The Fantastic Proposal for a Mega-Global Health Fund

Circle of money
Flickr, by AMagill

As we continue this week’s celebration (or denunciation, depending upon your perspective) of the world’s efforts to fight poverty, improve health and make the world a better place, it’s worth paying attention to a little side issue that keeps popping up.

Money. Everyone says we need more, of course. And everyone is also talking about making these efforts more “efficient” or “strategic.”

On the health front, some say what we need is a new, comprehensive Global Health Fund — to consolidate all of the various funding mechanisms that are now focused on single diseases or other health problems.

I think that’s just fantastic, as in a fantasy, and maybe even harmful.

One of the leading advocates of this new mega-fund is Mark Dybul, former chief of PEPFAR, the President’s Emergency Plan for AIDS Relief. PEPFAR is great, arguably the best thing President George W. Bush did in office, and Dybul is well-respected as an expert on HIV/AIDS and global health matters.

Here’s his pitch, made last week at a D.C. think tank.

It’s certainly true that most efforts aimed at improving global health today are focused on specific diseases or problems.

It is often a fragmented, uncoordinated and inefficient system. We have the Global Fund for AIDS, TB and Malaria. We have PEPFAR and the President’s Malaria Initiative. And now we have the Obama Administration’s proposed (and ill-defined) Global Health Initiative.

The list could go on to include hundreds of other organizations and targeted programs. They don’t always work together well and, more importantly, none of them have been given enough money to do the job.

That last point is critical to why I think a single Global Health Fund would be a bad idea.

Dybul made the same case in Seattle for a single mega-fund last spring, which I wrote about on my personal blog (pre-NPR).  He was debated in last week’s forum, somewhat weakly, by Julian Schweitzer of the Results Development Institute.

I should note that the debate was hosted by the Smart Global Health Policy group, which earlier held a public meeting in Seattle to explain what they meant by “smart.” That’s another issue …

Now, I can agree that integration, coordination and a single, simple mechanism for achieving planetary health all sounds good. But so does the idea of the United Nations (at least to most people), which many support in concept — just not when it comes to giving the UN any real authority or financial clout.

The main problem here is not so much how we manage the money; it’s that there’s so little of it.

Creating some new mega-global health fund without adding a lot more money to address these problems is hardly a solution. More like a shell game. A single fund might look better, bigger, but it could simply serve to disguise failure on individual fronts and may suffer from a UN-style tragedy of the commons.

The real question behind all this is if the U.S. should provide more support to the existing multilateral and international efforts in global health — like the Global Fund — or choose to do its own thing.

The Obama Administration is celebrating its commitment to its new Global Health Initiative despite the fact that this initiative, so far, represents a reduction in overall funding commitments for global health as well as yet another example of the U.S. deciding to do its own thing rather than collaborate.

See my earlier post on this, in which I note the military reportedly spends nearly as much on air-conditioning in Iraq and Afghanistan every year (about $20 billion) as is spent by the U.S. Agency for International Development on foreign assistance ($25 billion). Sheesh.

Anyway, you can watch the debate yourself and decide.

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Tom Paulson

Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science,  medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom[at]humanosphere.org, follow him on Twitter @tompaulson and/or send a comment below.