The Hoops of Global Health Financing: Responsibility & Accountability

These past few months, the UK, US, France, and a number of other nations pledged funding to the Global Fund to Fight Aids, Tuberculosis and Malaria’s campaign to raise $15 billion over the next three years. The Global Fund is an international financing institution that fights AIDS, tuberculosis and malaria through partnership, transparency, constant learning and results-based funding.

Last week, the Global Fund announced the signing of $68.8 million in new HIV grants for Benin. The funding will support the continued expansion of HIV treatment and of programs to prevent HIV positive mothers from infecting their babies.1 The goal is to provide treatment for 90 percent of individuals who need it by 2015.1

The Global Fund’s efforts and objectives are certainly commendable. However, we must step back to evaluate how exactly many organizations like the Global Fund are using their funding from worldwide donors, what imperative areas of need are addressed, and where funding is being spent. Moreover, organizations must address what kind of results or even unintended consequences develop from these global funding efforts.

Although the Global Fund’s contribution to Benin is significant, the WHO’s 2012 report states that communicable diseases account for more than 70% of death in Benin where malaria is the leading cause of health care consultations at 39.7%, with respiratory infections at 13.8%, gastrointestinal diseases at 6.6% and trauma at 5.6%. HIV/AIDS prevalence dropped from 2% in 2002 to 2005 to a stable 1.2% in 2006.2 Although HIV/AIDS has not been completely eradicated and there is undoubtedly much work to be done in this area, malaria remains to be the number one killer of children under-five in Benin and constitutes 40% of all out-patient consultations.3

As demonstrated by the Global Fund in Benin, HIV receives an unequal share of aid relative to its burden of disease. In 2012, donor funding for HIV programs worldwide doubled as a proportion of all development assistance for health from 2000 to 2007.4 Unfortunately, this disproportionate share of aid distributed to HIV has affected the funding of other diseases, programs, and influenced the functioning of health systems. An increase in funding for HIV programs crowded out delivery of immunizations especially in countries with a low density of human resources for health, and these consequences may or may not change.4 Also, although limited, there is evidence of a positive effect between HIV aid and specific maternal health services.

The Global Fund’s fundraising target by December of this year is $15 billion, a goal that most believe it will achieve. The Center for Global Development (an organization that conducts research and analysis on how policies and actions of the rich and powerful affect poor people in the developing world) has recommended that the Global Fund make some improvements to maximize its funding through a few basic reforms. Some include the allocation of funds to most effective products; payment for performance and not just fund and intervention distribution; and verification of accurate self-reported data.5

More recently, the Global Fund has made strides to gain trust from its supporters. Kate Thomson, the chief of community mobilizations at UNAIDS, will temporarily leave her position and lead Global Fund’s Critical Enablers and Civil Society hub to bring back donor confidence by increasing civil engagement throughout the grants process. The fund notes that they have already begun this process of engagement with early applicants, El Salvador and Myanmar.6

Although, the Global Fund has been in the media a lot lately, we are lucky to say that there are numerous organizations that also receive large amounts of funding to disseminate across various areas of global health. Thus, they are likewise responsible to ensure that their funding is appropriately spent to maximize health results. All of these organizations must consider both the intended and unintended consequences of funneling its revenues one way or the other, and remember that it is accountable to a worldwide donor base that is closely watching, waiting, and hoping for the best results.

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1)   “Global Fund signs $68.8 million in HIV grants for Benin.” http://vaccinenewsdaily.com/medical_countermeasures/327852-global-fund-signs-68-8-million-in-hiv-grants-for-benin/

2)   “WHO: Country Cooperation Strategy at a glance. Benin.” http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_ben_en.pdf

3)   “Global Health Initiative: Benin Country Strategy.” http://www.ghi.gov/whereWeWork/docs/BeninStrategy.pdf

4)   Grepin KA. (2012) HIV Donor Funding Has Both Boosted And Curbed The Delivery Of Dierent Non-HIV Health Services In Sub-Saharan Africa.” Health Aairs. 31(7):1406-14.

5)   “Global Fund’s $15bn must buy results rather than rhetoric.” http://www.theguardian.com/global-development/poverty-matters/2013/sep/27/global-fund-results-aids-malaria-tuberculosis

6)   “Hope for Global Fund’s Civil Society Engagement?” https://www.devex.com/en/blogs/49/blogs_entries/82125?source=MostPopularNews_3

Recommended Reading

“Is the Global Fund Really Worth $5 Billion?” Center for Global Development.

http://www.cgdev.org/blog/global-fund-really-worth-5-billion

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