{"id":10107,"date":"2020-02-05T13:39:41","date_gmt":"2020-02-05T17:39:41","guid":{"rendered":"http:\/\/plataformalac.org\/?p=10107"},"modified":"2020-02-05T13:39:48","modified_gmt":"2020-02-05T17:39:48","slug":"global-fund-adds-five-countries-to-its-2020-eligibility-list","status":"publish","type":"post","link":"https:\/\/plataformalac.org\/en\/2020\/02\/global-fund-adds-five-countries-to-its-2020-eligibility-list\/","title":{"rendered":"Global Fund adds five countries to its 2020 Eligibility List"},"content":{"rendered":"\n

Source: aidspan.org<\/a><\/p>\n\n\n\n

Author:\u00a0Samuel Muniu<\/p>\n\n\n\n

Updated transitions list projects 12 countries becoming \u2018upper-middle-income\u2019 by 2028<\/p>\n\n\n\n

According to the Global Fund to Fight AIDS, Tuberculosis, and Malaria\u2019s recently published Eligibility 2020 list, the list of countries and disease components currently eligible for Global Fund support<\/a>, 131 countries are eligible to receive an allocation from the Global Fund during the 2020\u20132022 period. However, this eligibility does not automatically result in an allocation as countries still need to apply for Global Fund funding, in line with the application process for 2020\u20132022, as described in a recent GFO article<\/a> (19 December 2019). The Global Fund also recently published the list of components projected to transition from Global Fund support by 2028<\/a>.<\/p>\n\n\n\n

The Global Fund allocates funding to countries for programs to fight the three epidemics (HIV, TB and malaria) once every three years, after raising funds through its three-year Replenishment cycle. Before the recent allocations announced in December 2019, the last Global Fund allocations were made in 2017, for country components eligible for funding for 2017\u20132019. The 2020 Eligibility list<\/a> determines countries\u2019 components eligible for funding from the Global Fund for the 2020\u20132022 period.<\/p>\n\n\n\n

A country\u2019s income category and disease burden are the main determinants for a country\u2019s eligibility for a Global Fund allocation. The Global Fund relies on the World Bank\u2019s income classification<\/a> that categorizes countries into four income groups: low income (LI), lower-middle income (LMI), upper-middle income (UMI), and high income (HI). For the purposes of setting its co-financing requirement, the Global Fund subdivides the LMIs into two categories: lower and upper-LMIs.<\/p>\n\n\n\n

The Global Fund also relies on the World Health Organization (WHO) and the Joint United Nations Programme on HIV\/AIDS (UNAIDS) classification of disease burden as \u2018High\u2019 or \u2018Not high\u2019.<\/p>\n\n\n\n

Disease burden classifications<\/strong><\/p>\n\n\n\n

According to the Global Fund Eligibility Policy<\/a>, a country\u2019s HIV burden is classified as \u2018high\u2019 when the national prevalence is one percent or more, or prevalence within a key population is five percent or more, and when a country is listed to receive support by the Organization for Economic Co-operation and Development (OECD) Development Assistance Committee (DAC). A country\u2019s tuberculosis burden is classified as \u2018high\u2019 when the incidence rate per 100,000 people is 50 or more, or when the proportion of new TB-resistant cases is five percent or more of the identified TB cases. A country\u2019s malaria burden is regarded as \u2018high\u2019 when the death rate from malaria is 12 people or more per 100,000 at risk of the disease, or the country contributes 0.25% or more to global malaria deaths, or the death rate is less than 12 people per 100,000 at risk of malaria and when more than 65 per 1,000 people at risk have the disease, or when there is a documented artemisinin (malaria drug) resistance in a country.<\/p>\n\n\n\n

Income category changes<\/strong><\/p>\n\n\n\n

Regardless of the HIV, TB and malaria burden, all low-income and lower-middle income countries are eligible to receive an allocation from the Global Fund. However, the upper-middle income countries are eligible to receive the Global Fund allocation only if they have a \u2018High\u2019 burden of one of the three disease components. Also, upper-middle income countries are eligible for an allocation if the International Development Association (IDA) classifies them as \u2018Small Island Economy Exceptions\u2019. High-income- and the Group of 20 upper-middle-income countries are ineligible to receive an allocation from the Global Fund. Moreover, countries that the WHO has certified as malaria-free are ineligible for a malaria component allocation.<\/p>\n\n\n\n

