The Global Financing Facility – the mechanism set up by the World Bank to support women’s children’s and adolescents’ health funding – could run the risk of seeming all things to all people. In any discussion about global health, the GFF is being proposed as part of the solution.
Some people are supporting its replenishment because it is another mechanism to move aid from donors to recipient countries. Like Gavi the vaccines initiative, or the Global Fund to Fight AIDS, TB & Malaria, it is right to generate donor resources for health improvements in low and middle-income countries. Unlike Gavi and the Global Fund, the GFF has a much broader remit – women’s, children’s and adolescents’ health – and can support comprehensive primary health care services that help a country to build Universal Health Coverage. At Save the Children, we know that ending preventable child deaths from causes such as pneumonia can only be done through a comprehensive and universal health system. This is a welcome antidote to the way that donor aid is often fragmented by disease or service. However, the amounts that the GFF is seeking to raise for its Trust Fund are quite modest – $2 billion dollars is its target – and the GFF is not aiming to try to raise this money again in the future as it does not intend to become a permanent fund.
For the World Bank – and for others who see that, in a time of stagnating resources, innovative solutions are needed if countries have any hope of making fast progress towards the Sustainable Development Goals – the GFF is important because it is a mechanism to get countries to make better use of World Bank money. Health and nutrition often miss out on International Development Association (IDA) and International Bank for Development and Reconstruction (IDRB) grants and concessional loans as they are traditionally used for economic infrastructure. World Bank President Jim Kim is pushing countries to use these facilities for health and the GFF mechanism is already showing results. However, loans have to be repaid and are suitable for investments but not for the ongoing running costs of a functioning health service.
For me, the GFF is most exciting as an opportunity to encourage countries to increase their own domestic resources for health and nutrition. The only substantial and long-term solution is for governments to tax fairly and allocate sufficient resources. This is especially true as countries transition from aid mechanisms like Gavi and the Global Fund. Many countries should and could be raising more tax from income, land and natural resources and preventing poor people having to pay cash (if they can afford it) for services.
As I’ve written before, the UK Secretary of State for International Development, Penny Mordaunt, seems to share our view, saying that countries need to be putting their hands in their own pockets as well as using aid. The UK has had a great history of supporting national heath systems as well as supporting Gavi and the Global Fund. So far, the UK has not committed to support the GFF in any substantial way and we are calling on it to make a one-off investment for the replenishment of £100 million (10% of the billion they contribute to Gavi). But we are calling on them to use their role as donor, as they do very effectively with Gavi and the Global Fund, to shape the policies of the GFF so that it truly builds sustainable change in countries without creating new donor dependencies.