I would encourage a discussion through the PHA-exchange and afro-nets on the strengths and weaknesses of this proposal. To start it off:
Strengths: For many years health activists have complained that vertical programming fractures health system development. The Global Fund has begun to allocate more of its funding (though still only a small amount) towards health system strengthening. Fractured health systems are unable to ensure coverage with existing vaccines, much less new ones. Rather than create new funding bodies to disburse resources for health system strengthening, it makes more logistical sense to reform existing mechanisms such as GAVI and The Global Fund to incorporate such work. Hence the commitment to undertake financing for health system strengthening by these two organizations is good news.
Weaknesses: There are no details in the letter about what this would look like. Is this an effort by two organizations to become THE conduit for multilateral donor assistance to strengthen health systems? A concern here may be that there is no information about what these organizations consider to be a health system, or its strengthening. The emphasis in the letter on results-based, focus and increased efficiency, without also referring to important IHP principles of country ownership, community participation and so on in the creation of health system strengthening plans, could lead to ‘cookie-cutter’ approaches to health system funding.
These comments are only conjectures. I am not intimately familiar with the workings of the two organizations. I think that those on this exchange who are should offer some comments. These comments ideally, and within a short time period, should be consolidated into a letter to the two organizations seeking clarity about what it is they are intending to do, that is, to request an elaboration on the details of their proposal.
Another comment:
What happens if the GFATM becomes a Global Health Fund in the short term AND there is NO change in thinking about fiscal space and sustainability? For me, this is the most likely and worst case scenario. There are strong forces pushing towards short-term radical horizontalism. There are NO strong forces pushing for new conceptions of fiscal space and sustainability and these new conceptions run into larger opposition based on the implications for macroeconomic policy.
So, please tread carefully.
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Ronald Labonte
mailto:rlabonte@uottawa.ca