The Global Fund was established in 2002 to significantly increase the resources available to developing countries to address HIV/AIDS, Tuberculosis, and Malaria . In recent years, the Global Fund has become one of the major multilateral funders in global health. It channels 82% of the international financing for TB, 50% for malaria, and 21% for HIV/AIDS . The Global Fund began funding for health systems in 2005, and 37% (US$ 362 million) was allocated to health systems support in 2008 . Recipient country ownership has been a key feature of the Global Fund’s policy. The Global Fund does not have an operational presence in the recipient country but it serves as a financial instrument, managing and disbursing resources through an accountable, transparent, independent and technical process which is usually rapid. Each recipient country is responsible for determining its own needs and priorities within the three diseases through the country coordinating mechanism (CCM). The Global Fund gives resources to a principal recipient, which is usually a government institution nominated by the country’s CCM. A local fund agent is also designated to assess a recipient’s capacity to administer funds. As many conflict-affected countries have weak administrative capacity, the role of the local fund agent is in some cases taken by a multilateral organisation such as the United Nations Development Programme (UNDP). Decision-making is based on consultation with a group of diverse stakeholders including national and local governments, NGOs, the private sector and people living with, or affected by, the diseases.
The GAVI Alliance (GAVI) was initiated in January 2000 at the World Economic Forum with the aim of reducing child mortality by providing a rapid delivery of new and improved vaccines for children in low-income countries. GAVI is a public-private partnership which includes: developing and industrialised country governments, research and technical health institutes, industrialised and developing country vaccine industries, civil society organisations, the Gates Foundation and other philanthropy organisations, the WHO, UNICEF and the World Bank Group. In December 2005, the GAVI committed US$500 million for Health System Strengthening for a 5-year period (2006–10), in parallel with its Immunisation Services Support (ISS). This was complemented by an additional US$300 million in 2008 . The GAVI Alliance allocates approximately 15% of its funds for health system support globally . GAVI health system support is aimed at sustaining increased immunization coverage, by providing complementary funding to strengthen health system capacity to provide basic health services in 72 low-income countries . Ministries of Health are invited to use sectoral reviews to identify health systems constraints and to plan responses that will strengthen the health system, and in doing so, improve coverage of immunization and maternal and child health care .