Transcript Slide 1

The Health Systems Funding Platform:
Are We There Yet?
Peter Hill1, Peter Vermeiren2, Katabaro Miti3,
Gorik Ooms2, Wim Van Damme2
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2.
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School of Population Health, The University of Queensland, Brisbane
Institute of Tropical Medicine, Antwerp
Department of Political Science, University of Pretoria, Pretoria
The Letter
The Recommendation
Recommendation 9:
Establish a health systems
funding platform for the Global
Fund, GAVI Alliance, the World
Bank and others to coordinate,
mobilize, streamline and channel
the flow of existing and new
international resources to support
national health strategies.
The Reaction
Action for Global Health issues
1. Respective roles of the different partners
2. Structure of the new platform and
relationship with other donor agencies
3. Resources and funding streams
4. Universal access to health care and
vulnerable groups
5. Role and engagement of civil society
The Research Aims
• To document the perceptions of key
stakeholders of the development of the
Health Systems Funding Platform and its
governance, and
• To explore the relation between these
perceptions, current discourses in global
health governance, and the evolution of the
structure of the Funding Platform
Methods
• Global health policy/governance case-study
– Literature review and documentary analysis
– Participatory observation
• Researchers’ research and professional networks
• INCO-GHI collegial insights
– Key informant interviews
• 13 framing unstructured interviews
• 11 targeted semi-structured interviews on HSFP
Key Informants
Institutional Affiliation
Role
Function
Bilateral
Donors
Government
Multilateral
Agencies
GAVI
Global Fund
Academic
Institutions
Civil Society
X
Country
Partners
X
Board Member
X
Senior
Management
X
X
X
X
X
Program
Management
X
X
X
X
X
X
X
X
X
X
Policy
Analysis
X
X
Technical
Advisors
X
X
X
X
The Shift to HSS
• GAVI launched 2001 from Children’s
Vaccine Initiative: immunization focus
– 2005 HSS window: $800 million over 5 years
– Strong Secretariat support; Board ambivalent
• Global Fund launched 2002 to target AIDS
Tuberculosis and Malaria
– HSS focus Round 5, subsequently integrated
– 30-35% of allocations classified as HSS
Health Systems Funding Platform:
GAVI and Global Fund
• For both GAVI and Global Fund, response
equivocal—issues similar to HSS rounds
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Anxiety around ‘dilution of mandate’
Resistance from some advocates, donors
Debate over potential competition for funding
Questions on use of International Financing
Facility for Immunization (IFFIm) funding
– Donors not consistent in their Board positions
Health Systems Funding Platform:
GAVI and Global Fund
• But...
– Strong support from Secretariat: conviction that
HSS is the necessary next step
– Positive evaluation of the GAVI HSS window
– Potential to rectify Global Fund’s ‘messy’ HSS
– Awareness that continued gains are difficult
– Indications that HSS may increase donor support
– Task Force – and WB – looking for solutions
Health Systems Funding Platform:
the critical issues
• Opposition from outside the proposed
partnership coalesced around three issues:
– The funding for the Platform
• Its size, origins and opportunity costs
– The governance of the Platform
• The partners, their histories and proposed roles
– The scope of the proposal
• Was this a ‘global’ initiative?
• Was it about HSS or HS? And why did it matter?
The funding
• Strategic approach to Taskforce for Innovative
International Financing for Health Systems
• A series of (unrelated) calls for a ‘Global Fund
for health’ raised a climate of expectation
• Innovative Funding Facility for Immunization
(IFFIm) funding raised questions
• Expectations high - but the Global Financial
Crisis intervened
The Governance
• World Bank interests in health systems
historically in tension with WHO
• NGO opposition to WB (post structural
adjustment) both ideological and pragmatic
• ‘Division of labour’ between WB and Global
Fund contested
• Engagement with Civil Society, transparency
and processes of funding approval different
The Scope
• Product of projected funding and proposed
governance raised questions of scope:
– Was this to presage the ‘global fund for health’?
• More difficult questions around the (re)defining
of HSS, and through that HS
• Would HS, defined through the prism of
‘vertical’ HSS perspectives, be distorted?
• And who would ‘own’ the agenda?
The resolution (for the moment)
• Global Financial Crisis impact on funding,
recent replenishments mean modest resources
• Single GAVI/Global Fund application (but
not common funding pool)
• World Bank processes unchanged
• Commitment to IHP+/Paris Principles
• Shifts focus to National Health Plan and Joint
Assessment of National Strategies
But this is a work in process...
• Agreement to common:
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National health plan
Financial management processes and audit
Shared procurement systems
Reporting system and indicators
• Nepal signed up – plan for 4 countries in 2011
• But personnel changes at GAVI and caution at
Global Fund could block expansion of this.