The belief that global health initiatives such as PEPFAR and the Global Fund are not strengthening health systems is a myth, Global Fund executive director Michel Kazatchkine told reporters in Cape Town today.
Speaking at the Fifth International AIDS Society conference, Dr Kazatchkine said that PEPFAR and the Global Fund to Fight AIDS, TB and Malaria are probably the largest funders of health system strengthening efforts. Over the past six years, he said, around $4 billion, one-quarter of the Global Fund’s grants, have been devoted to health system strengthening.
What is more, he pointed out, the Global Fund is funding the priorities identified by countries rather than imposing a donor agenda on health ministries. Critics of global health initiatives have claimed that national priorities are distorted by the priorities of donors and the availability of new money.
Professor Kazatchkine was speaking after an International AIDS Society workshop on the impact of HIV programmes on health systems, which looked at ways in which health system strengthening activities could be made more effective.
Last month a report by the Positive Synergies working group, a collaboration of health systems researchers supported by the World Health Organization, noted that on balance global health initiatives were having positive impacts on health systems, but said more research was needed to understand the long-term effects.
Professor Alan Whiteside of the University of Kwazulu Natal, who has been monitoring the impact of HIV on economies, societies and health systems in southern Africa for more than 15 years, said that HIV would require long-term investment.
“HIV is a long-term problem. We are going to need continued aid for some 20 to 30 years for some countries, and we need long-term commitments to strengthen health systems.”
He drew attention to recent research by his group on health system capacity in southern Africa, which showed that the worst health service outcomes were occurring in the countries with the highest HIV prevalence, due to the attrition of doctors and nurses by the disease.
“I find it quite incredible that we haven’t scaled up our training of health care workers in South Africa,” he said, suggesting that South Africa needs to look at innovative ways of expanding health service capacity, such as task shifting.
He also emphasised the need for governments in the South to be held accountable by their own inhabitants for their failures to invest in health care.
But all countries also needed to know that long-term sustained funding would be available for AIDS and for health system strengthening, he went on.
AIDS advocates were told that it would be very difficult to fund HIV treatment, said Dr Kazatchkine, “but what AIDS has shown is that when the world decides to come together around a goal it is possible to achieve [extraordinary things]. Now we are being told it is very difficult to find money for AIDS and health, but money was found to bail out the banks last year and I’m sure that if we have pandemic influenza in the autumn, the money will be found. We need to develop better advocacy arguments for increased funding.”