The Global Fund to Fight AIDS, Tuberculosis, and Malaria Has Been
Established but It Is Premature to Evaluate its Effectiveness
(07-JUN-02, GAO-02-819R).
Title I of the Global AIDS and Tuberculosis Relief Act act
provided for the creation of a trust fund to be administered by
the World Bank to combat the HIV/AIDS epidemic. The act mandates
that the Comptroller General of the United States submit a report
to Congress evaluating the effectiveness of the fund within two
years of enactment of the statute. In January 2002, the Global
Fund to Fight AIDS, Tuberculosis, and Malaria was formally
established, but as of May 2002, funds had not been disbursed to
any project. GAO reviewed the status of the Global Fund and found
that as of May 31, 2002, the Global Fund had received more than
$2 billion in pledges, with $700 million available for
disbursement in 2002. The United States has pledged a total of
$300 million to the Fund through fiscal year 2002, and the
administration has requested an additional $200 million in its
fiscal year 2003 budget request. At its first board meeting in
January 2002, the Fund called for proposals for its first round
of grants and had received 322 proposals for projects in 101
countries by the March deadline. At its second board meeting in
April 2002, the Fund awarded a total of $378 million over two
years to 40 programs in 31 countries and also agreed to a
fast-track process to approve an additional $238 million for 18
proposals in 12 countries.
-------------------------Indexing Terms-------------------------
REPORTNUM: GAO-02-819R
ACCNO: A03530
TITLE: The Global Fund to Fight AIDS, Tuberculosis, and Malaria
Has Been
Established but It Is Premature to Evaluate its Effectiveness
DATE: 06/07/2002
SUBJECT: Diseases
Grant monitoring
Grants
Reporting requirements
Sexually transmitted diseases
Trust funds
Infectious diseases
Global Fund to Fight AIDS, Tuberculosis,
and Malaria
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GAO-02-819R
GAO- 02- 819R Global Fund Evaluation Is Premature United States General
Accounting Office
Washington, DC 20548
June 7, 2002 Congressional Committees Subject: The Global Fund to Fight
AIDS, Tuberculosis, and Malaria Has Been Established but It Is Premature to
Evaluate Its Effectiveness
On August 19, 2000, Congress enacted the Global AIDS and Tuberculosis Relief
Act of 2000. 1 Title I of the act provided for negotiations for the creation
of a trust fund to be administered by the World Bank to combat the HIV/ AIDS
epidemic. Included in the act is a mandate that the Comptroller General of
the United States submit a report to Congress evaluating the effectiveness
of the fund within 2 years of enactment of the statute. Specifically, the
act required that we (1) evaluate the effectiveness of programs, projects,
and activities to reduce the worldwide spread of HIV/ AIDS, and (2) assess
the merits of continued U. S. financial contribution to the fund by August
19, 2002.
In January 2002, the Global Fund to Fight AIDS, Tuberculosis, and Malaria
was formally established. As of May 2002, resources from the Fund had not
been disbursed to any project. Therefore, it would be premature for us to
evaluate the effectiveness of the Fund or to report on the merits of
continued U. S. financial support of the Fund. We can nonetheless provide
information on the status of the Global Fund to date.
Actions Taken to Establish the Fund
A fund for AIDS and other infectious diseases was discussed at a meeting of
the G8 group of countries in Okinawa, Japan, in July 2000, and gained the
support of the Secretary General of the United Nations and the Director
General of the World Health Organization (WHO) in early 2001. In April 2001,
the Secretary General of the United Nations issued a call for action and the
creation of a global fund to fight HIV/ AIDS. At the close of the United
Nations Special Session on HIV/ AIDS in June 2001, the Secretary General
announced the creation of the fund and welcomed pledges from donor nations
and the private sector.
Between August and December of 2001, a transitional working group, comprised
of representatives of 40 countries and organizations, prepared a document
setting out the principles, purpose, scope, and basic architecture of the
Fund. The group determined that the scope of the Fund would include
tuberculosis and malaria as well as HIV/ AIDS, that the secretariat would be
located in Geneva, and that the fund
1 P. L. 106- 264 sec. 131, Aug. 19, 2000, codified at 22 U. S. C. sect. 6831.
Page 2 GAO- 02- 819R Global Fund Evaluation Is Premature
would be established as a foundation. The working group prepared a second
document that proposed guidelines covering governance, eligibility criteria,
technical review, accountability, legal issues, and fiduciary arrangements.
