Civil society debates the future aid architecture of global health
In a one-day workshop organised by Save the Children, in collaboration with Action for Global Health, Stop AIDS Campaign, and RESULTS UK, there was a great turn-out from the UK health-related NGO community. We listened and learned, debated and sought consensus on major issues relating to the mechanisms by which funding is channelled into healthcare at the global level and influences the direction of the funding — referred to as aid architecture.
The morning sessions were informative, with experts presenting on key existing organisations and initiatives, as well as the Department for International Development sharing some of the new government’s priorities and review processes which are underway.
Following this, the potential expansion of the mandate of the Global Fund to Fight Aids, Tuberculosis and Malaria was debated, and groups discussed some of the major themes of the day, which included:
- the tension between vertical disease (funding responses to one disease or medical condition, such as malaria) and horizontal health system approaches (funding for the core functions of the entire health system, such as paying for the training of health care staff)
- the pros and cons of bilateral (funding between two governments) versus multilateral aid (funding by many state governments)
- the focus on health care results
- key objectives of aid for improving healthcare.
The meeting was held under Chatham House rule to encourage honest discussion. Some controversial issues were flagged and argued out. For instance we discussed the reality that we — as advocates of specific areas of health care — will continue to compete for increased funding allocation to our priority areas. Yet there is scope for a degree of consensus on our vision for global health aid architecture, and the issues that need to be addressed, notably how we should approach DfID on some of these concerns.
It is clear that we need to readdress the balance between vertical and horizontal approaches, as experience now confirms that without comprehensive investments into the pillars of the health system, progress on any of the priority disease areas will be thwarted. A diagonal approach, combining funding for the entire health system and targeted disease-specific investments, thereby appeared to be a pragmatic option.
Serious concerns were raised about the power of donor imperatives to distort priorities in global health and generate trends that do not reflect the needs of the poor. At present at the global level, in light of the Muskoka Initiative of the G8 and the Secretary General’s Joint Action Plan for Millennium Development Goals 4 and 5, these priorities seem to be maternal, newborn and child health.
But the funding committed in Canada is grossly insufficient to meet the needs of maternal health and child survival. For the UK government, the focus appears to be on family planning and malaria. These narrow priorities mark a missed opportunity and failure to acknowledge the importance and economic benefits of an integrated approach covering the entire continuum of care. For example providing adolescent sexual reproductive health care to a teenage girl, through to her pregnancy and then following her newborn to becoming a five-year-old child.
Could the aid architecture become more adaptable and encourage donors to invest in national plans and nationally determined priorities, along with health system strengthening? Would this prevent the capacity for donor fads to distort funding priorities?
There was also the feeling that we need to make the financial crisis an opportunity for action, providing the impetus for a collective push for innovative financing mechanisms. This would certainly include a mechanism to generate funding from the financial sector, such as the financial transaction tax, part of which should be earmarked for investment into climate change, and health and the MDGs.
A lot else was said, and we will be working on a collaborative document as an outcome for the meeting. But the important first step has been made towards formulating a common position and forging consensus on some pertinent issues related to global funding for health, so watch this space…