PHM-Exch> Fwd: [health-vn] Towards a global fund for the health MDGs?

[Claudio Schuftan]

From: Vern Weitzel <vern.weitzel at gmail.com>
crossposted from: "[health-vn discussion group]" health-vn at anu.edu.au



The Lancet, Volume 373, Issue 9681, Page 2110, 20 June 2009
doi:10.1016/S0140-6736(09)61148-X Cite or Link Using DOI

Towards a global fund for the health MDGs?
Alvaro Bermejo a

Giorgio Cometto and colleagues (May 2, p 1500)1 propose an expanded
remit for the Global Fund in order to achieve all the health Millennium
Development Goals (MDGs). The International HIV/AIDS Alliance welcomes
this new and innovative thinking, particularly given the poor progress
on maternal health and the fact that the current financial crisis is
expected to cause an additional 200 000—400 000 children to die before
their fifth birthday. But this proposal also raises serious concerns.

The efficiency of health systems is positively related to health
expenditure per head. Performance increases greatly with expenditure up
to about US$80 per head per year. There is a minimum level of health
expenditure below which the system simply cannot work well,2 and much of
sub-Saharan Africa is well below these levels.

Without the necessary additional funding, this proposition will just
water down the Global Fund's current ability to deliver effectively and
make an impact. It will reverse the gains made in HIV, tuberculosis, and
malaria before they can be consolidated.

The Global Fund has produced some spectacular results delivering funding
for the three diseases. More than 2 million people are on antiretroviral
treatment, 4•6 million people are under treatment for tuberculosis, and
70 million bednets have been distributed. However, the Global Fund
currently faces a funding shortfall of $4—5 billion.

Expanding its remit even further would require a very significant
upfront funding commitment if it is to deliver tangible results.
The Global Fund is a model of successful health financing that is
delivering for those most vulnerable to HIV, tuberculosis, and malaria.
Jeopardising its ability to do this well would be a tragedy for the
millions who rely on its support.

I declare that I have no conflicts of interest.

References
1 Cometto G, Ooms G, Starrs A, Zeitz P. A global fund for the health
MDGs?. Lancet 2009; 373: 1500-1502. Full Text | PDF(63KB) | CrossRef |
PubMed
2 Evans DB, Tandon A, Murray CJ, Lauer JA. Comparative efficiency of
national health systems: cross national econometric analysis. BMJ 2001;
323: 307-310. PubMed
a Executive Director, International HIV/AIDS Alliance, Hove BN3 1RE, UK
________________________

The Lancet, Volume 373, Issue 9681, Page 2111, 20 June 2009
<Previous Article|Next Article>
doi:10.1016/S0140-6736(09)61150-8 Cite or Link Using DOI

Towards a global fund for the health MDGs?
Jeffrey D Sachs a, Paul M Pronyk a

In line with Giorgio Cometto and colleagues' Comment,1 we suggest that
the Global Fund should open three additional funding windows.
First, a health systems window would finance training and salaries of
community health workers and other professionals, alongside
construction, equipping, and maintenance of primary health facilities.

Second, a maternal and child survival window would enhance
facility-based services for antenatal care, safe delivery (including
emergency obstetric interventions), and newborn care,2 and structural
interventions to address major causes of child mortality including
diarrhoea, respiratory infections, and undernutrition.3

Finally, a neglected tropical disease window would finance an integrated
delivery package to control soil-transmitted helminths, lymphatic
filariasis, schistosomiasis, onchocerciasis, and trachoma.4

The Comment, however, misrepresented the perspective of the Harvard
Consensus Statement, suggesting it assumed that Africa's health systems
"were working reasonable well". The dismal state of public health in
Africa was in fact well known. Expanding antiretroviral treatment was
advocated because of the possibility to stop mass deaths from a
treatable disease. Furthermore, the Commission on Macroeconomics and
Health advocated a general scale-up of support for primary health,
including AIDS and other disorders.

The Commission called for donor support of 0•1% of donor gross national
product (roughly US$36 billion in current dollars).5 Actual donor aid
lags at around 0•04% ($12 billion). We are not overspending on AIDS but
underspending on the rest.

These needed sums are paltry relative to military spending or the bank
bailouts. The Global Fund offers an effective financing mechanism. The
choice is not between AIDS, health systems, and other Millennium
Development Goals. We can and must support them all.
We declare that we have no conflicts of interest.

References
1 Cometto G, Ooms G, Starrs A, Zeitz P. A global fund for the health
MDGs?. Lancet 2009; 373: 1500-1502. Full Text | PDF(63KB) | CrossRef |
PubMed
2 Kerber KJ, de Graft-Johnson JE, Bhutta ZA, Okong PAS, Lawn JE.
Continuum of care for maternal, newborn, and child health: from slogan
to service delivery. Lancet 2007; 370: 1358-1369. Summary | Full Text |
PDF(209KB) | CrossRef | PubMed
3 Ekman B, Pathmanathan I, Liljestrand J. Integrating health
interventions for women, newborn babies, and children: a framework for
action. Lancet 2008; 372: 990-1000. Summary | Full Text | PDF(239KB) |
CrossRef | PubMed
4 Hotez P, Molyneux DH, Fenwick A, Savioli L, Takeuchi T. A Global Fund
to fight neglected tropical diseases: is the G8 Hokkaido Toyako 2008
Summit ready?. PloS Neglect Trop Dis 2008; 2: e220. PubMed
5 Commission on Macroeconomics and Health. Macroeconomics and health:
investing in health for economic development. Geneva: World Health
Organization, 2001.
a The Earth Institute, Columbia University, Broadway and 116th, New
York, NY 10027, USA
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