New brief highlights Global Fund’s key role in supporting community-focused programming

17 December 2024

The Global Fund is the largest funder of HIV, tuberculosis, and malaria programs in the world. Since 2002, the Global Fund reports having saved 65 million lives through its partnership with governments, civil society, communities affected by the three diseases, and technical and development partners¹.

Ending the three diseases as a public health threat will require the leadership of the people and communities most impacted by the three diseases, including people living with or affected by the three diseases, key populations, and other vulnerable groups. According to UNAIDS, the proportion of new HIV infections among key populations² has grown from 44% in 2010 to 55% in 2022, highlighting significant barriers to accessing prevention and treatment services³. Ensuring that medical services reach everyone who needs them will require the engagement of communities in designing healthcare delivery approaches that are accessible, appropriate, and affordable for all populations.

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Key findings:

1. The Global Fund provided at least US$ 700M in funding for community-focused programs in 2024—a number which has steadily increased in the last five years. This includes programs focused on human rights and gender, key and vulnerable populations, and community system strengthening.
2. Community-focused programs are a major part of grants in upper-middle-income countries, totaling over 30% of all budgeted grant activities in these settings. This compares to 7% of grants for community-focused programs in low-income countries.
3. Funding to civil society Principle Recipients is a good investment and has high absorption rates (85%), especially for implementing community-focused activities (88%).
4. By making grant information publicly-available to country partners and advocates, these Global Fund data can facilitate evidence-informed advocacy for impactful programs.

The Global Fund is a major funder of community-focused programs, with growth as part of C19RM

Between 2020 and 2024, planned grant spending on community-focused programs totaled an average of US$ 543.1 million per year (Fig. 1). Annual planned budgets for community programs increased during this period, from US$ 371.4 million per year in 2020 to US$ 705.3 million in 2024.

The Global Fund’s COVID-19 Response Mechanism (C19RM) provided additional resources to countries to mitigate the effect of COVID-19 on HIV, tuberculosis, and malaria programs, strengthen community health systems, support resilient and sustainable systems for health (RSSH), and contribute to pandemic preparedness. The C19RM, which was launched in 2020, included several modules related to community-focused programming. Since this funding stream expires in December 2025, ensuring continuity of community programs by increasing community-focused funding in 2026 and beyond will be a key priority for countries and grant sustainability.

Community-focused programs have smaller budgets but are a large proportion of grants in upper-income countries

While community-focused programs support key activities, the budgets typically form a small proportion of the total grant in LICs. By contrast, community programs are a larger proportion in UMICs. This is consistent with the Global Fund’s focus of funding requirements, which require countries at higher income levels to prioritize scale-up of KVP programs. Whereas, grants in lower income countries typically include larger investments in commodities and human resources.

From 2020-2024, community-focused programs averaged 31% (from 1% to 66%) of annual grant budgets in UMICs, or US$ 128.4 million per year. In LICs however, community-focused activities accounted for 7% (from 2% to 13%) of annual grant budgets, or US$ 166.8 million per year. Portfolio-wide budgets for community-focused activities increased by 133% from 2020 to 2024 in UMICs, 53% in LMICs, and 144% in LICs.

Figure 4. Community-focused activities as (top) a proportion of overall grants and (bottom) the total grant budget, by region, 2020-2024.

*Includes two high-income countries (HIC). The Global Fund does not fund HIC, although newly-high-income countries continue to receive funding until their eligible grants end. During the period of this analysis, Panama was reclassified as a HIC in 2019, but received Transition Funding in GC5. Romania was reclassified as a HIC in 2024 but was implementing a GC5 grant until 2023..

Community-focused programs implemented by civil society organizations are high absorbing

In-country absorption represents the percentage of budgeted grant funding expended by the Principal Recipient (PR). Higher absorption rates are typically indicative of successful implementation, a lack of fiscal and programmatic roadblocks, and a greater likelihood of the activities achieving impact. Community-focused activities, when implemented by civil society PRs, absorbed 88% of budgeted funding in GC6, absorbing more than both government (70%) and multilateral organizations (78%) (Fig. 5). Notably, civil society PRs also had high rates of absorption when implementing other, non-community focused programmatic activities.

Conclusions

Ending HIV, tuberculosis, and malaria as public health threats will require ensuring that all KVP and impacted communities have access to high-quality healthcare services. The Global Fund has placed community programming and human rights at the heart of its Strategy.

Newly-released data offer unprecedented visibility into the Global Fund’s programs to support communities and KVP. These data reveal Global Fund as a major funder of community-focused programs, particularly in middle-income countries, and highlights that when implemented by civil society PRs, these activities are effective programs with high rates of in-country absorption.

These estimates are likely to underestimate community-focused programming, due to a lack of granularity in the Modular Frameworks in earlier cycles. In addition, since GC6 data did not track prevention budgets by targeted population, this analysis did not disaggregate by the key population or gender focus of budgeted activities. Ensuring that community programs are aligned with population-specific epidemiological need is a key opportunity for future analysis and funding recommendations.

This new level of transparency presents a new and important opportunity for Global Fund partners, including PRs, CCMs, donors, and civil society to advocate for and support impactful community programs. For CCM members, easily accessible information may help mitigate the barriers to meaningful grant oversight. For advocates, these data can identify where community-focused programming must be strengthened or maintained, particularly as many countries face human rights barriers to services, criminalization, and the anti-gender movement.

However, leveraging this opportunity will require a sustained commitment from Global Fund around data transparency. One year into implementation, for instance, the Global Fund has not released any expenditure data for GC7 grants, highlighting that transparency must include timely and regular publication timelines. Much of Global Fund’s key data continue to remain private, including data on sub-recipient implementing organizations, grant documents, Funding Request detailed budgets, and the “community annex” to the Funding Request produced during national consultations. Making these documents available can further support advocates to identify where Global Fund programming is being implemented in-line with community priorities and where there are opportunities for improvement. This work is to the benefit of all Global Fund stakeholders, implementers, staff, and service recipients who are working together for the most efficient, responsive Global Fund possible.

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