Discussions were initiated as Gorik Ooms shared a Lancet article that looks into Global Fund performance and its contribution to strengthening the response to HIV, tuberculosis and malaria and whether it should expand its mandate to include MDG 4 and 5 and become the Global Fund for Health-related MDGs. In the discussions, activists agreed that cost-effective competition between global health priorities, such as comparing the cost of treatment for PLHIV with treatment for other diseases, should not be used as an argument to downsize or flat-fund the Global fund, and that instead, the focus should be on mobilizing additional funding through new mechanisms.
Global priorities, which focus on the obscene waste of resources on the military, wars, bail-out speculators and inequities in the tax systems must be discussed as a new way to mobilize resources for health (Svend Robinson, Mohga Kamal-Yanni, Rick Rowder).
Some activists criticised the existence of the Global Fund and its narrow mandate, citing that it deteriorates independent health systems and management capacities of countries in low resource settings (Mukosha et al) and divides civil society into two groups with conflicting ideologies: ones that does not think the Global Fund is the right tool to achieve comprehensive health care for all and one that supports its current mandate. Others disagreed and reiterated that there is no supporting argument that the investment in health system strengthening is better than disease-specific funding (Prof. Brook Baker et al). There are several arguments that confirm that the resources provided by the Global Fund have improved health outcomes not only on the three specific diseases, but on health systems overall. However, there is concern that the concept of health system strengthening through the existing CCMs of the Global Fund is too top-down and barely reaches vulnerable margins of society (Meg Davis).
In terms of expanding the GF mandate, some are pessimistic, mentioning there wont be significant additional resources and this will end up “hurting AIDS & TB programmes” and, furthermore, ART may be “downgraded as a priority by many decisionmakers in this new global health architecture”. Therefore, the discussions on mandate expansion need to be held in the current political and operational realities, as some donors are scaling down the funding and saying that it is “hopeless that replenishment targets are corresponding to mere maintenance of the current programmes of the Global Fund”. Some donors will even use shrinking resources to pay for non-Aids, -TB and -malaria programmes (Khalil Elouardighi, Gregg Gonsalves, Gorik Ooms) using cost-effectiveness arguments to decide and compare global health priorities.
Gregg Gonsalves raised important and practical questions:
a) What should we be doing if the Global Fund expands its mandate and donors provide little or no additional resources?
b) How should resources be allocated if new funding is forthcoming, but is less than needed to completely support old and new mandates?
c) What are the specific national and international political strategies in terms of resource mobilization vis-à-vis the Global Fund for MDGs?
d) How strong is our advocacy movement at the moment? What do we need to do to strengthen our own work to ensure greater funding for health?
These questions are yet to receive answers and the discussions remain open.
Resources:
The Global Fund Secretariat: The Global Fund 2010: Innovation and impact
Lancet: The Global Fund: replenishment and redefinition in 2010
The Global Fund Observer: Latest issue of the Global Fund Observer is now available
OSI blog on the Global Fund: The Global Fund for Health? If Donors Pay Up
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