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To ensure continued funding, countries need to generate empirical evidence that demonstrates their progress in the HIV response.
At the same time, foreign sponsors and collaborators are not supporting local PI leadership, probably because the grants are initiated in the funding countries.
To access adaptation funding, countries have to show that the primary driver for the problem is climate change and not underlying societal phenomena such as failing health systems.
The importance of their inclusion has grown considerably with the recent Global Fund Board's decision to move towards funding countries' NSPs in future rounds.
In the absence of measures to decrease drug prices and/or increase funding, countries may be forced to choose between treating fewer people with newer and "better" regimens or treating more people with older and "less desirable" regimens.
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As recently as 2004, a study found that 44% of research projects in the developing world had been reviewed only in the funding country [ 22].
Such confusion is perhaps understandable as many research projects undertaken in Africa will have ethical review in the funding country as well as the African country, and the opinions of the different committees do vary.
To qualify for the funds, countries must demonstrate, in the president's words, that they are "ruling justly, investing in their people, and establishing economic freedom".
When European leaders announced that they would not fund countries that imprison or execute gay people, Malawi's President, Joyce Banda, announced she would not support such laws.
The continent's five least funded countries with recurring emergencies are Burundi, Liberia, Guinea, Eritrea and Angola.
In this scenario, the large purchasers such as PEPFAR could drive global prices lower but there was still sufficient purchase power remaining in Global Fund countries to facilitate competition among manufacturers who did not win the larger PEPFAR contracts.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com