Cross posted from: "[health-vn discussion group]" health-vn@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