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Wednesday, May 18, 2011

The Global Fund to Fight AIDS, Tuberculosis, and Malaria: U.S. Contributions and Issues for Congress

Tiaji Salaam-Blyther
Specialist in Global Health

The Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund, or the Fund) was established in 2002 as a public-private partnership that could provide significant financial support for global responses to HIV/AIDS, tuberculosis (TB), and malaria. As of March 31, 2011, the Global Fund has committed to provide some $21.7 billion to help 150 countries fight these three diseases. To date, the Fund reports providing support to treat 3 million HIV-positive people, about 8 million people infected with active TB, and 142.4 million cases of malaria, saving about 6.5 million lives.

The United States has strongly supported the Global Fund since making a founding pledge in 2001, serving on several Global Fund boards, donating more to the Global Fund than any other country, and increasing those contributions annually since FY2005. Donors last met on October 4, 2010, to make their pledges for the Global Fund over the next three years. There, the United States made its first multi-year pledge to the Fund, $4 billion.

In FY2011 and FY2012, the President requested $1.0 billion and $1.3 billion, respectively, for the Fund. Following rigorous debate, the 112
th Congress enacted the Department of Defense and Full- Year Continuing Appropriations Act of 2011 (P.L. 112-10), which maintained U.S. support for the Global Fund at FY2010 levels ($1.05 billion), excluding rescissions.

Many urge Congress to meet the President’s FY2012 request, in large part because donors have begun to follow the lead of the United States in setting their annual contributions. Although Congress has traditionally been a strong supporter of the Fund, several issues may affect congressional views about the Fund in the future. Such factors include the following: 

Fiscal austerity.
Proposals to reduce federal spending have begun to dominate foreign aid debates, with some Members of Congress aiming to target foreign aid accounts in an attempt to balance the budget. At the same time, others argue that cutting back on the relatively small size of foreign aid (about 1% of total budget authority) will do little to cut the deficit, but could imperil the lives of millions. 

Oversight and transparency.
In early 2011, reports about misuse of Global Fund resources in some grants ignited a debate about corruption in foreign aid in general, and in the Global Fund in particular. Some have called for donors to withhold support for the Fund until adequate safeguards are established. Others argue the Fund should not be penalized for oversight shortcomings, which are familiar to many aid programs. 

Role of the Global Fund in U.S. global health policy.
When the Global Fund was established, U.S. bilateral investments were relatively small. Since then, U.S. bilateral investments in HIV/AIDS and malaria programs have grown significantly, particularly through the President’s Emergency Plan for AIDS Relief (launched in 2003) and the President’s Malaria Initiative (launched in 2005). As U.S. investments in these programs continue to grow, some question what proportional role the Global Fund will play in U.S. global health policy.

This report provides background information on the Global Fund, discusses changes the Global Fund has made to improve the efficiency of its programs and address allegations of corruption, outlines U.S. funding for the Fund, and analyzes issues Congress might consider as it debates the appropriate level of support to provide the Fund.

Date of Report: May 3, 2011
Number of Pages: 32
Order Number: R41363
Price: $29.95

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