Our recent report, More Health for the Money, aims to answer the question: How can the Global Fund save more lives with the billions it spends each year to combat AIDS, TB and malaria? So at our recent launch event, we put this question to a panel of experts (and a room full of practitioners and policy makers) to highlight where progress on value for money is being made, and where room for improvement remains.
The event took place on the sidelines of the UN General Assembly in New York City and featured remarks from Christoph Benn and Shu-Shu Tekle-Haimanot from the Global Fund, Stefano Bertozzi from UC Berkeley, Julia Martin from PEPFAR, and Mphu Ramatlapeng from the Clinton Health Access Initiative. The discussion covered a lot of ground and tracked closely to the four main chapters of our report – allocation, contracts, costing and spending, and verification. So I’ve curated a few of my favorite sound bites that highlight the progress and potential in each area.
Allocation: Julia Martin discussed how increased transparency around the allocation of funds is critical to country ownership:
“Allocative efficiency is a very good place for talking about how country ownership can fit. It’s in the transparency on how you’re allocating all of the available resources to promote a good response for HIV…You need to look at donor resources and countries own resources to determine where the different funding streams are maximally used for the best value...but to intentionally have that discussion…you must have a forum and you must have a commitment to using that forum and not just as a check box that says ‘we’ve spoken to everyone in the country’. It needs to be real. And it needs to be transparent.”
Contracts: Stefano Bertozzi discussed the need for financing mechanisms that create incentives for results:
“One of the things sketched out in your cartoon, is that it would be nice to have funding mechanisms that have inbuilt incentives to drive efficiency. Unfortunately, it’s not clear to someone who is about to make a contract with a country what that mechanism is and how it should work. So we need investment in the design, testing, and diffusion of mechanisms that have better incentives build in.”
Christoph Benn also mentioned that the Global Fund is piloting the Cash-on-Delivery aid model in some of its grants (which we’re thrilled to hear, and look forward to seeing more on):
“We are exploring COD, we have one pilot going on in Mesoamerica, it’s an interesting one where you really pay based on the results achieved, not on the input. We’re exploring currently if we can introduce that in Rwanda on a much bigger scale.”
Costing and Spending: Christoph Benn discusses changes at the Global Fund to help reduce the costs of bed nets:
“We had a very passive approach – it was part of our philosophy of country ownership…– and it meant that we did not leverage at all our significant purchasing power. That is changing now...we are working very closely with all the other major players – PMI, DIFID, UNICEF, the World Bank and others – and…tendering for these commodities together and simplifying the process… to drive the prices down with bed nets. We’ll see similar developments with drugs and other commodities. So that’s something that we’ll focus even more on in the future, but the first steps have been taken.”
To this point I’d add my hope that they focus on the most cost effective commodities, not just the lowest cost.
Verification: Christoph Benn highlighted the Global Fund’s new results, and acknowledged that they only capture program inputs rather than health outcomes:
“Now you can ask yourself, ‘did this guy not listen to us? We don’t want these kinds of input indicators, we don’t want to hear about how many bed nets you’ve distributed, we want to hear how many children are sleeping under bed nets…’ We did get that message...We’re not shifting that quickly….But you’re absolutely right. In the future we’re going into more outcomes indicators and we’ll report on that.”
And the final word goes to Julia Martin, who said "We aren't finished stretching our dollars - not even close." I was particularly glad to hear that, and will be watching (and chiming in with advise) as the Global Fund and their partners continue working to improve their return on investment in health around the world.