Community Health Meeting in Tigray Region, Ethiopia. Shannon Kowalski/Open Society Institute
Jeff Sachs recently published a blog post in the Guardian calling for changing the mandate of the Global Fund from AIDS, TB and malaria to health generally. It’s a great idea. But in truth, the Global Fund is already doing a lot to fund health systems.
At least 30 percent of the Global Fund’s funding in rounds one through seven were focused on health systems inputs. In rounds 8 and 9 the Global Fund made its commitment to providing funding for strengthening health systems much more explicit and encouraged countries to submit cross-cutting health systems strengthening proposals. The Global Fund is already funding: training and paying health care workers, strengthening laboratory capacity, upgrading infrastructure, strengthening procurement and supply chain management systems, improving monitoring and evaluation, and even strengthening health insurance systems, to name just a few key areas. While this funding must be related to improved outcomes for the three diseases, spending on health systems has never been restricted to just fighting the three diseases (although some countries may have planned and implemented programming in that way).
In November, I visited some of the projects the Global Fund is funding in Ethiopia and saw for myself how Global Fund resources are being used to strengthen health systems. Ethiopia’s Health Extension Programme trains workers in rural areas to provide health education and basic services to their communities. These services include family planning, encouraging pregnant women to get antenatal care and give birth in health facilities, HIV prevention, testing and treatment, the distribution of bednets to prevent malaria, and education about nutrition and sanitation, among other things. The community members I spoke with told me how these small interventions made a big difference in improving lives and health in their village. It’s a great example of what the Global Fund is doing and already can be doing more of, if only countries would ask for it.
Of course, much more needs to be done to improve health systems, beyond what the Global Fund is able to do and should do. But the Global Fund is not the only player in this field. The GAVI Alliance and World Bank give significantly in this area, and the three partners are currently discussing launching a joint health systems funding platform that could cut down transaction costs of applying for and managing health systems funding considerably. Bilateral donors and, of course, national governments, are also investing in this area. The question the Global Fund’s board and donors will need to answer is: Can the Global Fund do more in this area, without compromising on its commitment to effectively fight AIDS, TB and malaria?
The elephant in the room of course is money. Sachs acknowledges that this is an issue and states that to effectively address health more broadly the Global Fund needs $12 billion a year.
This is a year of replenishment for the Global Fund and donors will make their pledges in October for the period from 2011-2013. And while many are calling for the Fund to expand its mandate even further, public sector donors are indicating that pledging even $13 billion over three years might not be possible (nevermind the $36 billion Sachs proposes). As I have written previously, a $13 billion replenishment ($4.3 billion a year) will not let the Global Fund scale up its response to the three diseases, let alone effectively address any other health issue. That means very few additional people receiving anti-retroviral treatment, few additional women and children sleeping under bednets, and only modest expansions in the number of people receiving basic TB care (while letting multidrug-resistant TB run rife). We would be giving up the fight, just as we could achieve major public health breakthroughs.
So let’s talk about the Global Fund for Health. But, until we see the outcomes of the pledging conference in October, the Global Fund’s board and secretariat should tread carefully. The test is the amount of money that donors put on the table. If they do pledge $12 billion a year as Sachs proposes, I will be the first to champion it.
Topics: donors, Global Fund, HIV/AIDS, malaria, Shannon Kowalski, tuberculosis
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At this current time we have 3 scenarios of donor funding. Realistically, some of us are more realistic and can pinpoint the scenario which will be replenished by donors. Even with the three scenarios the Global Fund would need a dramatic increase of funding (20%) to be the Global Fund for Health, which at this time we know this is not possible and extremely critical as we are facing a short-fall of funding as we speak.
Shannon you are right. GFATM is already doing a lot for health systems.
What i often find in such debates is the voice of the south is either stifled or nor heard at all.
In a recent National Level Consultation on the new World Bank HIV strategy, communities were clear that the current structures first need to deliver what they are meant to deliver.
Secondly the principle of "Nothing about us Without us" comes to play.
Any such move - apart from funds it is the voices of the communities and most affected the experts need to take into account before we start championing cause that may prove to detrimental in the long run.
For example Government of India is keen to integrate HIV and AIDS and its flagship Rural Health Mission - primarily a programme for Maternal and Child Health.
For reasons unexplained to anyone the merger came in a hush hush manner and we found Harm Reduction programmes being merged into an MCH programme.
Community voices will ensure that such insane mergers and proposals do not go through just because it is now in the air that GFATM is moving to be GFH.