Ideas to Action:

Independent research for global prosperity

Taufiqur Rahman

International Health Consultant

Taufiqur Rahman is an international health consultant with over 25 years of experience in communicable diseases, health systems, reproductive health, civil society partnership, and health governance. He worked for The Global Fund, Marie Stopes International, The Asia Foundation, and John Snow Inc. He has BA and MBA degrees from the University of Wisconsin. Please note that this post is a personal opinion and does not represent any institutions.

When the Global Fund (GF) was started in 2002, it had a single focused mission, to reduce the mortality and morbidity from the three diseases.  It had one single strategy, to scale up best practice interventions so that deaths and disease burden can be reduced quickly. Massive scale up took place between 2003-2010.  Country led proposals and implementation excited the countries after many years of donor driven programs.  The Fund was completely focused on moving money and meeting the targets.  In 10 years, the Fund has achieved considerable results and made a huge difference.

The time has come for a new mission, new focus, and a new commitment.  The focus should be building health systems for sustainable service delivery and a health system that can make most effective and efficient use of national resources.  GF should not try to do everything which is what the new strategy looks like.  Focus and doing few things well are critical to successful implementation and delivering results. During the International AIDS Conference,  the World Bank (WB) President  made a commitment to strengthen and build health systems.  The GF and WB should therefore join hands in funding health systems strengthening, combining loan and grant funds under a strategic investment platform.  Since World Bank has the technical expertise and country presence, the World Bank should take the lead in providing technical assistance to countries to develop health systems proposals and financing packaging. WB consortium on technical assistance could include WHO, CDC, PEPFAR, USAID, GAVI, and others. UNAIDS, STOP TB, and RBM will need to come together to provide critical coordination and facilitation support to the countries and donors. Countries will be in the driving seat to decide what investments and technical assistance are needed for health systems strengthening, and capacity building for national resource management.  Such an initiative is urgently needed which will also mean a more efficient GF, drastically reducing the need for large Secretariat in Geneva but much more reliant on technical and financing competencies of WB, WHO, UNAIDS, Gates Foundation, donors, international organizations, and local partners.

So, what happens to treatment?  GF should negotiate with its donors to allow all funds for health procurement to be managed by another agency.  GF does not have core competencies in procurement nor does it have the field presence to monitor quality and avoid corruption. The time has come for consolidation of procurement for three important reasons:(i) lower prices, (ii) universal quality; and (iii) avoid corruption.  Since UNITAID funds large procurement of drugs and diagnostics from resources generated from airline levy, it can expand its capacity to manage all procurement. Pooling of global resources can help it to use the same strategies to lower prices as well as assure quality for drugs and diagnostics.  It has good implementation partnership with WHO, UNICEF, GDF, CHAI, and others on this.  Implementing partners core competencies and field presence will contribute to quality and accountability. Therefore, donors can think about this possibility where all procurement/distribution will be managed through UNITAID for the three diseases.  Innovative financing such as financial transaction tax could be introduced to fund the gap in drug procurement. France has agreed to this, others can consider it.  Lower prices would allow low and middle income countries to use  their internal resources to fund universal access to treatment and care.  And that is sustainable health financing.  Historical evidences point to the fact that lower drug prices do not need international subsidy.  Government and citizens pay for these, thus allowing private sector development to meet local demands.

It is time for the donors to rethink their strategies and financing of the three diseases.  It is also time for GF Board to revisit the strategy that was approved in 2011 and ask tough questions on relevance and assumptions.  The new Executive Director will need to reach out to all relevant players to initiate a new but bold strategy for GF that will contribute to major investments in health systems in partnership with other key players.  Sustainable health systems and financing can save million more lives for years to come.