September 27, 2011 10:46 pm

Global health fund plans radical shake-up

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The world’s largest funder of global health is set to radically shake up the way it disburses and manages donor money, in a move to boost efficiency that could reallocate a third of its financing in order to save more lives.

The board of the UN-backed Global Fund Against Aids, TB and Malaria, which channels $3bn a year in governments’ money to fight the killer infectious diseases in the developing world, will in November discuss revising its focus on “country ownership”, by which countries themselves set priorities on how to spend donor money.

The action comes at a time of criticism of the fund’s governance by an independent panel of leading officials, against a backdrop of increasing strains on generating fresh money following the international economic slowdown.

Michel Kazatchkine, executive director of the fund, told the FT there was likely to be a shift towards far greater “informed demand”, with officials “engaging in an active dialogue to focus more on high burden countries and where we can have the greatest impact”.

He said he was looking at ways reallocate existing funds and considering delaying the next round of fundraising scheduled for May 2012 as signs grew that only half of previous forecasts of $1.6bn from donors would be available. The EU, Denmark, Italy and Sweden are among countries yet to disburse €300m pledged this year alone.

The fund’s board on Tuesday separately supported recommendations by an independent review panel which criticised the governance of the organisation, insufficient supervision of its secretariat, weaknesses in grant management and recipient countries which did not take sufficient responsibility for programmes.

Mr Kazatchkine said there was a need to give greater priority to countries that bore the greatest burden of infectious disease, and to reallocate spending towards programmes that were most effective in those countries in reducing deaths and infections. He cited likely cancellation of support for a prison TB project in Russia.

Other shifts will include better use of diagnostics to identify when to use drugs; improved combination treatments to reduce HIV transmission from pregnant mothers to children; and a shift away from “generalised” HIV prevention education to more “targeted” programmes in countries where the virus is transmitted primarily by injecting drug users or among gay men.

Rifat Atun, director of strategy, performance and evaluation at the fund, said: “This would be a huge shift from the current pattern that emphasises disbursement of funds towards a more evidence-based approach.”

He said preliminary calculations showed that from $2bn earmarked for tuberculosis alone during 2011-15, improved programmes could save a further 600,000 lives rather than 400,000 by continuing with the current approach. He estimated a similar impact across the fund’s portfolio by shifting a third of its money to save a third more lives.

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