The 'diagonal' approach to Global Fund financing: a cure for the broader malaise of health systems?

Gorik Ooms, Wim Van Damme, Brook K Baker, Paul Zeitz, Ted Schrecker, Gorik Ooms, Wim Van Damme, Brook K Baker, Paul Zeitz, Ted Schrecker

Abstract

Background: The potentially destructive polarisation between 'vertical' financing (aiming for disease-specific results) and 'horizontal' financing (aiming for improved health systems) of health services in developing countries has found its way to the pages of Foreign Affairs and the Financial Times. The opportunity offered by 'diagonal' financing (aiming for disease-specific results through improved health systems) seems to be obscured in this polarisation. In April 2007, the board of the Global Fund to fight AIDS, Tuberculosis and Malaria agreed to consider comprehensive country health programmes for financing. The new International Health Partnership Plus, launched in September 2007, will help low-income countries to develop such programmes. The combination could lead the Global Fund to fight AIDS, Tuberculosis and Malaria to a much broader financing scope.

Discussion: This evolution might be critical for the future of AIDS treatment in low-income countries, yet it is proposed at a time when the Global Fund to fight AIDS, Tuberculosis and Malaria is starved for resources. It might be unable to meet the needs of much broader and more expensive proposals. Furthermore, it might lose some of its exceptional features in the process: its aim for international sustainability, rather than in-country sustainability, and its capacity to circumvent spending restrictions imposed by the International Monetary Fund.

Summary: The authors believe that a transformation of the Global Fund to fight AIDS, Tuberculosis and Malaria into a Global Health Fund is feasible, but only if accompanied by a substantial increase of donor commitments to the Global Fund. The transformation of the Global Fund into a 'diagonal' and ultimately perhaps 'horizontal' financing approach should happen gradually and carefully, and be accompanied by measures to safeguard its exceptional features.

References

    1. Garrett L. The Challenge of Global Health. Foreign Affairs. 2007;86
    1. Jack A. From symptom to system. Financial Times 2007, September 28.
    1. Uplekar M, Raviglione M. The "vertical-horizontal" debates: time for the pendulum to rest (in peace)? Bulletin of the World Health Organization. 2007;85:413–414. doi: 10.2471/BLT.07.041756.
    1. World Health Organization Scaling up for Better Health: IHP+ workplan of the Health 8 agencies. Report, October 2007 Geneva: World Health Organization.
    1. Frenk J. Bridging the Divide: Comprehensive Reform to Improve Health in Mexico. Lecture for WHO Commission on Social Determinants of Health, Nairobi. 2006, June 29.
    1. Global Fund to fight AIDS, Tuberculosis and Malaria Decisions of the Fifteenth Board Meeting. Geneva. 2007 April 25–27.
    1. UNAIDS International Health Partnership Launch Press release, 2007, September 5.
    1. Partnership for Maternal, Newborn and Child Health 'Orphaned' cause of women and children gains champions Press release, 2007, September 27.
    1. Moore A, Morrison J. Report, September 2007. Washington: Center for Strategic and International Studies; 2007. Health Worker Shortages Challenge PEPFAR Options for Strengthening Health Systems.
    1. Ooms G. Health Development versus Medical Relief: The Illusion versus the Irrelevance of Sustainability. PLoS Med. 2006;3:e345. doi: 10.1371/journal.pmed.0030345.
    1. Ooms G, Derderian K, Melody D. Do We Need a World Health Insurance to Realise the Right to Health? PLoS Med. 2006;3:e530. doi: 10.1371/journal.pmed.0030530.
    1. Global Fund to Fight AIDS, Tuberculosis and Malaria Proposal Form – Round 7. Geneva: Global Fund to fight AIDS, Tuberculosis and Malaria. 2007.
    1. Buse K, Waxman A. Public-Private Partneships: a Strategy for WHO. Bulletin of the World Health Organization. 2001;79:748–754.
    1. Médecins sans Frontières . Help wanted: confronting the health care worker crisis to expand access to HIV/AIDS treatment: MSF experience in Southern Africa. Johannesburg and Brussels: Médecins sans Frontières; 2007.
    1. Chen L, Evans T, Anand S, Boufford JI, Brown H, Chowdhury M, Cueto M, Dare L, Dussault G, Elzinga G, Fee E, Habte D, Hanvoravongchai P, Jacobs M, Kurowski C, Michael S, Pablos-Mendez A, Sewankambo N, Solimano G, Stilwell B, de Waal A, Wibulpolprasert S. Human resources for health: overcoming the crisis. Lancet. 2004;364:1984–90. doi: 10.1016/S0140-6736(04)17482-5.
    1. UNAIDS Financial Resources required to Achieve Universal Access to HIV, Prevention, Treatment, Care and Support. Geneva: UNAIDS. 2007.
    1. England R. Are we spending too much on HIV? BMJ. 2007;334:344. doi: 10.1136/bmj.39113.402361.94.
    1. Bosman M. Health sector reform and tuberculosis control: the case of Zambia. Int J Tuberc Lung Dis. 2000;4:327–332.
    1. International Monetary Fund, Independent Evaluation Office . The IMF and Aid to Sub-Saharan Africa. Washington: International Monetary Fund; 2007.
    1. de Renzio P, Goldsbrough D. Background Paper, April 2007. Washington: Center for Global Development; IMF Programs and Health Spending: Case Study of Mozambique.
    1. European Commission . Aid Delivery Methods: Guidelines on the Programming, Design & Management of General Budget Support. Brussels: European Commission; 2007.
    1. International Monetary Fund . Fiscal Policy Response to Scaled-Up Aid. Washington: International Monetary Fund; 2007.
    1. Rivers B. Tanzania and Uganda – Unanticipated Headaches. Global Fund Observer. 2003.
    1. Örtendahl C. Report, October 2007. London: HLSP Institute; The Uganda health SWAp: new approaches for a more balanced aid architecture?
    1. Global Fund to fight AIDS, Tuberculosis and Malaria An Evolving Partnership: The Global Fund and Civil Society in the Fight Against AIDS, Tuberculosis and Malaria. Geneva: Global Fund to fight AIDS, Tuberculosis and Malaria. 2007.
    1. Over M. Blog. Washington: Center for Global Development; AIDS Treatment as an International Entitlement: Are We Ready for a Global Welfare Paradigm? September 28, 2007.
    1. Godal T. Global Business Plan. Presentation at the Partners' Forum of the Partnership for Maternal, Newborn and Child Health, Dar Es Salaam. 2007, April 17–20.
    1. Organisation for Economic Co-operation and Development . OECD in Figures 2007. Paris: Organisation for Economic Co-operation and Development; 2007.
    1. Global Fund to fight AIDS, Tuberculosis and Malaria Donors Provide US$9.7 Billion to the Global Fund. Initial Pledges for 2008–2010 Enable the Global Fund to Triple in Size Press release, 2007, September 27.
    1. Schieber G, Fleisher L, Gottret P. Getting Real on Health Financing. Finance & Development.
    1. Murray C, Frenk J, Evans T. The Global Campaign for the Health MDGs: challenges, opportunities, and the imperative of shared learning. Lancet. 2007;370:1018–1020. doi: 10.1016/S0140-6736(07)61458-5.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren