HIV/AIDS, Tuberculosis and Malaria are diseases of poverty or deprivation. Effective rolling back of the three diseases must also roll back poverty. The intimate link between equity in health and poverty reduction cannot be ignored by the international community and poses the challenge for effectiveness of the Global Fund. The share of the global burden of the three diseases for Sub Sahara Africa is unacceptably high, and increasing, deepening poverty and threatening human survival. This region deserves special consideration under the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM) UNAID estimates that the global requirement for prevention and care per year for the three diseases ranges from US$ 9.3 to 12.3 billion (HIV/AIDS: US$ 7-10 billion, Tuberculosis: US$ 0,3 billion and Malaria US$ 2 billion). To date the GFATM has raised US$ 2.08 billion (17 to 22%) of the annual requirement. The current low level of international commitment and contributions falls by far short of the requirement of rolling back the three diseases. Grants from the first round (April 2002) amounted to US$ 0.616 billion for a period of two (2) years an amount which translated to 0.308 billion per year or 2.5 to 3.3% of the estimated need. The practicality of the GFATM is in doubt. The situation calls for action now. The UN and The World Bank should intervene with highly concessionary loans /grants. The flow of fund to GDATM gives little hope of rolling back the diseases sin the Southern African region. The region is home to 70% of all people infected with HIV (28 million persons); 16 % of all TB cases (1.5 million) accounting for 59% of global infection for the two diseases. In addition, it carries 90% of all death (900,000 persons) from the 300-500 million malaria cases per year. The effects are catastrophic given her small population (11% of Global population) relative to that of the world. The share grants from GFATM for the whole Africa was 52%. On the basis of the global morbidity and morbidity data, Sub Saharan Africas fair share is about 73% of the estimated requirement or GFATM grant region. There is a need to develop fair indices for allocation of the GFATM Experiences over the past 20 years support the approach of factoring poverty reduction in roll back initiatives of the three diseases. About 20% of households are food poor and 50% of households are unable to obtain basic needs. GFATM needs to develop basic indices for the diseases and level of household deprivation in order to do just to resource allocation to affected countries. The data is there. The current criteria for proposals has the effect of excluding those most affected. The poorest are least advantaged to compete for the GFATM through the calls for proposals procedure and most likely to come from Southern Africa. During the first call for GFATM, forty (10%) of all programs form 31 countries qualified for award out of a total of 300 proposals. What happens when one of the most affected countries cannot put up a credible proposal in the long run and how many Southern African countries have failed to qualify! Coverage of a least 80% of the target population for interventions in prevention and care is necessary for it to have impact.. Over the past 20 years, experiences in the region underscores the importance of supporting community based initiatives (CBI). GFATM should needs to support CBI in accessing basic diseases information, healthcare, food security and income generation with technology and micro finance support. This support can transform community initiatives into sustainable, cost effective ways addressing the disease burden. This is essentially a bottom up approach with top down support form GFATM.. Affected countries should in turn mobilize and support community based initiatives to achieve a good success rate. GFATM’s proposal mechanism is to support twenty eight (28) countries to fight HIV/AIDS from a total of 31 awards. Twenty one or a third of all countries are to receive HIV/AIDS grant for the purchase of antiretrovirals The fund seems to have set a precedent in facilitating global demand for antiretroviral treatment. However, the cost of antiretroviral treating for 28 million HIV positive people in Sub- Sahara Africa is over US$ 11 billion per year (US$ 1.00 per day/ person). The limited grant award cannot support this except to benefit a few urban elite. This model has far less chance of making a difference than support for the informed resource allocation model of CBI for prevention and care. The UN/World Bank has the humanitarian obligation to explore other means of urgently bridging the funding gap of GFATM. It needs to develop indices for fair allocation of adequate resources to affected countries according to need. The Fund should commit eligible countries to support and work with communities to roll back the diseases.