This is a joint post with Andrew Rogerson, ODI.
The United Kingdom, in its new Aid Strategy out this week, and the Bill & Melinda Gates Foundation have jointly announced the creation of a £1 billion Ross Fund (named after a pioneering scientist) to fight malaria and neglected tropical diseases. Through intensified research and in-country programs, the Fund will help tackle the unacceptable blight on our humanity caused by these diseases and potentially make millions of lives better.
What’s not to like? On its surface, this is a fine way to deploy philanthropic and taxpayer largesse. Let’s stop malaria once and for all, country by country, village by village, bed net by bed net, pill by pill, hopefully soon jab by jab. We share the goal. Pass the hat around!
But hang on. Remember a multi-billion fund created by the UK, Bill Gates, and like-minded folk more than a decade ago, called The Global Fund to fight Aids, Tuberculosis and wait... what was that last letter M? Oh right, Malaria!
Why not use this existing international powerhouse for the new initiative instead of creating yet another health-related fund, of which the world is already lumbered with too many? The Global Fund is up and running, has a good track record on malaria together with the US President’s Malaria Initiative, and brings everybody--including the Gates Foundation and the UK, but also countries rich and poor, NGOs and the private sector—around the table to fight the disease. Global Fund spending, operations and results are also transparent and accountable to the taxpayers that fund these efforts through their development agencies.
There are three possible reservations related to the Global Fund, but just as many reasons to address the reservations directly, especially given that the Global Fund is about to enter a replenishment year in 2016.
First, it’s true that the Global Fund is not today focused on R&D, and does not yet have an explicit mandate for neglected but nasty tropical diseases like river blindness and trachoma. There are other organizations that do, and are likely worthy recipients of this funding. But if the concern is to place money in a single institution, go and talk to your partners and change the Global Fund mandate in order to fund the necessary research. It may even make sense to anchor R&D funding close to service delivery financing—there will be a clear incentive to develop products that suit health system conditions in most affected countries. Do not take the superficially easier route of cutting the ribbon on yet another a new multilateral bureaucracy.
Second, to eradicate and not just control diseases—think of polio—you have to spend a whole lot of money on the last remaining few cases, and perhaps those are found in relatively wealthier countries rather than poorer ones. Meanwhile, the Global Fund rightly needs to ensure fair treatment across countries and diseases, and focus on the highest burdened countries. Yet this too could be addressed within the rules of a new facility or window managed by the Fund, focused on elimination and eradication.
Third, which we trust is not the reason for a new Fund, it is of course much more comfortable for all of us to do things around a small table of like-minded friends than in a bigger collective, and to begin with the founding members (Gates and DFID) who may feel they have a lot more control, commensurate with their stakes than they have in a bigger Global Fund. Although quite understandable, we will never get to the Global Goals for Sustainable Development if we create a closely-held fund for every problem we perceive, and then spend years arguing about turf (or so-called division of labour) with other, perhaps not-invented-here instruments.
If the UK and Gates signal that other mechanisms will work better than the Global Fund to address malaria, just ahead of a replenishment year, global health will be headed in the wrong direction, a direction of inefficiency and redundancy. Reform of our existing Global Fund rather than creation of yet another new Fund is the answer. We call on the UK and Gates to consider this option seriously.
CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise.
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