The head of the Global Fund to Fight AIDS, Tuberculosis, and Malaria has pledged to improve the efficiency of the organization so it can make the best use of new U.S. assistance. At the same time, a new report prepared for Congress says the fund has made good progress, but is threatened by a lack of resources.

A report by the General Accounting Office (GAO), the investigative arm of the U.S. congress, says the independent Geneva-based fund has made progress since its founding at the beginning of 2002.

Since then, it has disbursed about $21 million in grants to 25 countries in Africa, Asia and Latin America. Fund directors have been establishing the organization's management structure, and working to improve the process of making grants to organizations in AIDS-stricken countries.

Executive Director, Richard Feachem, says the fund is now committed to 155 programs in 92 countries nearly half of this money going to non-government organizations. What can be achieved by these grants, he says, is a significant step forward in the fight against all three diseases.

"It will put 500,000 additional people on anti-retroviral therapy. It will place two million additional people on effective TB treatment," he said. "It will increase the treatment of drug-resistant malaria in Africa from a current extremely low level of about 15,000 per year to 30 million. And it will finance the purchase of 30 million insecticide-treated bed-nets, which as we know are a central preventive strategy for the control of that great killer of African children."

However, the very ability of the fund to continue making grants longer than a two-year initial period is threatened by what the GAO report calls a lack of sufficient resources. David Gootnick, GAO director for international affairs and trade, spoke to a congressional subcommittee.

"The fund faces short and long-term resource constraints," he said. In the short term, the fund has roughly $300 million available for new grants in future rounds. This is far less than the fund projects it will need to support technically-sound proposals."

As part of the AIDS funding bill Congress is expected to send to President Bush later this month, the United States could contribute as much as $1 billion to the Global Fund in 2004. That's on top of more than $1.5 billion already pledged by Washington as of April.

However, the GAO report says the fund will need another $2.2 billion to support already-approved programs over the full five year life of most grants.

The GAO has also raised questions about how the fund has been approving grants, and its ability to monitor their performance.

Tommy Thompson, U.S. secretary of health and human services, also serves as chairman of the Global Fund. He says he is committed to making sure the fund operates efficiently.

"I am working hard to ensure that the fund has the right management and the accountability systems in place in order to fulfill this subcommittee's vision, as well as mine and the president's," he said.

Of grants approved by the Global Fund, Mr. Thompson says 36 have gone to fight AIDS, tuberculosis and malaria in 13 of 14 African and Caribbean nations targeted by President Bush's initiative to battle the diseases.