AEGiS-IAPAC: The GFATM: Which countries owe, and how much?

The GFATM: Which countries owe, and how much?

IAPAC Monthly - Vol. 8, No. 5, May 2002
Tim France, Gorik Ooms, and Bernard Rivers

Nearly one year ago, the majority of the world’s nations resolved at the United Nations General Assembly Special Session on HIV/AIDS [June 25-27, 2001] to increase annual expenditure on the AIDS epidemic to US$7-10 billion by 2005, with much of this money to be raised and disbursed by a new global fund. When the fund was eventually set up, its mandate was extended, and it was named the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM).

AIDS, an unprecedented and accelerating emergency, is already having a devastating impact in Africa, with similar impacts unfolding on other continents. Every day, 8,000 die, and 13,000 more become infected. Experts agree that reasonable expenditures on prevention and treatment of AIDS, tuberculosis and malaria can be of dramatic benefit not only to human health, but also to economic development.

Thus far, efforts have been made to raise the money needed by the GFATM through ad hoc voluntary donations. These efforts have failed. [As of May 2002,] governments have pledged a mere US$1.8 billion. Contributions from the private sector have been even more disappointing, with not a single meaningful pledge since the Bill & Melinda Gates Foundation offered US$100 million [more than] 10 months ago.

It is time for a new approach. The GFATM needs to grow rapidly to the point where it raises US$10 billion a year. Contributions to the GFATM should be equitably shared among the countries whose citizens live the most comfortable and unthreatened lives. This means that the wealthiest countries, such as the United States, should contribute considerably more than they currently do. But it also means that contributions should come from the likes of Australia, Singapore, and the United Arab Emirates—relatively wealthy countries that have not yet contributed a penny.

Part of the problem is that to date, nobody has proposed which countries should give how much. Table 1 thus offers an “Equitable Contributions Framework” that can be used as a starting point for working out an appropriate contribution level for each country, and for measuring how well each country is doing against that level.

The Equitable Contributions Framework suggests that US$1 billion a year should come from the private sector, as a minimum to justify the label “public/private partnership” and the two seats it has out of the 18 voting seats on the GFATM board. The remaining US$9 billion a year should come, in proportion to Gross Domestic Product (GDP), from the 48 countries that have a “high” Human Development Index (HDI)—the United Nations’ HDI measures the overall quality of life based on standard of living, life expectancy, and literacy rates plus school enrollment.

The proposed contribution comes to 0.035 percent of GDP for each country. Not one country has yet given at this level. Assuming, in the absence of better data, that every contribution made thus far is entirely for use this year, The Netherlands (contributing at 97 percent of its proposed level), Sweden (73 percent) and Italy (57 percent) have done reasonably well. Seventeen countries have given between 1 percent and 50 percent of the proposed level, with Japan and the United States at a very disappointing 12 percent and 13 percent, respectively. And 28 “high development” countries have given nothing at all.

It is to the credit of countries such as Uganda and Nigeria that, poor as they are on a per capita basis, they have made multimillion- dollar contributions to the GFATM. And it is to the shame of many of the 48 relatively wealthy countries that they have contributed little or nothing, without even stating why.

The GFATM represents a bold new approach. Its leaders say that it will be more fast moving, participatory, transparent, and accountable than traditional channels. The GFATM needs a chance to prove itself. What a shame if [the GFATM] were to fail simply because it did not receive the funding needed to get properly established and to respond to the most urgent and obvious needs.

Tim France is Director of Health & Development Networks, an Irish nonprofit organization based in northern Thailand that works to improve communication in HIV/AIDS and other health fields. Gorik Ooms is Head of Mission of Médecins Sans Frontières-Luxembourg’s operations in Mozambique. Bernard Rivers is head of Aidspan, a New York-based nongovernmental organization providing fundraising assistance to developing country AIDS projects.

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