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The Global Fund to Fight AIDS, Tuberculosis and Malaria may have to cut back on life-saving projects and reject new proposals unless it can raise extra funds.

The fund's budget can no longer keep up with its ever-expanding workload, despite donations steadily increasing since 2005.

To address this, the fund's board will meet informally next month to plan two 'replenishment' meetings for later in the year (March and October) at which donors will present their new commitments to the fund.

The organisation has become a victim of its own success, creating a demand that it can no longer meet, said Bernard Rivers, head of Kenya-based watchdog Aidspan. He pointed out that five years ago the expertise to design and implement expensive projects did not exist in many developing countries.

The fund is responsible for a quarter of international AIDS funding, two-thirds of tuberculosis funding and three-quarters of malaria funding. In total it has invested US$18.7 billion, saving an estimated 4.7 million lives in eight years.

Rivers is confident that donors will maintain their support or at worst "flatline". But this may still put an end to the fund's reputation for investing in any sound proposals that come its way. Projects may have to be more stringently prioritised, for example on the basis of greatest need.

Link to full article in Nature