The Global Fund has proven itself effective at mobilizing substantial resources to meet the financial demands of HIV, TB, and malaria. The five year Impact Evaluation provides a way for GFATM to look back and assess results. However, Global Fund lacks a long-term (i.e. five to twenty) year strategy for projecting the HIV, TB, and malaria related costs of each recipient country.   Assessing the needs of each country is essential if countries will begin to take on the financial demands of providing health care for HIV, malaria, and TB for themselves.

Global Fund is only as sustainable as the Member States' and others' willingness to refill its coffers. If it is to become a long-term viable partner in international health and if it is to honestly promote itself as an agent of sustainable development, it is imperative that GFATM begin to strategize how countries will ever be able to finance their own health care costs, or at least a portion of them, sometime in the next several decades. This analysis should forecast the costs related to HIV, malaria, and TB-related health care and commodities over twenty years at five year intervals, given epidemiological projections, commodity forecasts, demographic trends, inflation, and other variables pertinent to member countries. The estimates may be rough and inexact, but they would at least quantify the resource needs that would confront a Country X during the next 20 years, given their burden (and projected burden) of HIV, malaria, and TB.

What will be the HIV, malaria, and TB costs for Country X in 5, 10, 15, and / or 20 years? This analysis would allow us to understand the financial resources that GFATM must mobilize in this time frame to meet demand. It would also allow GFATM to develop a long-term resource mobilization strategy and set realistic targets. Such an analysis would tell us, for example, the first (and possibly second) line treatment costs for X people living with HIV and AIDS during the next few decades in Country X. This would in turn allow GFATM to plan accordingly to raise the resources to meet this demand.

Essentially, the analysis will ask two sets of questions. 1. For countries: What growth rate and health expenditure per person must Country X achieve in order to provide X % of the costs per person associated with HIV, malaria, and TB prevention, treatment, care and support needs over the next 20 years? What percent of the national budget will need to be allocated to health in general and the three diseases in particular?

2. And for the GFATM: Given this analysis, how much will need to be raised at five year intervals in the next 20 years to meet this demand? What is the strategy for long-term resource mobilization?

One obstacle may be lack of capacity at local level to conduct this analysis. Therefore, GFATM should provide technical support so that Ministries of Health, World Bank, IMF and other relevant stakeholders can assess what percent of the national budget will be needed for a country to begin financing the response to these three diseases. With technical support and appropriate capacity-building, developing countries must begin to strategize about how they will handle these epidemics on their own.

Realistic expenditure targets should be set at the national level for each disease so that health care as a percentage of the national budget is scaled up over time to meet the costs forecasted in the analysis.

Finally, there will be a need for high-level advocacy to push countries to conduct this analysis. Ultimately GFATM, civil society organizations, and recipient countries will benefit from the analysis. GFATM will be able to point to its success in working with recipient countries to relieve themselves of the burden of the three diseases.  Civil society organizations will be able to hold accountable governments who have not taken steps to cater for their own response. Recipient countries will know the price tag - far in advance - for the response to these three diseases over the next 20 years.  Otherwise, GFATM risks interfering with the state's role to provide long-term health care for its citizens.