While the recent report from a High-Level Independent Review Panel of the Global Fund to Fight AIDS, Tuberculosis and Malaria, “and the corresponding decisions of the Board, mark an important step towards the necessary improvements the Global Fund must make to fulfill its vital mandate in the coming decade and beyond,” “the report does not provide direction or solutions on certain critical issues that will define the further success and impact of the Global Fund,” Richard Feachem, founding executive director of the Global Fund, writes in a Lancet commentary.

“First, the Global Fund must do more to achieve its ambition to pioneer and embrace performance-based funding,” such as “paying for impact instead of inputs,” Feachem writes. Second, if the Global Fund “[s]implif[ied] processes for low-risk countries [it] would increase value for money and enable the Global Fund to focus scarce capacity on higher-risk investments,” he states. “Third, as it undergoes reforms, the Global Fund must be mindful of” maintaining a “purchaser-provider split,” Feachem writes, concluding, “In implementing these steps, the Global Fund must be vigilant to maintain its role as a financial rather than a technical or implementing institution,” a “separation [that] has been at the heart of the extraordinary impact of the Global Fund during its first decade” (11/19).