By JEFFREY D. SACHS
WORLD leaders will come together at the United Nations in September in order to accelerate progress towards the Millennium Development Goals (MDGs).
Three of the eight MDGs involve bringing primary health services to the entire world’s population.
A small amount of global funding, if well directed, could save millions of lives each year.
The key step is to expand the Global Fund to fight AIDS, tuberculosis, and malaria into a Global Health Fund.
The Global Fund was created in 2002 to help the world battle those three killer diseases, and its accomplishments have been spectacular, making it arguably the most successful innovation in foreign assistance of the past decade.
As a result of Global Fund programmes, an estimated 2.5 million people are on antiretroviral AIDS therapy.
No fewer than eight million people have been cured of TB.
And more than 100 million long-lasting insecticide-treated bed nets have been distributed in the fight against malaria.
In total, studies suggest that Global Fund programmes have saved five million lives.
The Global Fund’s remarkable successes result from its operational procedures.
Disease-specific committees, called the Country Coordination Mechanism (CCM), are constituted in each developing country.
Each CCM is chaired by the national government, but incorporates input from non-governmental organisations to formulate national-scale, disease-specific plans for submission to the Global Fund.
Once the Global Fund receives these plans, they are sent to a technical review panel (TRP) to check that the plans are scientifically sound and feasible. If the TRP approves, the plan is sent to the board of the Global Fund, which then votes to approve financing.
Once the programme gets underway, the Global Fund follows its implementation, undertaking audits, monitoring, and evaluation.
Since 2002, the Global Fund has approved around US$19 billion (K54 billion) in total funding.
There are two huge challenges now facing the Global Fund, and especially the donor countries that support it.
The first is lack of financing.
The Global Fund has been so successful that countries are submitting increasingly ambitious programmes for consideration.
Unfortunately, the Global Fund is already in a state of fiscal crisis.
It needs around US$6 billion (K17 billion) a year in the next three years to cover expansion of programmes for the three diseases, but it has only around US$3 billion (K8.5 billion) a year from donor countries.
Unless this is corrected, millions of people will die unnecessarily.
The second challenge is to broaden the Global Fund’s mandate.
So far, the Global Fund has addressed MDG 6, which is focused on the control of specific killer diseases.
Yet control of these three diseases inevitably involves improvement of basic health services – community health workers, local clinics, referral hospitals, emergency transport, drug logistics – that play a fundamental role in achieving MDG 4 (reduction of child mortality) and MDG 5 (reduction of maternal mortality).
All three health MDGs are interconnected; all are feasible with an appropriate scaling up of primary health services.
The obvious step to address MDGs 4 and 5 is to explicitly expand the Global Fund’s financing mandate.
Many programmes, such as those in the millennium villages project, already show that a scaling up of primary health systems at the village level can play a decisive role in reducing child and maternal mortality.
Expanding the Global Fund’s mandate to include financing for training and deployment of community health workers, construction and operation of local health facilities, and other components of primary health systems could ensure the development of these local systems. – Project Syndicate
*Jeffrey D. Sachs is Professor of Economics and Director of the Earth Institute at Columbia University