Building stronger health systems

I attended a two-day workshop last week organised by the Global Fund on the joint platform to strengthen health systems. The Global Fund wanted to update civil society (mainly ‘northern’ NGOs with few representatives from ‘southern’ civil society) on the progress of the initiative and to get our views on the direction the platform should take.

There is as yet no clarity as to how this platform will work: how national health plans will be assessed, how resources will be pulled if at all, and how they will be disbursed in country? The ‘how’ is still very much in discussion. The ‘whether it is worth it’ though is not up for discussion as the decision for the platform to go ahead has already been taken. But is it a worthwhile investment of time, energy and resources? Is it not yet another layer created by donors with no less burden on low-income countries seeking funding for health systems and hence yet more transaction costs?

Another crucial issue to which we did not get any satisfactory answer is the issue of resources. These discussions of a joint platform are a bit of a waste if no additional resources are allocated to support those countries wishing to strengthen their health systems.

Yet when asked the question, all 4 partners (The Global Alliance for Vaccines and Immunisation, The Global Fund, the World Health Organisation and the World Bank) agreed that the Taskforce report and the additional resources promised were a major disappointment.

We need a minimum of US$250 billion by 2015 to strengthen health systems and achieve the health-related MDGs. Yet the final Taskforce report proposes US$5.3 billion by 2015 only. A major disappointment indeed. It therefore felt that we were all sitting for two days to discuss an idea which 1/ was not necessarily that good and 2/ had no financial backing.

We also expressed concern around the performance of the health institutions involved in the platform, particularly the World Bank. This joint approach will give them increased power in defining what can or cannot be funded and what qualifies as health systems strengthening. But if their approach is not very successful in the first place should they have that power?

On a positive note, it was great to see how engaged civil society was, and how receptive the Global Fund was to new ideas and apporaches.

We will continue to call for greater budget support, accountability towards civil society by all actors, and progressive approaches that ensures that children, particularly those most vulnerable, are not forgotten.