IN THE print edition this week, we have a piece on the Global Fund, the main multilateral agency dealing with AIDS, tuberculosis and malaria, and the difficulties of extracting money from donors in these austere times. Here on Baobab, we have delved deeper into the issue.
Before the meeting the Global Fund distributed three hypothetical financing scenarios to show what was at stake. In the first scenario, the fund gets $13 billion, the minimum investment needed for the organisation to tread water. In practical terms, this would result in 4.4m people being on antiretroviral therapy, compared with 2.5m in 2009 (and compared with the current global need, estimated at 15m). The annual distribution of insecticidal nets would reach 110m, saving an estimated 16m life-years. The prevention of mother-to-child HIV transmission would reach 610,000 mothers annually compared to 345,000 in 2009. In scenario number two, it gets $17 billion, the minimum to ensure that progress can be maintained. In the final option, it gets $20 billion which would allow faster progress towards achieving the health-related Millennium Development Goals (MDGs).
When the party was over the Global Fund was left with $11.7 billion in pledges, not even enough to keep treading water. In development, disappointment and cynicism are commonplace. But the fact that the Global Fund could be so under-funded just weeks after the world pledged anew its commitment to the MDGs still comes as a shock.
The problem is not that the donors think that the Global Fund is an ineffective health financing mechanism. An independent report by the EU found that aid disbursed through the Global Fund had made a significant contribution to tackling HIV/Aids, tuberculosis, and malaria. Recent research from the Centre for Global Development paints a positive overall picture of the fund.
According to a recent study on malaria financing by a research programme in Nairobi, global funding for malaria is already 60% short of the $4.9bn needed to properly control the disease in 2010. Precise funding allocations haven't been announced but past trends give some clues. The Global Fund has historically allocated 29% of its budget to combat malaria and so it probably spent about $795m on malaria in 2009—around 40% of global malaria spending. Financing for the Global Fund will be up by roughly 20% from 2008-2010, this will remain far below what it needed to guarantee coverage.
Multilateral aid makes it hard for individual countries to take credit because it obscures the ultimate source of funding. So some hope that governments may increase their giving rather than giving more to the Global Fund. This is unlikely though so the challenge will be to find more money. According to Professor Bob Snow, one of the authors of the study mentioned, this should include putting pressure on malaria-endemic countries with large domestic incomes—such as Gabon and Equatorial Guinea—to do more to help themselves. "A failure to maintain the momentum will mean money spent so far will have been for nothing" said Mr Snow. Existing treatment levels will be maintained under the minimal Global Fund replenishment but a smaller proportion of the infected will be treated as these diseases continue to spread.
There is a sense in the aid community now that efficiency appears to strictly mean "more with less". Not that aid commitments were on track before the recession. But global debt and widespread belt-tightening are likely to provide convenient excuses. The latest OECD estimates suggest that rich countries will fall short of their promises for 2010 by $20 billion and won't come close to their commitment to provide aid equivalent to 0.7% of GNP. Some countries, such as the Nordic ones and Britain, might but a lot of it could be through clever accounting.
One encouraging shift in the global development effort is that the donor roster is growing. If aid from the West suffers it will be partially offset by aid from non-traditional sources, such as Brazil, China and other emerging economies—what the development community refers to as "south-south co-operation". It was estimated that these new donors contributed between 8%-10% of total aid in 2006. But the interventions of this new club of donors tend to focus on infrastructure, agriculture and opening up the extractive industries rather than health.
Ultimately, African governments will need to cover costs in the health sector. According to Paula Akugizibwe, Advocacy Coordinator for the AIDS and Rights Alliance for Southern Africa, "the colossal funding gap will test the strength of African governments' rhetorical commitments to the fight against HIV". Unfortunately, African governments don't have a great track record with respect to fulfilling promises to their citizens either. Overall, the outlook appears bleak for the global fight against disease.
