A new global fund to combat HIV/AIDS, tuberculosis and malaria will be administered by the World Bank in collaboration with WHO and UNAIDS. Officially announced by UN secretary general Kofi Annan in May, discussions have so far focused on raising the US$10 billion experts say is needed. Less clear are details on how it will fit into national processes and poverty reduction strategies.
Some NGOs, academics and officials are worried the fund reflects donors’ priorities and the desire to apply “quick fixes” to complex problems.
Welcoming the fund in principle, Save the Children, UK, and MEDACT warn in a joint report that lessons of the past 30 years must be taken into account or “billions of dollars could be wasted”. “Donor led programmes that focus on specific diseases rather than taking a holistic approach to building services and resources have contributed to the collapse of developing countries’ health systems,” comments Regina Keith, health adviser to Save the Children, UK. The report The Bitterest Pill of All: The Collapse of Africa’s Health System, argues that a significant amount of any new global health fund should be dedicated to the long term strengthening of health systems. European Commissioner for Development Poul Nielson also warns that, without efficient delivery systems, “there is a big risk of this whole discussion being hijacked by PR-politics in rich countries”.
Kofi Annan has called on governments to generate “new money” for the fund and not just use existing development budgets. The money will be managed by the World Bank, and is likely to be channelled through national health systems and purchasing agencies to buy drugs and pay for disease prevention efforts. It may also create an advance purchase fund to encourage research and development on new drugs. A board will be created with government and UN officials, plus private sector and non-governmental representatives.
A similar World Bank-administered health fund, the Global Alliance for Vaccines and Immunisations (GAVI), was set up in 2000 with a contribution from the Bill and Melinda Gates Foundation to provide affordable vaccines to children. Although UN agencies and donors have praised the initiative, a South Asian government official has pointed out “unrealistic expectations” that governments will be able to assimilate the costs of newer, more expensive vaccines when GAVI funding ends. The World Bank hopes, on the other hand, that the fund “will create a viable market in poor countries” for some of the new drugs.
“There are some difficult questions to be asked about these global health funds,” says Dr Gill Walt, Professor of International Health Policy at London School of Health and Tropical Medicine. “It is my impression that little thinking has gone into the ‘how’ of such funds: who is going to choose beneficiaries, by what criteria, what organisational mechanisms will be needed and how much duplication and undermining of existing organisations will result”.
Based on the common argument that “people are poor because they are unhealthy, and unhealthy because they are poor”, Professor Angus Deaton of Princeton University suggests tackling poverty rather than the “diseases of poverty” to break the vicious circle. He points out that the immuno-deficient diseases that many of the malnourished children die of are essentially the same as when they die of HIV/AIDS. “Yet we have a cure for malnourishment – money – while we don’t know what to do about AIDS,” he adds.
More details of the global health fund will be announced by the G8 summit in Genoa in July.
Before the summit, the Bretton Woods Project will produce a briefing on the World Bank’s health agenda and the new global health fund. See social issues topic page.
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