At its creation, the Global Fund presented itself as an “innovative mechanism”, flexible, lightweight, and able to distance itself from international organisations and the criticisms they faced. The Fund also personified the “new paradigm” of international development assistance, as set out in the Paris Declaration: effectiveness, ownership, participation, and alignment with the needs and demands of countries rather than with the offer of assistance (Nantulya, 2004). These principles are reflected in the Fund’s organisation and operating procedures.

Ownership of AIDS strategies by inclusive partnerships of stakeholders was expressed both at the international level, by the Fund’s Board of Directors, and at the level of the national coordinating bodies, or the Country Coordinating Mechanism (CCM). The Fund’s Board has 20 members, representing the governments of the donor countries (eight seats), recipient countries (seven seats) and civil society and the private sector (five seats). The Board of Directors therefore consists of an inclusive partnership and a "demand-driven” mechanism, in that it includes representatives of the Fund’s beneficiaries (Garmaise. 2009). The Fund’s Board of Directors is a site of power, comparable to the United Nations Security Council. Balances and alliances between representatives lead to sometimes contested decisions, such as the decision to cancel the eleventh round, or call for funding proposals, in 2011. This decision raised questions about the decisionmaking process within the Board of Directors and the real reach of voices from countries of the South (Global Fund Observer, 2012/02).

The entire structure of the Fund ensures it is demand-driven. Funding requests submitted to the Fund are developed at the level of countries by national multisectoral partnerships through the national CCMs. The CCMs, and through them all national stakeholders involved in the three targeted diseases, submit grant applications to the Global Fund based on national priorities and strategies.

With the goal of effectiveness, independent assessments take on importance. Proposals are evaluated by a technical review committee (a panel of independent experts) who make recommendations to the Board of Directors. The Fund itself is subjected to an individual evaluation by a “technical reference group for evaluation”. “Local Fund Agents” verify and validate the financial and programmatic reports submitted by the principle beneficiaries.

Examining the principles and operating methods of the Fund can provide a clear understanding of AIDS governance and the importance of actors both at the international level (secretariat, board of directors) and at the national level (the role of the CCMs and the relationship between its members and other AIDS actors).

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