Summary of discussions from the four languages (February 2008)
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02-29-2008 10:12 AM
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Switzerland
Global Fund Secretariat
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Summary of discussions from the four languages (February 2008)
Vertical vs. Horizontal Approaches to global health challenges
Two demographics need to be considered when deliberating over the best approach to health care systems – children at risk of dying before their 5th birthday, and those living with HIV, also at risk of not surviving longer than 5 years due to unsustainable drugs programs. Obviously, the hope for survival for these two groups lies in the assurance that such health programs will continue beyond 5 years. Which approaches can therefore give them this hope? [Read full text]
I think that the diagonal approach will still have the same effect of 'quick wins', 'JUST spend the money, prove it' as the vertical approach. But the truth of the matter is that Health Systems Strengthening is primarily the responsibility of the government in the recipient country. They are the ones that should be held accountable and not the Global Fund. [Read full text]
I would like to refer to the LA Times article "Unintended victims of Gates Foundation generosity", to which the Global Fund released a statement. The article brought to the fore a very important matter, but failed to provide holistic solutions to the dilemma caused by vertically implemented health programs. The regulation and management of health systems is primarily the responsibility of the government of the recipient developing countries.
One of the major problems we have in Africa is poor leadership and the "failure" of vertically implemented public health programs lies squarely on the shoulders of the government of these countries, and not on the good gestures of development partners and donor agencies. Nevertheless, the Global Fund should use its powers to set some rules that will require that potential recipient countries show visible, tangible and concrete evidence that they have health systems, and that are working before they are qualified to receive more grants. It must be noted that if these funds had not been poured into Africa we would be worse off. The fact that many programmes, like the one in my native Nigeria, have been running for two years now is a miracle, where things are just beginning to work. [Read full text]
By Gabrielle Appleford, Not currently affiliated with the Global FundWhile I acknowledge that governments do have ultimate responsibility for the state of their health systems, the Global Fund also has responsibility for ensuring that the programmes that it funds will not undermine or overwhelm fragile health systems. Balance can and should be struck between horizontal support for health systems and the vertical delivery of specialised products and services for disease specific programmes. The Global Fund has acknowledged the need for HSS; however it has also sent mixed signals to countries in terms of what is permissible under this. It is important that Global Fund resources catalyse HSS in countries where this is not being adequately addressed. In countries where it is, the Global Fund can support this by ensuring that their funding is ‘joined up’ with HSS strategies articulated in national health plans and supported by other development partners. [Read full text]
On Health Systems Strengthening in Developing Countries - Remuneration for Healthcare Providers
The topic of "Health Systems Strengthening" needs to be discussed further among the development sector stakeholders. The Global Fund is channeling a lot of funds to poor countries, and for this reason, it has gained the support of many developing countries. But it is the Global Fund’s approach to health systems – that national responses must be both comprehensive and holistic – that is its most powerful tool. If the Global Fund succeeds in supporting developing countries to have well performing health systems in place, this could be one of the most important achievements of the development sector in recent history. Durable impact will only be achievable through well structured and well managed national health systems. It is the responsibility of the international community to work with the Global Fund in this area. In addition to funds already committed for the day-to-day fight of the three diseases, the Global Fund will have to raise significant levels of unrestricted funds to develop contextually adapted health systems with appropriate resources. [Read full text]
I believe there needs to be a serious paradigm shift in the fundamental principles of the Global Fund in how it measures the success of programs in terms of performance, to measuring success in terms of impact. No impact can be expected if countries have not been implementing HSS strategic actions as they indicated when they filled out the GF forms. After Seven Rounds of Funding, it is time to evaluate the impact of programs on the basis of health systems in those countries. The emphasis on performance has been counterproductive in that it has put pressure on GF implementers to just produce routine data, which is the case for many vertically implemented programs. [Read full text]
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