The experience of GAVI and the Global Fund's targeted health initiatives shows that simple and fast results are not in conflict with more complicated and long-term solutions. The question is whether these experiences from the health area can be applied in other areas, such as the climate. It writes Anders Nordström, Sweden's ambassador for Global Health.
Simple means and quick results have often been criticized for being less good aid. Targeted efforts and vertical funds, many believe, undermine the very foundation of sustainable development based on an understanding of how complex reality is.
Of course, I share the view that development and the conditions for poverty reduction require knowledge of and a strategic approach to a multidimensional problem and solutions, but I also want to argue that targeted efforts can lead to broader development effects.
Just over 10 years ago, two specific global funds were created in the field of health. One to increase access to vaccinations (GAVI) and one to tackle the three diseases AIDS, tuberculosis and malaria (The Global Fund to fight AIDS, TB and Malaria). These initiatives had to endure a lot of criticism for being too vertical and not contributing to more sustainable systems in the countries.
We can now state 10 years later that these initiatives have contributed to millions of people surviving and today living healthy and productive lives. The fact that child and maternal mortality has decreased as rapidly as it has in Africa can in all probability be attributed to these efforts. The effects are not only healthier but broader than that. Reduced incidence of malaria and fewer people infected with HIV and dying from AIDS means that countries do not lose educated labor. Many companies in Africa testify to how important these efforts have been for production and profitability. Healthy employees are also more productive. Poor people who have the opportunity to stay healthy have greater opportunities to improve their living situation.
The Global Fund's replenishment conference for the next three-year period has just ended in Washington and the result was close to SEK 80 billion (!) In new resources for the period 2014-16. The Global Fund is thus the largest development financing mechanism in the world today, second only to the World Bank's IDA.
Through very active board work, Sweden has succeeded in changing the Global Fund's working model very radically. From a system of applications that were sent to Geneva and where after a long time you received a positive or negative message, the financing of initiatives today takes place in a much more strategic way. Based on an assessment of the country's health situation and its own ability to be able to finance the activities, a tentative allocation of a certain "resource envelope" takes place. This contains partly a base plate and partly a part that depends on quality and performance. A negotiation then takes place where the Global Fund's resources become part of the financing of the national program and contribute in a way to a more integrated and sustainable national system.
Furthermore, Sweden has pushed through a strengthened system for identifying and managing risks with a focus on reducing the risks of corruption.
The results of both GAVI and the Global Fund are impressive;
- The number of people who have access to antiretroviral drugs in the last year alone has increased by 21% to 5,3 million (2013).
- The number of pregnant HIV-positive women reached by treatment for themselves and to prevent transmission to the child increased from 1,7 million to 2,1 million women.
- At the same time, the number of malaria cases treated increased by 13% to a total of 330 million. In the first half of 2013 alone, 30 million mosquito nets were distributed.
- A total of 145 million children in the world were vaccinated in 2013 with support from GAVI, which was 48 million more than in 2012. This in turn led to the lives of 2 million children being saved.
Taken together, these efforts have contributed to a significant reduction in maternal and child mortality in several low-income countries. The conclusion is that resources are also needed for basic service and give clear results in a nutshell and long term. Improved health and survival are a prerequisite for poor people to be able to move on in life. It is also an important contributing factor to a positive demographic and economic development where e.g. gender equality and the situation of women and girls is central.
Directed, or so-called vertical, efforts are not sufficient or sustainable in the long run. Therefore, Sweden has actively worked in the board of the Global Fund and GAVI to change the financing model itself, which is now happening. The Global Fund is now submitting an application procedure with Geneva at the center of a system of negotiated and to some extent predetermined land grants with the respective countries' governments at the center. Where financial sustainability and efficient health systems are emphasized.
The question is what can we learn from these successes when similar structures are established for e.g. climate issues. In my opinion, there is a lot to learn as we also have to deal with the more specific related needs in terms of climate issues, while at the same time taking a more long-term development and sustainability perspective on our work. There is no contradiction in that.
Nordström is different
Ambassador for Global Health
Ministry of Foreign Affairs