The international community celebrated last year when Barbara Hogan was appointed Minister of Health in South Africa, replacing the controversial former Minister Manto Tshabalala-Msimang (aka Dr. Beetroot). Although Hogan herself has since been replaced, this move was cheered by many due to the fact that “Manto” has been seen as an HIV denialist and personally responsible for denying treatment to thousands in need. (To read more, my friend Pride Chigwedere has an article on this topic, read more here).

It is therefore quite shocking that the controversial former Minister has been appointed an African Union “Goodwill Ambassador” on maternal, infant and child health. Activists in South Africa are shocked, and so am I. Read more here. Then again, the AU welcomed Mugabe after his “successful” re-election last year.

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Some interesting upcoming events and activities related to global health that might be of interest to readers:

1. Hear Michel Sidibe, the new Executive Director of UNAIDS speak in Washington. Details: Friday, June 5, 2009, 10:00 am – 11:30 am.CSIS, Washington, DC. Center for Strategic & International Studies (CSIS), Global Health Policy Center. Click here for more information. If you go, report back, I would love to hear your thoughts and impressions of this guy.

2. Macro International, the guys that bring you the DHS surveys offer a Fellowship in Population and Health for Ph.D. students and recent Ph.D. graduates. Click here for more information. Strong preference is given to candidates from developing countries. You get some money, access to data, and help working on your papers. A sweet deal.

3. A few weeks back a reader made me aware of the Copenhagen Consensus Center, a think tank who goal is to help governments and philanthropists to spend aid more effectively. They are organizing a conference on malnutrition and will be hosting conferences back to back in Nairobi and New York. Click here for more information.

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The early 2002, I spent a month volunteering at the newly formed Global Fund to fight AIDS, Tuberculosis, and Malaria in Geneva. My task was to try to pull together an analysis of what, in aggregate, the US$866 million round 2 funding would actually pay for: how many people were expected to get treatment, how many nets, and what types of drugs. My task involved reading and synthesizing the proposals from 98 programs in 73 countries. I worked day and night on a report that went to the Board. Sadly I don’t think anyone read it – but I learned a lot.

There was a lot of enthusiasm at that time about what the GFATM was trying to do. It was created based on a growing consensus that these major killers of people in developing countries should be addressed and that the tools existed to do so, it was just a lack of money that was preventing the scale up of such interventions. There was also a growing consensus that existing aid mechanisms were not sufficient to accomplish these goals. A novel approach based on a “demand driven” model was created. So 7 years later, how has it done?

An independent external evaluation was commissioned to do a 5 year evaluation of the program. The findings of this evaluation have recently been released and the reports are now available on their website. The evaluation focused on three aspects of the program, namely:

Organizational efficiency and effectiveness of the Global Fund (Study Area 1)

Effectiveness of the Global Fund partner environment (Study Area 2)

Impact on HIV, tuberculosis and malaria (Study Area 3)

The evaluation finds that the GFATM has been tremendously successful at mobilizing resources, presumably new resources, for the target diseases. These new resources have translated to higher service coverage, although the data available prevent more meaningful evaluation of the health impacts of the programs. However, I found a few recommendations a bit surprising:

Recommendation 2.1 The Global Fund’s business plan should increasingly differentiate its prevention and
treatment approaches in specific countries based on the epidemiological profiles of AIDS, TB and malaria and
the assessment of a country’s capacity to execute its planned disease control programs.

Recommendation 2.2 The Global Fund should adjust its “demand-driven model”’ and focus its resources
on prevention and treatment strategies that utilize the most cost-effective interventions that are tailored to the
type and local context of specific epidemics.

Are they saying what I think (and hope) they are saying?

The current GFATM model allows countries to apply for funding to support any type of intervention, whether it is a real priority or not. The reality is that not every country likely needs support to scale up all types of interventions but would likely be better off focusing in on the one or two key elements that are most appropriate given their epidemiological and health system profile. But because they can get funding for these other interventions, they apply.

These recommendations suggest that instead of just being a funding agency, the GFATM needs to play a better role in allocating resources where they are most needed to the types of interventions most needed in each country. This does represent a radical departure from the current model of the Fund, but one that I think could make existing resources more effective going forward. While I like the concept, I wonder if anyone really knows what works best when and where? We are going to need much better data to inform this process, but hopefully it means that evidence of effectiveness will be given more weight in funding decisions.

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