Program implementation

Faced with a sharp decline in international aid, growing competing priorities, and an imminent risk of financial crisis, the Global Fund is making budget cuts—postponing certain expenditures related to infrastructure, equipment, and research—to keep its HIV, tuberculosis, and malaria programs running. While COVID-19 response efforts remain untouched for now, other critical initiatives risk delays, legal hurdles, and disruptions, particularly for frontline NGOs and contracted partners. The message is clear: “Protect what matters, adapt to the crisis.” The way forward? “Do more with less, without leaving the most vulnerable behind.” But were there really any unnecessary expenses to begin with? In any case, this new budgetary reality is expected to shape much of the discussion at the 53rd Board Meeting, to be held from May 7 to 9, 2025, in Geneva, Switzerland.

This article analyses the Global Fund’s 2024 OIG Annual Report, which was presented at the 53rd Board Meeting, from May 7 to 9, 2025, in Geneva. The report highlights the Global Fund’s progress amid global uncertainty, identifies key governance-related risks, and calls for bold operational reforms to maximize efficiency and safeguard billions in the fight against HIV, tuberculosis, and malaria.

This article highlights the key points of the Global Fund’s 2023-2028 Strategic Performance Summary Report, which will be presented at the 53rd Board Meeting, scheduled to take place from May 7 to 9, 2025, in Geneva, Switzerland. Without excessive pessimism, the prevailing feeling is a mix of hope and deep concern.

This special issue dedicated to the 53rd Board Meeting, to be held from May 7 to 9, 2025, explores the growing tension between strategic ambitions and budgetary constraints within the Global Fund. Balancing hope, warnings, and ethical dilemmas, it highlights the critical issues that will shape the decisions ahead.

ABSTRACT The Technical Review Panel recently released a report on RSSH investments in the 2017–2019 allocation period. Although there has been progress, the TRP found, a greater focus on resilient and sustainable systems for health will be required in the 2020–2022 allocation period if the Global Fund is to achieve its RSSH-related strategic objectives. The TRP analyzed 50 funding requests from Windows 1–5. This overview is one of three GFO articles on the report; the other two, on integrated health systems and human resources for health, will be published in a future edition of the GFO.

ABSTRACT The Global Fund has terminated its three grants to Myanmar (Burma), because it has concluded that political restrictions imposed by the government mean that the grants "cannot be managed in a way that ensures effective program implementation."