Ten years since its founding, the Global Fund is facing a serious financial shortfall, and the Fund’s board voted recently not to accept new grant requests until at least 2014. The author states that the question is not whether the Global Fund works, but how to ensure it keeps working for years to come, according to this article. There are four reasons this is imperative. First, the world needs to expand, not contract, access to health care because of the sheer burden of disease. Second, the Fund doesn’t simply give handouts: it takes the longer road of investing in and working with health ministries to build (or rebuild) local health systems. Third, the Global Fund proves how much multilateral organisations can accomplish, when one looks at the many lives it has helped save. While the usual players like the G-8 bear the greatest financial burden, the author urges some of the recipient countries to consider themselves partners of and contributors to the fund – India, Russia and China can play meaningful roles as both external funders and as recipients of grants. Fourth, a global recession is not an acceptable excuse for external funders to avoid the responsibility of meeting their financial commitments to the Fund.
Resource allocation and health financing
The national health insurance (NHI) system that is envisaged for South Africa would be more akin to the excellent publicly funded health systems found in countries such as Costa Rica, where the NHI as a large, single purchaser of health services is able to improve resource use in the overall health system and to get ‘value for money’ for its citizens. However, services in South Africa’s public health sector are of poor quality at present. Actions that would be required to improve quality include: addressing health worker conditions of service through implementing the long-awaited occupation specific dispensation (or OSD); increasing staffing levels by at least 80,000; funding the maintenance and repairs of buildings, equipment and other infrastructure; and granting greater management autonomy to public sector hospitals to reduce red tape. Strong political commitment and genuine civil society involvement are essential to successful implementation.
There is general agreement that donors made more progress in 2008 in terms of increasing aid to Sub-Saharan Africa than in 2006/7. While, in 2007, the G8 countries were significantly off track, the encouraging performance in 2008 demonstrates that if performance is maintained at the same level, most of the countries will meet the targets set for 2010, 2011 and 2013. But there are some, notably Italy and France, who will not deliver. Italy has so far delivered only about 3% of the US$8 billion it pledged in additional funding and may actually be planning cut, not increase, aid in the coming years. Developed countries can help by fast-tracking the process of debt relief under the Highly Indebted Poor Country Initiative (HIPC) Initiative. Donors can ensure that African Diaspora is protected from attacks and discrimination. Trade should be further liberalised in favour of the products of poor countries so that there can be compensation for any loss of aid. And the available resources should be invested in the most productive sectors so as to gain the highest return.
In January 2012, The UK’s Department for International Development announced a fivefold increase in its support for programmes to control neglected tropical diseases (NTDs). However, the authors of this paper point to a growing body of research that highlights hazards associated with current modes of implementing NTD control strategies, including undermining already-fragile health care systems, facing serious logistical problems and medical risks, and contributing in administrative failure. They draw on fieldwork in Uganda and Tanzania to shows that the specific political, economic, and social contexts in which mass drug administration (MDA) programmes are rolled out profoundly affects the uptake of drugs for the treatment of some NTDs. Average drug uptake in 2010 was well below 50%, an issue which remains unaddressed. The authors call for governments to deal with NTDs in a sustainable way that will involve a range of factors, including behavioural change, and promote an integrated bio-social approach, with more adequate monitoring and surveillance.
Though condom use is now higher than ever before, key gaps remain in countries and in certain populations, where use has stagnated or even decreased. This survey comprised five standalone national cross-sectional surveys carried out in randomly selected geographical areas. Quantitative data were collected from adult men who purchased or obtained a condom in the three months preceding the surveys. A minimum of 1,200 participants was enrolled for each country, with quotas for urban and rural respondents; and brand types that a user most often used (i.e., free, socially marketed (SM), and commercial). The AIDSFree team identified important differences in each of the countries’ condom markets. The team noted many overarching themes: Supplies of free condoms appear to significantly exceed use of such condoms; SM brands should set prices based ability-to-pay trends in country, rather than on trends in costs or available subsidies; It is not just price—brand appeal and availability are important factors in men’s choice of condom brands; Low-priced commercial condom brands are emerging, at the same or lower price than SM brands. However, lower awareness and availability appear to limit their market share.; Introducing a single pack of condom brands does not appear to change the market structure significantly.