The Fund, a public- private partnership, has 18 voting board members
comprised of representatives of donor countries, developing countries,
nongovernmental organizations, a private foundation, and a private sector
firm. UNAIDS, WHO, and the World Bank hold ex- officio (nonvoting) seats on
the board. The board includes a person infected with or affected by HIV/
AIDS, tuberculosis, or malaria, also in a nonvoting seat.
The Global Fund Has Received Pledges and Approved Its Initial Programs
As of May 31, 2002, the Global Fund had received more than $2 billion in
pledges, with $700 million available for disbursement in 2002. The United
States has pledged a total of $300 million to the Fund through fiscal year
2002, and the administration has requested an additional $200 million in its
fiscal year 2003 budget request.
At its first board meeting in January 2002, the Fund called for proposals
for its first round of grants. The call for proposals was followed by
activity at the country level, including establishment of country
coordinating mechanisms (CCM). CCMs are national coordinating bodies that
include broad representation from government agencies, nongovernmental
organizations, community- based organizations, private sector institutions,
and bilateral and multilateral agencies. Their stated purpose is to ensure
that proposals submitted to the Fund have the approval of major development
partners including government, civil society, the private sector, and
development assistance agencies.
By the March 2002 deadline, the Fund had received 322 proposals for projects
in 101 countries. After an initial screening of proposals that did not meet
the criteria established by the board, the Fund?s technical review panel
evaluated about 150 proposals. The purpose of the Technical Review Panel is
to identify projects that will have clear and demonstrable impact in the
fight against AIDS, tuberculosis, and malaria. The 17- person panel includes
members from government and nongovernmental organizations who serve as
experts in their fields, rather than representatives of their institutions
or governments.
At its second board meeting in April 2002, the Fund awarded a total of $378
million over 2 years to 40 programs in 31 countries and also agreed to a
fast- track process to approve an additional $238 million for 18 proposals
in 12 countries. Approximately $1.4 billion will be needed to fund these 58
programs over the next 5 years. In addition, the board selected the first
executive director of the Fund.
Page 3 GAO- 02- 819R Global Fund Evaluation Is Premature We Will Monitor and
Report on Progress of the Global Fund
As part of our commitment to address the issues in the congressional
mandate, we will continue to monitor the Global Fund?s efforts to combat
AIDS, Tuberculosis, and Malaria and will provide reports to the Congress. In
2003, we will report on the Fund?s structure and governance and its major
challenges. That report will evaluate the potential gap between
contributions and demand for funding, and efforts to coordinate with other
funding sources to combat infectious diseases. In 2004, we will conduct an
evaluation of the Fund?s effectiveness and an assessment of the merits of
continued U. S. financial contributions to the Fund.
If you or your staff have questions about this report, please contact me at
(202) 512- 3149. Thomas Melito, Assistant Director, and Thomas Zingale,
Senior Analyst, contributed to this report.
Sincerely yours, David B. Gootnick, Acting Director International Affairs
and Trade
Page 4 GAO- 02- 819R Global Fund Evaluation Is Premature
List of Congressional Committees The Honorable Robert C. Byrd, Chairman The
Honorable Ted Stevens, Ranking Minority Member Committee on Appropriations
United States Senate
The Honorable Joseph R. Biden, Jr., Chairman The Honorable Jesse Helms,
Ranking Minority Member Committee on Foreign Relations United States Senate
The Honorable C. W. Bill Young, Chairman The Honorable David R. Obey,
Ranking Minority Member Committee on Appropriations House of Representatives
The Honorable Henry J. Hyde, Chairman The Honorable Tom Lantos, Ranking
Minority Member Committee on International Relations House of
Representatives
The Honorable Michael G. Oxley, Chairman The Honorable John J. LaFalce,
Ranking Minority Member Committee on Banking and Financial Services House of
Representatives
(320130)
*** End of document. ***