by Beatrice M. Spadacini, Health Journalism Network Manager
On September 22, one day after the end of the 7th Replenishment Conference of The Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund), the Health Journalism Network hosted a Twitter Spaces event to reflect on the outcomes of this global health financing effort, which raised over US$14 billion. Despite falling slightly short of its US$18 billion goal, The Global Fund still managed to raise a record-breaking amount of funding towards combatting these diseases and building the foundation for pandemic preparedness. Most importantly, some commitments came in from countries that had never pledged before. This is remarkable, considering all the competing budget priorities that countries face amidst climate change, widespread food insecurity, and pandemic recovery across multiple sectors.
18 African countries are global health donors
“For the first time in the history of The Global Fund, African countries stepped into the leadership role,” said Rosemary Mburu, global health advocate with WACI Health in Nairobi, Kenya. “It matters that African countries can put money on the table. It matters because it changes the narrative and the conversation that African countries are not just recipients or implementers. They are stepping up into the donor role, which is very encouraging, especially because we need to rethink the AIDS architecture. Some of the African countries that pledged were donors for the very first time.”
Mburu was in conversation with Chris Collins, President and CEO of Friends of the Global Fight, an organization that advocates for U.S. support to end AIDS, tuberculosis, and malaria. Neha Dixit, an investigative health reporter from India, moderated the discussion and asked questions to help other media professionals understand how this financing mechanism works and why is it critical for improving health outcomes. Collins and Mburu both emphasized the participatory nature of The Global Fund and the role that governments play in setting their own health priorities and raising additional resources.
A financing model that promotes participation, collaboration, and partnership
“During the COVID-19 pandemic, we saw a failure of global solidarity and a failure of the North to think globally,” said Collins. “It’s a real shame and it prompts interrogation. We have realized that the old model of global health aid needs to be revised to become a partnership model. We need to move into a much more collaborative way of advancing health equity. People are realizing that The Global Fund is perhaps the best model that exists out there that fosters participation, collaboration, and partnership.” Civil society and community engagement are especially critical in defining the global health agenda.
Countries that receive funding from The Global Fund are required to contribute a percentage of the total amount from their own domestic budgets. The goal is to ensure that countries commit their own resources towards their health priorities. “The Global Fund structure helps to catalyze resources from national governments,” said Mburu. “It’s a collaboration that brings in external money. For example, in this granting cycle we are still aiming to raise US$ 18 billion to invest over the next three years. This will spur about US$59 billion in domestic resources [from recipient governments], which is real progress.”
Preparedness must be intentional and focused on strengthening health systems
After almost three years of living through a pandemic, the conversation inevitably shifted towards preparedness. Both speakers underscored that The Global Fund already invests in strengthening various aspects of health systems, but that we need to be more intentional going forward.
“I don’t think we should be having the preparedness conversation by saying that we have created a new fund. Global Fund investments, and similar investments, are all about preparedness. Preparedness is not about buying a diagnostic machine and putting it on the shelf. It is about making investments that can help people today to get the support they need,” said Collins. Many studies, he added, confirm that about one third of global fund investments end up strengthening pandemic preparedness. “This is not surprising, after all, the best way to prepare for the next pandemic is to deliver health services today,” he said, “and to strengthen health systems, invest in community health workers, laboratory surveillance, supply chain, procurement systems, etc.”
The COVID-19 pandemic confirmed the critical role that first responders played around the world. “In many of our countries, the pandemic response was riding on the previous Global Fund investments, especially on community health workers. They were the guardians of our continent, moving from one community to another and from village to village. They were delivering information, services, figuring out what was going on at the community level. This was the infrastructure and the framework that was used, even for disseminating commodities, including PPEs and information on vaccinations.”
The role of the media in ensuring that global health investments save lives
Journalists always have an important role to play when it comes to accountability and putting a human face to global health problems and solutions. “We need journalists to look at all aspects of global health investments,” said Collins. “How successful is programming? Are the investments driving down incidents and mortality in the three disease areas? To what degree are those investments, truly strengthening health systems and solidifying preparedness for the future?”
On this point, Mburu added, “I think the story behind the money matters a lot. That is what communities bring to this space. It is about lives saved, new infections averted, and households supported because there is wellbeing within the family,” emphasized Mburu. “These are the stories of impact that really help with resource mobilization because you need to see the value for the money.”
While the conference may be over, fundraising for The Global Fund goes on. Thus, telling the story of inaction, said Mburu, is equally important. “What does a shortfall really mean? The investment case tells us that if we raise US$18 billion, we are going to save an additional 20 million lives. So, if we don’t meet US$18 billion, are we saying that we are missing out on saving a particular number of people?”
At the end of the day, a shortfall not only sets a bad precedent but also lowers the bar for all future fundraising efforts. It basically says, it is ok to shortchange people and gamble with their lives.
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