In an unprecedented show of global solidarity and political will, donors at the Global Fund's Sixth Replenishment Conference pledged the largest amount ever raised by any multilateral health organization. It was also the largest amount ever raised by the Global Fund. This will, of course, have significant impacts on the HIV response and also on the success of differentiated service delivery (DSD) for HIV. As a result of the Sixth Replenishment, the Global Fund has funding both for country applicants to include DSD and for a strategic initiative to strengthen the implementation of DSD on impact and progress towards national targets.
The pledges from countries and the private sector ranged from $4.68 billion from the United States to $1 million from countries including Benin, Chad, Madagascar, Niger, Senegal and Togo. All pledges make a huge difference to the Global Fund’s ability to reach its Sixth Replenishment targets, as outlined in the Investment Case. They also show the political will of the world to invest in saving 16 million lives by reducing the mortality rate by 52%, averting 234 million new infections and reducing the incidence rate of HIV, tuberculosis (TB) and malaria by an average of 42% by 2023.
Although the success of the Sixth Replenishment is unprecedented and should be celebrated, the work begins now and political will be critical for seizing the momentum. Central to the Global Fund is its partnership model and country ownership. This means that political will at country level to implement programmes is as important as the political will of donors to invest in the Global Fund.
The Global Fund provides guidance for country applicants preparing funding requests through a series of information notes. The HIV Information Note, published in September 2019, includes prioritized and strongly encouraged interventions that all funding requests should include. These include both “a strategic mix of differentiated approaches” for HIV testing and “DSD models that provide people centered services”.
In addition to providing funding for country allocations, the Global Fund reserves a portion of the funds for catalytic investments. Catalytic investments are activities and strategic investments not adequately accommodated through country allocations that are essential for achieving the aims of the Global Fund Strategy 2017-2022 and plans of global partners. Catalytic investments include strategic initiatives, which are priority areas identified to support the success of country allocations.
Differentiated service delivery for HIV is a strategic initiative included in the catalytic investments to incentivize increased programme quality and efficiency along the HIV testing and treatment cascade. Achieving the global 90-90-90 targets and closing the testing, treatment and care gap while addressing the needs of key and vulnerable populations requires focused and differentiated approaches to reach those most in need. HIV must be diagnosed early with active linkage to treatment through person-centred service delivery approaches to improve retention and viral suppression.
The aim of this strategic initiative is to catalyse the effective use of country allocations by integrating cost-effectiveness considerations along the HIV care cascade to result in improved programme quality and efficiency of national HIV responses and to accelerate implementation and the achievement of national and global targets for these countries. Ultimately, the hope is that DSD will drive innovative or ambitious programming to accelerate progress towards strategic objectives of the Global Fund and enable more effective use of country allocations.
For this to succeed, we will need the political commitment of countries to prioritize client-centred models of delivery of HIV services in their grant application to the Global Fund.