On May 9-10, the board of the Global Fund to Fight AIDS, TB and Malaria will meet in Skopje, Macedonia to approve a new policy on which countries are eligible for funding.

I’ve been immersed in this labyrinthine policy as a consultant for the three civil society delegations on the board of the Fund: Developing Country NGO Delegation, Developed Country NGO Delegation and Communities Delegation. They came together to press for an overhaul of the policy. For a variety of reasons, that didn’t happen.

But there has been some progress; there are some big questions for civil society to weigh in on before May, and some critical areas to monitor if the current version is approved.  Here’s an overview: heads up, it’s a long blog.

Why an eligibility policy? Funds are limited, lives are literally at stake, and difficult choices must be made about where to invest. What are the principles that should be used when you’re facing three global crises – the epidemics of HIV, TB and malaria? This is not just a question of health economics – it is also an ethical challenge.

It’s a problem that dates to the beginning of the Fund, when grants were in the millions, not hundreds of millions. To solve it, the World Bank offered to draft an approach. Sixteen years later, with over $10 billion to allocate, the criteria the World Bank identified over a decade ago still define Global Fund eligibility: national income and disease burden.