[The Global Fund to fight HIV/AIDS, TB and malaria policy issues].

The five-year evaluation of the Global Fund to fight HIV/AIDS, TB and malaria (GFATM) was carried out by a Consortium of several Universities and institutions, led by a consulting firm based in Washington DC. Evaluation focused on three study areas: (i) organizational efficiency and effectiveness of the Global Fund, (ii) effectiveness of the Global Fund partner environment, (iii) system effects of the Global Fund and impact of increased funding on the level of response to the three diseases. Findings can be summed up as follows: the Global Fund has been successful in mobilizing additional funding and in attracting new players. However, the demand-driven model used for allocation of funding is poorly adapted to epidemiological profiles with regard to population, persons at highest risk, and number of persons affected by the disease. The partner environment of the Global Fund, involving UN technical partners and institutions cooperating in development has failed to produce planned results due to weak institutional capacity of recipients and health systems overall, as well as little synergy and coordination work between international partners. Increased financial resources have allowed rapid expansion of prevention and care services for the three diseases. Spectacular results have been achieved against malaria in Eastern African countries, but little progress has been made in the collective effort to slow down the spread of HIV/AIDS. In preparation for the upcoming Replenishment Conference of the Global Fund and prior to any further decisions to expand the use of innovative financing instruments for development, the author of this article calls the attention of policy-makers on the need to ensure the development of accompanying strategies to increase the effectiveness and impact of these instruments.