This brief outlines the Director General's closing summary remarks on a discussion at the 128th Executive Board (EB) on the future of financing for WHO. It notes that a vision for WHO includes coherence in global health, with WHO leading in enabling the many different actors to play an active and effective role in contributing to the health of all people, WHO meeting the expectations of its Member States in addressing agreed
global health priorities, focused on the actions and areas where it has a unique function or comparative advantage, and financed in a way that facilitates this focus; and as an organization which is fit for purpose – efficient, responsive, objective, transparent and accountable. The EB proposed a programme of reform that includes a plan for strengthening WHO’s central role in global health governance, comprising a proposal to hold a regular multi-stakeholder forum (the first in May 2012, subject to the guidance of the World Health Assembly); a clear articulation of WHO’s unique role and functions, and a detailed plan for managerial reforms. This will be presented to the 64th World Health Assembly in May 2011.
Resource allocation and health financing
Several themes emerged from initial discussions in this consultation, which was convened by the World Health Organization (WHO): determining to what extent, and how, WHO should address the broader social and economic determinants of health; deciding what constitutes good partnership behaviour at global and country level; determining how WHO can match the support it provides more closely and flexibly to the needs of different countries; and improving WHO’s involvement in the field of technical collaboration. Participants agreed that improving performance is intimately linked to the way WHO is financed and this warrants further consideration. They indicated a need to seek the views of all member states on the wider issues raised at this meeting. Questions raised in this report will be used as the basis for a web-based consultation, to which all countries will be invited to contribute their views.
The landscape of foreign aid is changing, according to this book. New development actors are on the rise, from the 'emerging' economies to numerous private foundations and philanthropists. At the same time the nature of the global poverty 'problem' has also changed: most of the world's poor people no longer live in the poorest countries. Sumner and Mallet review of research on foreign aid to outline a series of policy proposals for global development cooperation in the twenty-first century.
The new consensus towards universal health care (UHC) suggests that an evidence-based approach to policy may finally be prevailing over an ideologically driven approach. While the new consensus shifting in favour of UHC is to be welcomed, the author argues that the international health community cannot dismiss the unnecessary suffering and harm caused by the reckless adoption of ideologically driven user fees policies over the last 30 years. It is incumbent on the international health community to reflect and take stock of what went so badly wrong that led to the widespread application of user fees in the world’s poorest countries and take steps to determine accountability for those responsible. The past victims of user fees must have their voices heard and all potential avenues for compensation must be fully pursued, as their right to health was violated for so long. More broadly, the current lack of accountability and liability in the economics profession should be of concern to the international health community as it increasingly relies on the advice and direction of health economists.
The Global Fund 2010 results report has projected that the virtual elimination of mother-to-child HIV transmission by 2015 is within reach, that malaria may be eliminated as a public health problem within a decade, and that the international target of halving tuberculosis prevalence could be met by 2015. According to the report, Fund-supported programmes saved at least 3,600 lives per day in 2009 and an estimated total of 4.9 million since the creation of the Fund in 2002. By the end of 2009, Fund-supported programmes provided antiretroviral treatment to 2.5 million people with HIV and AIDS, treatment to 6 million people who had active TB, and had distributed 104 million insecticide-treated nets to prevent malaria.
In August 2005, the Global Fund to fight AIDS, Tuberculosis and Malaria Secretariat suspended its five grants to Uganda following an audit report that exposed gross mismanagement in the Project Management Unit. How could this have been avoided? How can other countries avoid a similar pitfall? We argue that if a legitimate and fair decision-making process were used, the suspension of funding to Uganda could have been avoided, and that this lesson should be applied to other countries. The “accountability for reasonableness” framework of relevance, publicity, revisions and enforcement would help in implementing legitimate and fair decision-making processes, which would improve effectiveness, accountability and transparency in the implementation of Global Fund programmes, preventing future suspension of funding to any Global Fund projects.
Tim France, Gorik Ooms and Bernard Rivers (21 April 2002).
Nearly one year ago, the majority of the world's nations resolved at `UNGASS', a major UN conference on AIDS, to increase annual expenditure on the AIDS epidemic to $7-10 billion by 2005, with much of this money to be raised and disbursed by a new global fund. When the fund was eventually set up, its mandate was extended, and it was named the Global Fund to Fight AIDS, Tuberculosis and Malaria. AIDS, an unprecedented and accelerating emergency, is already having a devastating impact in Africa, with similar impacts unfolding on other continents. Every day, 8,000 die, and 13,000 more become infected. Experts agree that reasonable expenditures on prevention and treatment of AIDS, tuberculosis and malaria can be of dramatic benefit not only to human health, but also to economic development. Thus far, efforts have been made to raise the money needed by the Global Fund through ad hoc voluntary donations. These efforts have failed. Governments have pledged a mere $1.8 billion. Contributions from the private sector have been even more disappointing, with not a single meaningful pledge since the Bill & Melinda Gates Foundation offered $100 million ten months ago. It's time for a new approach.
The Global Fund is one of the largest actors in global health, disbursing in 2015 close to 10 % of all development assistance for health. In 2011 it began a reform process in response to internal reviews following allegations of recipients’ misuse of funds. Reforms have focused on grant application processes thus far while the core structures and paradigm have remained intact. The authors conducted 38 semi-structured in-depth interviews in Maputo, Mozambique and members of the Global Fund Board and Secretariat in Switzerland. In-country stakeholders were representatives from Global Fund country structures (eg. Principle Recipient), the Ministry of Health, health or development attachés bilateral and multilateral agencies, consultants, and the NGO coordinating body. Thematic coding revealed concerns about the combination of weak country oversight with stringent and cumbersome requirements for monitoring and evaluation linked to performance-based financing. Analysis revealed that despite the changes associated with the New Funding Model, respondents in both Maputo and Geneva firmly believe challenges remain in Global Fund’s structure and paradigm. The lack of a country office has many negative downstream effects including reliance on in-country partners and ineffective coordination. Due to weak managerial and absorptive capacity, more oversight is required than is afforded by country team visits. While decision-makers in Geneva recognize in-country coordination as vital to successful implementation, to date, there are no institutional requirements for formalized coordination, and the Global Fund has no consistent representation in Mozambique’s in-country coordination groups. In-country partners provide much needed support for Global Fund recipients, but the authors argue that roles, responsibilities, and accountability must be clearly defined for a successful long-term partnership.
The Stop TB Partnership has announced the publication of the Global Plan to Stop TB. The document describes the action and resources needed over the next five years to expand, adapt and improve directly-observed treatment, short-course (DOTS) - meeting the 2005 global targets to Stop TB, and setting the world on the road to the elimination of TB. Nine billion dollars is needed to fulfill the objectives of the Plan, and with a gap of nearly four billion dollars, much work is needed to mobilise more resources. The Global Plan has been prepared over the last two years by a team from Partners in Health and the Stop TB Partnership secretariat, with funding from the Soros Foundation and USAID. It incorporates contributions from over 150 writers around the world, and the backing of the WHO, the World Bank and other partners.
This weekend, six million people in urgent need of essential Aids drugs face betrayal by world leaders. The Global Fund to Fight Aids, TB and Malaria starts two days of meetings in Geneva today, and ActionAid can reveal it is not getting the heavyweight political support it needs. So far, the UK government is the only major donor to declare its support. Without commitment from other countries, the Fund is unlikely to announce any new grants to fight HIV/Aids in 2006.