Hilary Benn of DFId calls for the global community to deliver better health for poorer people around the world.
In this speech to the World Health Assembly, World Bank Group President Jim Yong Kim outlines five specific ways the World Bank Group will support countries in their drive towards universal health coverage. First, he pledges the bank will continue to ramp up its analytic work and support for health systems. Second, he highlights the World Bank’s commitment to support countries in an all-out effort to reach Millennium Development Goals 4 and 5, on maternal mortality and child mortality. The third commitment is that, with the World Health Organisation and other partners, the World Bank Group will strengthen its measurement work in areas relevant to universal health coverage. Fourth, the Bank will deepen its work on what is called ‘the science of delivery’, a new field that the World Bank Group is helping to shape, in response to country demand. Fifth and finally, the World Bank Group will continue to step up its work on improving health through action in other sectors, such as agriculture, clean energy, education, sanitation, and women’s empowerment. Kim argues that the fragmentation of global health action has led to inefficiencies: parallel delivery structures; multiplication of monitoring systems and reporting demands; and ministry officials who spend a quarter of their time managing requests from misguided international partners. He calls for integrated management of health issues facing the world today.
The first round of consultations for the World Bank’s review of its procurement policy has been completed. Clear areas of contention between external funders, developing countries, and their private sector have arisen in the process on issues of domestic preferences and the use of developing countries’ procurement systems. The Bank has to decide whether it stands on the side of development and developing countries, or whether it stands for market orthodoxy and “business as usual,” argues the author of this article. For the most part developing countries and their domestic private sector argued that managing multiple external funding procurement systems with already limited capacity could be overwhelming. If the Bank wishes to demonstrate its commitment to development, it should support the use of domestic preferences, and live up to its international commitments by using country procurement systems as the default option. Furthermore, it should support developing countries in building transparent end effective country procurement systems and not undermine the policy space that these countries need to implement their development strategies and industrial policies. Eurodad supports calls from civil society organisations to initiate an independent review assessing barriers and how to effectively support small and medium-sized businesses.
In its annual World Health Report, the World Health Organization (WHO) shows how all countries, rich and poor, can adjust their health financing mechanisms so more people get the health care they need. It highlights three key areas where change can happen – raising more funds for health, raising money more fairly, and spending it more efficiently. WHO says that in many cases, governments can allocate more money for health. In 2000, African heads of State committed to spend 15% of government funds on health, a goal that three countries – Liberia, Rwanda and Tanzania – have already achieved. If the governments of the world’s 49 poorest countries each allocated 15% of state spending to health, they could raise an additional $15 billion per year – almost doubling the funds available, notes the report. Countries can also generate more money for health through more efficient tax collection, and find new sources of tax revenue, such as sales taxes and currency transactions. A review of 22 low-income countries shows that they could between them raise $1.42 billion through a 50% increase in tobacco tax. The report also cites the role of the international community, noting that most donors still need to allocate 0.7% gross domestic product (GDP) to official development assistance. Smarter spending could also boost global health coverage anywhere between 20-40%, the report points out, highlighting 10 areas where greater efficiencies are possible, including the use of generic drugs wherever possible – a strategy that saved almost US$2 billion in 2008.
Will leaders act now to save lives and make health care free in poor countries? On 23 September 2009 leaders met at the United Nations General Assembly in New York for a high-level event on health. On the table was a proposal to support at least seven developing countries to fully implement free care for women and children or to expand free health services to all, including Malawi and Mozambique. Oxfam recommends that governments of these countries make high-level commitments to introduce free health care for women and children and/or fully implement and expand free health care for all, as well as increase government spending on health to at least 15% of the national budget. The authors argue that the same commitments are required from rich country donors and multilateral aid agencies to provide additional long-term and predictable funding necessary to successfully implement free health care in all seven countries, and to officially extend the offer of financial and technical support for free health care to all poor countries who wish to remove fees and to make this event a global turning point in the fight to make health care free for all.