The $20.4 million in interim applicant funding approved for Cameroon (first announced in this GFO article) will be used exclusively to procure antiretrovirals (ARVs), related health products and medicines to treat opportunistic infections. The money will be added to an existing HIV grant, CMR-011-G11-H, for which the principal recipient is the Ministry of Public Health (MPH), to be used over the remaining ten months of Phase 1 of that grant.

When the transition phase of the new funding model (NFM) was launched, $81 million was allocated for Cameroon. However, the Global Fund chose to award only $20.4 million at this time and to consider awarding the remaining $60.6 million at the time of Phase 2 renewal in 2014. The Global Fund is concerned about two things: (1) Cameroon has been experiencing recurrent ARV stock-outs; and (2) the Government of Cameroon is not meetings its ARV funding commitments.

According to Antoine Ambassa Bekolo, M&E officer at FIS (For Impacts in Social Health), an NGO, Cameroon also needs to reassure the Global Fund Secretariat that it is able to quantify its ARV needs. "The Global Fund prefers to be cautious before committing more money," Mr Bekolo said. He added that it became evident during the last joint mission by the Global Fund and the (US) President's Emergency Plan for AIDS Relief (PEPFAR) in June 2013 that Cameroon does not even know the exact number of patients on ARV treatment.

When the Round 10 HIV treatment grant was signed in December 2011, it was agreed that the government would fund 64% of ARV needs and that the Global Fund would fund the remaining 36%. However, the GAC said, recurrent stock-outs in 2012 and early 2013 made it apparent that the government is struggling to meet its ARV commitments. (The GAC noted, nevertheless, that the government's funding commitment for ARVs was still in excess of the percentage required by the Global Fund's counterpart financing policy.)

The GAC said that the Global Fund will maintain high level discussions with the Government of Cameroon to confirm its level of ARV funding commitments.

Because the ARV stockouts had become so widespread, in August 2013 additional funding was provided by both PEPFAR ($10 million) and Cameroon President Paul Biya ($10 million of his personal funds). The MPH issued a communiqué thanking the President for his considerable contribution.

When it was discussing the funding award, the GAC acknowledged that there were opportunities in Cameroon to implement interventions designed to ensure that the human rights of activists and marginalised groups are protected. Some activities related to this are expected to be implemented in Phase 2 of the grant. Meanwhile, the GAC said, the country team has reprogrammed savings from the prevention component of another Round 10 HIV grant focusing on key populations to provide institutional support and legal aid to lesbian, gay, bisexual and transgender associations involved in programme implementation.

According to Isaac Tita, Vice-Chair of the CCM, the CCM has not been sufficiently involved in the discussions concerning the request for funding. He said that the Secretariat was negotiating only with the PR and with technical partners.

Information for this article was taken from Board Decision GF-B29-EDP9 and from GF-B29-ER5, the Report of Secretariat Funding Recommendations. These documents are not available on the Global Fund website. Our regional correspondent for West and Central Africa, Bertrand Kampoer, contributed to this article.