Combating disease: A stretched safety net

Here’s an interesting article from the Financial Times looking at the UN’s global health fund:

In 10 years the UN’s fund to fight Aids, tuberculosis and malaria has attracted $22bn in pledges for projects throughout the developing world. But as donors retrench it will have to refocus its targets for support

In deciding where best to tackle the world’s 800,000 annual death toll from malaria, China is seldom the first place that comes to mind. For that very reason, the country has become a big talking point, however, as international donors debate how to spend their increasingly squeezed funds.

Over the past decade, the UN-backed Global Fund to Fight Aids, Tuberculosis and Malaria has pledged it $144m to fight the parasite. Yet China is not only one of the world’s fastest-growing economies but is also where most of the sweet wormwood grows that provides the most effective cure. Never mind that, in the world’s most populous nation, a mere dozen people a year die from the ailment.

Since its creation by governments at the turn of the millennium, as a revolutionary new way to channel their aid to tackle the world’s big killer diseases, the Geneva-based Global Fund has pledged $22bn from governments to save millions of lives in poorer countries around the world.

After a period of fast expansion, and strong progress in tackling Aids, TB and malaria alike, the fund has become a target in the era of austerity. With a shift in power between the world’s traditional and emerging economies, and donors seeking ways to cut support, billions of dollars and millions of lives are at stake.

In the week the organisation should have been celebrating its 10th anniversary at a board meeting in Ghana, it instead had its most bruising ever gathering. It scrapped its next round of grant applications and imposed on itself an intense internal restructuring against a backdrop of demands for improved efficiency. “We’ve got to be a much smarter in how we give out money,” says Brian Brink, medical director at Anglo-American, the southern African mining group, and a director of the Global Fund, who fiercely defends its achievements to date but supports a wide-ranging overhaul for the future. “We must have value for money.”

Allegations of corruption this year triggered calls for reform by a high-level panel of politicians and officials – recommendations that were adopted this week. But China highlights a different issue: how much the Global Fund and its counterparts gave too easily to the wrong countries, for the wrong diseases, to pursue the wrong policies and in the wrong way. To survive, the organisation will need to overhaul how it is governed, who receives money and how it is spent.

When it was created in 2001 as a way to channel donor money from richer countries to poorer ones with a heavy burden of infectious disease, the fund was pioneering. Sir Richard Feachem, its founding executive director, says: “The Global Fund has not only achieved remarkable impact in tackling disease and death, but also successfully implemented a new business model for development finance. However, on its 10th anniversary and in the face of declining income, significant reforms are overdue.”

From the start, the organisation was distinctive in several ways. One is transparency: funding requests, results, audits and board minutes are all published on its website. Its openness has made it the sometimes disproportionate target of critics, while counterparts – from the UK’s Department for International Development to the US Agency for International Development and the World Bank – are shielded by greater opacity.

A second was its ability to provide long-term support through regular “rounds”, or requests for funding from countries in need. That created stability compared with conventional short-term bilateral aid, which is subject to annual budgetary reviews.

The third characteristic was its hands-off approach. Donors are often accused of dictating aid programmes seen as patronising, self-interested and faddish. By contrast, Global Fund programmes are “country-led”. Recipient nations themselves set the priorities and are given places on the governing board alongside donors.

However, since the global financial crisis, the context has radically changed. Craig McClure from the World Health Organisation says: “In the first few years, the Global Fund was an emergency response to diseases drastically underfunded for two decades. There was not a lot of focus on which were the best interventions to be funded. Now, apart from the economic challenges, we have learnt a lot and need to be more efficient.”

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