The Global Fund is the largest multilateral funder of HIV, malaria and TB programmes in developing countries. When the organization was first created in 2002, only 40,000 people living with HIV in low- and middle-income countries were receiving lifesaving anti-retroviral drugs. The latest 2010 UNAIDS statistics (UNAIDS World AIDS Day Report 2011 pdf) display an encouraging picture and show that the world can eliminate new HIV infections in children, if it wishes to do so. The report claims humanity has finally “bent the HIV/AIDS curve”, citing a descending trend in new HIV infections and AIDS-related deaths over the past decade and the stabilization of the number of people living with HIV worldwide.
So there is momentum, spurred in large part by new scientific discoveries. Enter the ‘historic’ Global Fund Board meeting in Accra. On Tuesday, November 22, the board of the largest provider of antiretroviral therapy in the world, took the unprecedented decision to cancel Round 11 of funding.
The reason for the financial difficulties faced by the GF – as expressed by the Board - echoes previous predictions by Murray et al. that the global economic crisis that began in 2008 would probably jeopardize the capability of the richest countries to meet their pledges.
Even if Stuckler et al. found no robust evidence to support the hypothesis that recessions lead high-income countries to reduce their total development assistance for health, the fear that governments will (ab)use their dire economic situation to cut back state funding for health is far from imaginary, and there may be several other reasons, hidden or not. Keep in mind the recent DFID Aid Withdrawal in Malawi.
Canceling a full round of funding is an unparalleled event in the 10-year history of the organization. Needless to say, the decision has several (dire) implications.
As no new patients will be able to begin treatment (at least in a number of countries), already long treatment waiting lists will become even longer. According to Médecins Sans Frontières, “the devastating effects of the overall funding shortage are already becoming clear. Cameroon and Zimbabwe may soon no longer be able to support people already on treatment, and the Democratic Republic of Congo is capping the number of people able to start ART. In other countries, such as Mozambique, funding problems have prevented the country from providing earlier treatment and better drugs, per WHO-recommended guidelines.”
The Fund’s Executive Director, Michel Kazatchkine, said: “It is deeply worrisome that inadvertently, the millions of people fighting with deadly diseases are in danger of paying the price for the global financial crisis.”
Round 11 was launched in mid-August 2011. The deadline was supposed to be mid-December 2011. I am very curious to know whether your country had submitted a proposal (or was about to submit one) for round 11? If so, what could be the next step now that this round is cancelled?
Governments in recipient countries will probably need to reconsider inter and intra sector budgetary arbitration through more transparent budgeting practices.
What does the future of the fight against AIDS, TB and malaria in Africa look like amidst shifting political agendas and the global economic crisis?
While contributions to ‘trendy’ agencies like GAVI have exceeded expectations, the world has failed to adequately fund the Global Fund. Are we about to enter another period of increased competition for resources among the many important global health priorities? Meanwhile, Shafik anticipates that an increasing share of aid will go to tackling other global public goods such as climate change and conflict prevention. So the future looks gloomy.
However, recession does have at least one advantage. It invites us to make sure that the money we spend on health is spent wisely and that budget estimates are based on money we are sure to mobilize. The Busan conference on aid effectiveness is already behind us, but it will remain urgent in the coming years to take another close look at concepts like accountability of donors and recipient countries, and the predictability of aid.
A major lesson of this unprecedented GF decision is that developing countries that are able to raise more domestic revenue will need to do so, and realize that foreign aid should be the exception and not the rule. In other words, they will have to become less reliant on international donors. Even when enjoying the horseback ride, one should always keep in mind that one day, the horse may either suffer from a broken leg or simply refuse to go further.
Now that the financial crisis has brought to light the fragility of Western economies, developing countries must increasingly look domestically in their quest to mobilize more resources for health. Otherwise, how will they ever get off the foreign aid bandwagon which proves – time and again - so unpredictable?