A comparative analysis of countries income status in the 2017 and 2020 Eligibility lists reveals that ten countries moved up while nine were downgraded in income category, as summarized in Table 1.Table 1: Country income changes in 2017 and 2020<\/strong><\/p>\n\n\n\n

No<\/strong>Countries that moved up in income<\/strong>Income category in 2017<\/strong>Income category in 2020<\/strong><\/td>No<\/strong>Countries that moved up in income<\/strong>Income category in 2017<\/strong>Income category in 2020<\/strong><\/td><\/tr>
1Bhutanlower-LMIupper-LMI2Cambodialow incomelower-LMI3Comoroslow incomelower-LMI4Guatemalaupper-LMIupper-middle income5Guyanaupper-LMIupper-middle income6Kosovoupper-LMIupper-middle income7Moldovalower-LMIupper-LMI8Papua New Guinealower-LMIupper-LMI9Samoaupper-LMIupper-middle income10Zimbabwelow incomelower-LMI<\/td>1Angolaupper-middle incomeupper-LMI2Congoupper-LMIlower-LMI3Georgiaupper-middle incomeupper-LMI4Mongoliaupper-middle incomeupper-LMI5Nigeriaupper-LMIlower-LMI6Syrian Arab Republiclower-LMIlower-LMI7Timor-Lesteupper-LMIlower-LMI8Tunisiaupper-middle incomeupper-LMI9Ukraineupper-LMIlower-LMI    <\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
Source: Global Fund\u2019s 2017 and 2020 Eligibility Lists:<\/em><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

Newly \u2018eligible\u2019 countries<\/strong><\/p>\n\n\n\n

Five new upper-middle-income countries \u2014 Fiji, Nauru, North Macedonia, Russian Federation, and Venezuela \u2014 \u00ad\u00ad\u00adwere the new additions to the 2020 Eligibility list. The new country components categorized as \u2018eligible\u2019 to receive an allocation in 2020\u20132022 period are Nauru\u2019s TB, North Macedonia\u2019s HIV, the Russian Federation\u2019s HIV, and Venezuela\u2019s malaria components. These components are eligible to receive an allocation following their disease burden classified as \u2018high\u2019, and after they were determined to be eligible for a second year in succession. Fiji had one determination of eligibility following the IDA re-classification<\/a> of the country as a Small Island Economy.<\/p>\n\n\n\n

Changes in eligibility status<\/strong><\/p>\n\n\n\n

Five countries\u2019 malaria components \u2013 Egypt,  Kyrgyzstan, Syrian Arab Republic, Tajikistan, and Uzbekistan \u00ad\u2014 are \u2018not eligible\u2019 in the 2020 Eligibility list, whereas they were \u2018eligible\u2019 in the 2017 Eligibility list<\/a>. These countries have already been determined as malaria-free. Armenia\u2019s HIV, Guyana\u2019s malaria, Kosovo\u2019s HIV and TB, and Guatemala\u2019s malaria and TB components moved from \u2018eligible\u2019 in the 2017 Eligibility list to \u2018transition\u2019 in the 2020 Eligibility list for two reasons. First, their related disease burdens are \u2018Not high\u2019, and second, all these countries, except Armenia, grew economically, with their income status moving from upper-LMI to upper-middle income.<\/p>\n\n\n\n

Inversely, some countries\u2019 disease components that were transitioning are now once again \u2018eligible\u2019, indicating a worsening of those countries\u2019 economies. These are: Cuba\u2019s HIV, Iraq\u2019s TB, Surinam\u2019s TB and Turkmenistan\u2019s TB components. Similarly, Ecuador\u2019s malaria, Jordan\u2019s TB, and Tunisia\u2019s TB components changed from \u2018not eligible\u2019 in 2017 to \u2018eligible\u2019 in 2020. This was due to the increase in malaria and TB burden in Ecuador and Jordan, respectively. However, in Tunisia the change results from a downgrade from upper-middle income to upper-lower middle income. Such reverse movement calls into question these countries\u2019 (other than Tunisia) preparedness for transition. (See GFO article<\/a> about this discussion after the Global Fund’s 42nd Board meeting in November 2019.)<\/p>\n\n\n\n

Transition from Global Fund support<\/strong><\/p>\n\n\n\n

The Global Fund\u2019s Sustainability, Transition and Co-financing policy<\/a> aims to encourage countries to progressively move away from reliance on donor funding to greater levels of domestic financing of their health programs. A country or disease component may transition from Global Fund support if it meets one of three possible scenarios: a country of its volition declines the Global Fund\u2019s support, when the disease component is \u2018ineligible\u2019 based on the Global Fund\u2019s Eligibility Policy<\/a>, or after a country receives the final allocation from the Global Fund.<\/p>\n\n\n\n

