Fund allocation
Total minimum co-financing requirement of €132,423,550 |
| Democratic Republic of the Congo | US$700,653,867
H 189,997,416 |
US$706,653,867 | 15% of Congo’s total Global Fund allocation
Total minimum co-financing requirement of €18,476,727 |
| Gambia | US$40,967,167
H 17,044,875 |
US$40,967,167 | Gambia must present a credible case that it is on track to realize an agreed total minimum co-financing requirement for HIV, TB, malaria and RSSH investments |
| Ghana | US$234,047,975
H 95,049,043 |
US$234,061,975 | 15% of Ghana’s total Global Fund allocation Ghana must present a credible case that it is on track to realize an agreed total minimum co-financing requirement for HIV, TB, malaria and RSSH investments. |
| Guinea | US$145,182,911
H 52,493,058 |
US$145,182,911 | 15% of Guinea’s total Global Fund allocation Total minimum co-financing requirement of US$67,029,729 |
| Liberia | US$87,307,984
HIV: 35,963,003 TB: 7,811,749 Malaria : 43,533,232 |
US$93,207,984 | 15% of Liberia’s total Global Fund allocation |
| Niger | €151,050,791
H 20,638,936 |
€151,050,791 | 15% of Niger’s total Global Fund allocation
Total minimum co-financing requirement of €62,108,568 |
| Nigeria | US$933,156,931
H: 361,689,416 T: 153,771,804 M: 417,695,711 |
US$946,656,931 | 15% of Nigeria’s total Global Fund allocation |
| Sao Tome and Principe | €12,934,452
H 1,015,355 |
€12,934,452 | 15% of Sao Tome and Principe’s total Global Fund allocation Total minimum co-financing requirement of €8,900,388. |
| Senegal | €76,327,990
H 32,065,008 |
€ 80,907,565 | 15% of Senegal’s total Global Fund allocation Total minimum co-financing requirement of €76,933,404 |
| Sierra Leone | US$126444674
H:38,051,061 T:15,157,877 M:73,235,736 |
US$136,244,674 | 15% of Sierra Leone’s total Global Fund allocation |
| Togo | €112,827,812
H 44,808,281 |
€112,827,812 | 15% of Togo’s total Global Fund allocation
Total minimum co-financing requirement of €44,136,274 |
Tableau II: Summary Findings for Global Fund Allocation Letters, 2023-2025, ESA Countries
| Countries | Final Allocation
(US$ Mn) |
Catalytic funds + Final Allocation | Co-financing requirements |
| Angola | US$125,964,744 H 57,007,044 T: 20,957,852 M: 47,999,848 |
US$125,964,744 | 25% of the Global Fund’s total allocation |
| Comoros | €6,476,659
H 987,992 |
€6,476,659 | Total minimum co-financing requirement of €4,065,389 |
| Lesotho | US$69,999,497
H 59,981,314 |
US$71,299,497 | Lesotho must present a credible case that it is on track to realize an agreed total minimum co-financing requirement for HIV, TB and RSSH investments. |
| Kenya | US$392,989,068
H:252,843,015 T:61,567,466 M:78,578,587
|
US$407,989,068 | |
| Malawi | US$517,146,345
H 404,987,463 |
US$525,146,345 | 15% of Malawi’s total Global Fund allocation
Malawi must present evidence that it is on track to realize an agreed total minimum co-financing requirement for HIV, TB, malaria and RSSH investments |
| Namibia | US$32,752,913
H: 23,914,632 T: 5,744,469 M: 3,093,812 |
US$34,052,913 | 20% of Namibia’s total Global Fund allocation |
| Mozambique | US$770,542,490
H 506,987,373 |
US$770,557,490 | 15% of Mozambique’s total Global Fund allocation Total minimum co-financing requirement of US$ 112,650,000 |
| Rwanda | US$172,114,507
H 109,231,273 |
US$3,752,000 | 15% of Rwanda’s total Global Fund allocation
Total minimum co-financing requirement of US$272,389,378 |
| South Sudan | US$141,955,200
H 68,125,558 |
US$141,957,200 | 15% of South Sudan’s total minimum co-financing requirement
Total minimum co-financing requirement of US$9,139,944 |
| United Republic of Tanzania | US$602,877,336
H 370,004,151 |
US$602,881,336 | 15% total Global Fund allocation
United Republic of Tanzania must present a credible case that it is on track to realize a total minimum co-financing requirement of US$1,162,557,593 for HIV, TB, malaria, and RSSH investments |
| Uganda | US$58,127,533
H 288,484,740 |
US$587,140,533 | 15% of Uganda’s total Global Fund allocation
Total minimum co-financing requirement US$443,143,809 |
Bangaman Christian AKANI
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REFERENCES
Buckholtz, A. (2021, June). Inside Africa’s Push to Make its Own Medicines, https://www.ifc.org/wps/wcm/connect/news_ext_content/ifc_external_corporate_site/news+and+events/news/cm-stories/africa-pharma-manufacturing-hubs-en
Global Fund. (2017, April 28). Audit of Global Fund Supply Chain Processes,
https://www.theglobalfund.org/en/oig/updates/2017-04-28-audit-of-global-fund-supply-chain-processes/
Global Fund. (2022). Guidance Note Sustainability, Transition and Co-financing Allocation Period 2023-2025, pp. 20–25, https://www.theglobalfund.org/media/5648/core_sustainabilityandtransition_guidancenote_en.pdf
Global Fund. (2023, January 18). 2023-2025 Allocations Now Available,
https://www.theglobalfund.org/en/updates/2023/2023-01-18-2023-2025-allocations-now-available/
UNAIDS. (2022). UNAIDS Fact Sheet 2022, p. 5, https://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdfWHO. (2022a). World Malaria Report 2022, pp. 18–19, https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2022
WHO. (2022b). Global Tuberculosis Report 2022, pp. 13–22, https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022
