Report Release: Informing Advocacy on Global Fund Efforts in Human Rights, Support to Middle-Income, and Access to Essential Medicines


In April 2015, the Open Society Foundations convened a meeting of experts and advocates concerned about the future of the Global Fund to Fight AIDS, Tuberculosis and Malaria, particularly in the areas of preserving support to important programs in middle-income countries.

The meeting discussed important implications of the Global Fund’s new funding model for middle-income countries and access to medicines. A key message from the meeting was:

“There is an urgent need to revive and re-energize civil society advocacy to hold the Global Fund accountable to its origins and founding principles. Recent changes in Global Fund policy and practice have taken it away from the country-­‐driven character that set it apart from other aid agencies. It risks becoming less centred on rights-based strategies to support national responses to AIDS, TB and malaria.”

The new funding model at the Global Fund steps back from the Fund’s previous ‘country-driven approach’ and instead assigns funding totals to countries independent of those countries own estimates of how much program funding they need.  The new funding model uses a formula based on income and disease burden to get to an ‘appropriate’ funding amount. This method severely disadvantages middle-income countries. The majority of people living with HIV and TB live in middle-income countries. This is in addition to the fact that many of the HIV and TB epidemics are concentrated in key populations (people who use drugs, sex workers, MSM and transgender people). These populations already receive insufficient amounts of funding due to their plight (access to rights-based health programming) being politically difficult for spineless politicians to take on. A recent trend has been for some middle-income countries to enact laws that criminalise sexual orientation and behaviour in countries such as Uganda and Russia – both of which have high prevalence of HIV in all four of the key populations. These countries, despite their designation as middle-income and the compelling epidemiologic case, have not supported programs for these populations in government health budgets. The new funding approach has already resulted in severe cuts to HIV programming in some countries, often at the same time as cuts by ministries of health to HIV programming.

The second paper, ‘Access to Medicines’ discusses the affordability, availability, and financing of medicines and other health commodities that have always been a central issue.  The new funding model requires the Fund to look for ‘better value for money’ when it procures or buys medicines from pharmaceutical companies. Prices of newer ARVs and treatments for multi-drug resistant tuberculosis (MDR TB) and hepatitis C are rising due to increased patenting. Increased patenting also excludes or limits the availability of low cost generic production and supply generally. This means that there are fewer options around for getting medicines cheaper. Furthermore, the ability to buy improved formulations (as advances are made and medicines are improved) where they are only made by generic producers is also restricted.

Participants included leaders of civil society organisations representing the interests of key populations as well as organisations active in country-level Global Fund processes, health service delivery, and health-related human rights advocacy and programs. The meeting participants produced some concrete recommendations to help direct advocacy on Global Fund efforts in human rights, support to middle-income countries, and access to medicines.

The two briefing papers that informed the discussion on access to medicines, middle income countries, and human rights are available as resources below. Further to these papers is the meeting report summarising concrete outcomes and recommendations to the Global Fund.

Solidarity Sidelined: Is there a future for human rights-driven development assistance for health at the Global Fund?

Access to Medicines

The Global Fund at a Crossroads: Informing advocacy on Global Fund efforts in human rights, support to middle-income countries, and access to medicines (meeting report)