GHF2006 – PS01 – Do Global Funds Really Facilitate Access to Health?

Session outline

Parallel session PS01, Wednesday, August 30 2006, 16:00-17:30, Room 3
Chair(s): Elisabeth Fee, Chief, History of Medication Division, National Library of Medicine, USA, Bernardino Fantini, Director, History of Medicine and Health Institute, Faculty of Medicine, University of Geneva, Switzerland
Summary: Numerous international funds have been set up in recent times to address global health challenges such as HIV, TB and malaria, in an effort to provide sustainable funding for selected diseases affecting billions of people in the poorer regions of the world. Despite impressive investments in terms of money and stakeholders' involvement at national and international levels, enabling the scaling up of specific health initiatives, the collective impact of these initiatives has sometimes created or exacerbated problems such as the poor coordination or duplication of programmes, heavy burdens on local health practitioners, variable degrees of country ownership, and a lack of alignment with country systems. Relying on the establishment of inclusive partnerships, financial institutions like the Global Fund to Fight AIDS, Tuberculosis, and Malaria do not take full responsibility for implementing funded programmes which require the active participation of partners in proposal development and realization (through Country Coordinating Mechanisms). One of the major reasons for the apparent ineffectiveness of global interventions is the historical weakness of the health systems of underdeveloped countries, which contribute to bottlenecks in the distribution and utilisation of funds.

  • What are the pros and cons of the global funds from different country perspectives?
  • In theory, the global funds programmes are to be continued and sustained in the long term by the countries themselves. Is this a reasonable expectation?
  • Is the money coming into the global funds? programmes (from the donors and also the recipient countries) new money, or is it simply being shifted from one health programme to another?
  • How can the funds best support equity, universal coverage, and sustained improvement in health systems? performance?
  • What are the key steps needed to implement the Paris declaration, with its guiding principles of ownership, harmonisation, alignment, results, and mutual accountability?

This round table session will debate the pros and cons of the ways the global funds work (or fail to work) in practice and try to answer the above questions.

 Panelist 1: Lola Dare, Executive Secretary, African Council for Sustainable Health Development, Nigeria
 Panelist 2: Marcos Cueto, Professor Principal, Universidad Peruana Cayetano Heredia, Peru
 Panelist 3: Suwit Wibulpolprasert, Ministry of Public Health Advisor, Ministry of Health, Thailand

Session report

Submitted by: Hassatou Conde (ICVolunteers); Contributors: Elise Magnenat (ICVolunteers)

Image: Viola Krebs, ICVolontaires.org

On the first day of the Geneva Health Forum, a roundtable took place on the subject of the efficiency of Global Funds in improving access to health for populations. The participants took a historical perspective on the efficiency of Global Funds programmes and recognized the importance of ensuring that all stake holders, including patients, community leaders and contributors to the fund, participate in its negotiation. "Global partnerships are increasing but results are missing", said Dr. Cueto, first panellist of the Symposium on Global Funds and Access to Health. The debate focused on the gap between the increasing number of global initiatives and expectations of local populations.

Dr. Marcos Cueto is a historian and a professor at the School of Public Health of the Universidad Peruana Cayetano-Heredia in Lima, Perú. His main focuses are the history of epidemic diseases and of public health in Latin America.

Dr. Cueto brought a historical perspective of international health in Latin America and discussed the Global Fund to Fight AIDS, Tuberculosis and Malaria. According to Dr. Cueto, a historical approach is essential for a better understanding of the present public health challenges. Dr. Cueto took the example of Malaria Eradication Campaigns and Primary Health Care Programmes set up during the 1950s and the 1970s in Latin America. He pointed out several drawbacks and shortcomings of the methods used, mostly related to the lack of communication between the major stakeholders and to the absence of adoption of the programmes by local actors. Most people in Least Developed Countries (LDCs) do not really see health system reforms as essential, he said, and this leads to misunderstanding between these populations and the decision takers.

Concerning the Global Fund fight against AIDS, Tuberculosis and Malaria, he noticed that the resources invested in this initiative are important and have a positive impact and he confirmed that the Global Fund represents a great opportunity for LDCs. But the question is: "Are we ready to catch this golden opportunity?"

Dr. Lola Dare, a community physician and medical epidemiologist from Nigeria, was the second panellist. In 2001 she was given an award by the African Regional Office of the World Health Organization for the 'Oriade Initiative', which aims to identify culturally sensitive and adaptive mechanisms for community co-financing and management.

Dr. Dare had a more critical perspective, highlighting the numerous constraints that Global Health Initiatives have to deal with, often leading to an absence of concrete results. Global Health Initiatives have been in existence since colonial times, but although "the goals change, the main issue of inequality in access to health remains", explained Dr. Dare. Hence, there seems to be a real problem as regards equality of access to health, as well as the increase in the number of initiatives.

Dr. Dare balanced her criticism by noting that the increase in Global Funds have also brought benefits, although often the receivers of the funds, local populations, are not always in a position to take advantage of them due to a lack of coordination.

Both panellists were in agreement on the question of the preparedness of countries to receive Global Funds and the necessity to align the objectives and programmes of Global Funds with country's priorities, policies and fiscal capabilities.

The participants of the Symposium agreed that one of the key goals for effective use of the Global Funds is to ensure access to health for local populations. Hence it is important that all stake holders participate in negotiations, including patients, community leaders and the contributors to Global Funds.

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