Global-Fundization: HIV/AIDS funding mechanisms and programming in Sierra Leone

This thesis explores how the Global Fund’s standardized funding stipulations and expectations impact HIV/AIDS programs in Sierra Leone. Situating funding mechanisms within the current trajectory of international healthcare delivery and financing, I argue that the Global Fund’s business-oriented financing approach has shaped Sierra Leonean program targets towards data production and digitization, allowing the Global Fund to make decisions ‘from a distance.’ Drawing on three months of ethnographic fieldwork in Freetown, Sierra Leone, I demonstrate how: 1) contradictions between weak infrastructure and Global Fund expectations impact HIV program practices; 2) the Global Fund’s data requirements and timeframes create asymmetries and disconnects in-country; and 3) audit and accountability technologies in HIV programs can become practices unrelated to health outcomes.