All countries that were eligible for an allocation for the 2017\u20132019 period were included in the 2020 list except Albania, Palau, and Panama. Albania\u2019s HIV and TB components were allocated Transition Funding during the 2017\u20132019 period following the country\u2019s upgrade to upper-middle-income status in 2015. Similarly, both Palau and Panama are upper-middle income countries with low burdens of HIV, TB, and malaria.<\/p>\n\n\n\n

According to the updated projected transition list<\/a>, two main transition pathways exist for countries to move away from Global Fund funding: a lower-middle income country with a \u2018not high\u2019 disease burden moves to upper-middle income status, or an upper-middle income country with any disease burden moves to high-income status.<\/p>\n\n\n\n

The Global Fund projects that a total of 17 disease components from 12 lower-middle income countries will move to upper middle-income status by 2028. These countries and disease components are as follows:Table 2: Lower-middle income countries projected to move to upper-middle income status with
\u2018Not high\u2019 disease burden<\/strong><\/p>\n\n\n\n

No<\/strong><\/td>Country<\/strong><\/td>Disease components<\/strong><\/td><\/tr>
Moved to upper-middle income status in 2018 \u2013 2020 and eligible for Transition Funding in 2020 \u2013 2022<\/td><\/tr>
1<\/td>Armenia<\/td>HIV<\/td><\/tr>
2<\/td>Guatemala<\/td>TB and malaria<\/td><\/tr>
3<\/td>Guyana<\/td>Malaria<\/td><\/tr>
4<\/td>Kosovo<\/td>HIV and TB<\/td><\/tr>
Projected to move to upper-middle income status in 2020 \u2013 2022 and eligible for Transition Funding in 2023 \u2013 2025<\/td><\/tr>
1<\/td>Bolivia<\/td>Malaria<\/td><\/tr>
2<\/td>Eswatini<\/td>Malaria<\/td><\/tr>
3<\/td>Philippines<\/td>Malaria<\/td><\/tr>
4<\/td>Sri Lanka<\/td>HIV<\/td><\/tr>
Projected to move to upper-middle income status in 2023 \u2013 2025 and eligible for Transition Funding in 2026 \u2013 2028<\/td><\/tr>
1<\/td>Bhutan<\/td>HIV and malaria<\/td><\/tr>
2<\/td>Cabo Verde<\/td>HIV, TB and malaria<\/td><\/tr>
3<\/td>Egypt<\/td>TB and malaria<\/td><\/tr>
4<\/td>Lao PDR<\/td>HIV<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
Source: Global Fund\u2019s list of components for transition by 2028:<\/em><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

Similarly, the Global Fund projects that 16 disease components from 11 upper-middle income countries will move to high income by 2028. These countries and disease components are as follows:Table 3: Upper-middle income countries projected to move to high income status<\/strong><\/p>\n\n\n\n

No<\/strong><\/td>Country<\/strong><\/td>Disease components<\/strong><\/td><\/tr>
Ineligible for allocation in 2020\u20132022<\/td><\/tr>
1<\/td>Costa Rica<\/td>HIV<\/td><\/tr>
2<\/td>Malaysia<\/td>HIV<\/td><\/tr>
3<\/td>Mauritius<\/td>HIV<\/td><\/tr>
Ineligible in 2023\u20132025<\/td><\/tr>
1<\/td>Dominica<\/td>HIV and TB<\/td><\/tr>
2<\/td>Grenada<\/td>HIV and TB<\/td><\/tr>
3<\/td>Guyana<\/td>HIV and TB<\/td><\/tr>
Ineligible in 2026\u20132028<\/td><\/tr>
1<\/td>Dominican Republic<\/td>HIV<\/td><\/tr>
2<\/td>Gabon<\/td>TB <\/td><\/tr>
3<\/td>Kazakhstan<\/td>HIV and TB<\/td><\/tr>
4<\/td>Lebanon<\/td>HIV<\/td><\/tr>
5<\/td>St. Vincent & the Grenadines<\/td>HIV and TB<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
Source: Global Fund\u2019s list of components for transition by 2028<\/em><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

Further reading:<\/em><\/strong><\/p>\n\n\n\n