PHA-Exch> From the Global AIDS Response towards Global Health?

[Claudio Schuftan]

Food for thought….and for your comments:



*From the Global AIDS Response towards Global Health?*

Gorik Ooms

January 2009 (excerpted)





If we agree that *health is a human right* for all human beings, there must
be a globally shared responsibility for the health of all people.

This is not merely a truism. The right to health is subject to progressive
realization  – countries must realize it step by step – but also to
immediate realization: there

is a minimum level, a core content that countries must realize immediately.

Realizing this minimum level is too expensive for low-income countries.
Therefore, the right to health can only exist if low-income countries are
entitled to assistance from high-income countries.

Thus, health can only be a human right for all human beings if there is a
globally shared

responsibility for the health of all people.

We should take all donor agencies endorsing health as a human right at their
word If health is a human right, there must be an international obligation
responding to an international entitlement.

The collective entitlement and collective obligation create a challenge
which cannot be

tackled with legal theory alone. We need a pragmatic solution.

The Global Fund demonstrates that a pragmatic solution is feasible. However,
the Global Fund should become a Global Health Fund in order to achieve this.

When the Global Fund was created, it held the promise of becoming a US$10
billion per year fund.

The prospect of ‘unlimited’ funding encouraged many countries to develop
ambitious proposals to fight AIDS, tuberculosis and malaria, reflecting
their countries true needs and intentions.

To achieve similar progress for comprehensive primary health care, the
expectation that sufficient long term funding could be available is needed.

The principles of the Paris Declaration on Aid Effectiveness – ownership,
harmonization, alignment, results and mutual accountability – are
meaningless if the point of departure is insufficiency of financial
resources.

The Global Fund has demonstrated how all those principles can become reality
if they are backed by a real commitment from all stakeholders.

The transformation of the Global Fund into a Global Health Fund is not an
idle wish or an

imaginary nightmare: it is already happening.

At present, 13 countries are developing national compacts and in 2009 they
will probably submit applications based on these compacts to the Global
Fund.

The question as to whether or not the Global Fund will be enabled to finance
those compacts integrally needs to be answered.

This perspective provides an opportunity and a threat. The opportunity is
that

comprehensive primary health care will benefit from the innovations obtained
in the fight

against AIDS, tuberculosis and malaria: the exceptional momentum will be
broadened. The threat is that interventions to fight AIDS, tuberculosis and
malaria will again be forced to comply with the rules of the ‘Ancien Regime’
of health development, i.e.,  preoccupations over sustainability and fiscal
space that perpetuate the under-funding of anything that requires long-term
external support, and has no real involvement from civil society.
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