"It is not always easy to spend money wisely and with an impact," Peter Piot, executive director of UNAIDS, told United Press International at a panel sponsored by the Brookings Institution. "Some countries are faced with a (100-fold) increase over the last five years.

"It's not enough to have money, the money should go to where it can have a major impact."

When UNAIDS was founded in 1996, it was given a budget of $292 million. Now global spending on AIDS is more than $8 billion -- but that falls far short of the $20 to $23 billion per year figure that global health needs are expected to reach by 2010.

Care needs to be taken to make sure the end recipients of those funds can absorb them, Piot said. "We need to invest. Projects without overhead for investment in overall capacity should never be approved."

And that figure does not include other pressing global health needs like vaccinations, and battling other deadly diseases like malaria and tuberculosis. An estimated additional $35 billion is needed just to reach the 27 million children who do not have access to vaccines.

At the G8 summit that recently concluded in Moscow, several ideas were floated for meeting the gap between what donors give and what global health needs demand.

To spur investment in global health research, such as developing new vaccines, the United States and others pushed for Advanced Market Commitments -- promises by donor countries to purchase fixed amounts of newly developed vaccines for high prices to compensate drug companies for their research costs.

But to make sure current needs are met, cash on hand is needed. British Member of Parliament Gordon Brown proposed a solution called the International Financing Facility that is intended to raise about $50 billion per year.

Under this strategy, facility donor countries sign legally binding, 20-year commitments to give money, which will then be leveraged to raise funds in international capital markets.

A pilot project designed specifically to raise $3.2 billion in dispensible funds for immunizations before 2015 is already underway.

But where should the influx of cash be directed?

To answer the question, new conversations are taking place within the Global Alliance for Vaccines and Immunization about where investments should be made, said Alice Albright, CEO of GAVI.

"There's a trade-off between things that will pay off immediately and investments that will pay off with better treatments in the long run."

Donors must be careful not to overwhelm the capacity of countries, but the countries themselves must also find ways to make wise decisions about where funding should go, Mexican Minister of Health Julio Frenk, told UPI.

Mexico is in the midst of a seven-year universal health insurance coverage scheme that is pioneering the concept of "democratic budgeting" whereby funds are not allocated bureaucratically, but instead follow people.

Countries should learn from this and other attempts to make the budgeting process more inclusive, Frenk said.

"Every country must have a balanced portfolio," he said. "You get extra funding, then what do you do? That's where the real problem starts."

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