Sept. 30, 2013, 5:44 p.m.
This week, news broke that the UK had pledged up to £1bn to the Global Fund to Fight Aids, Tuberculosis and Malaria. This pledge is part of the fund's campaign to raise $15bn (£9.3bn) over the next three years.
Early indications from major donors are strong. The UK joins the US, which has signalled it may pledge up to $5bn; France has committed $1.4bn, and the Nordic countries have committed $750m. A robust advocacy base – complete with celebrities and heads of state – has mobilised to make it likely that the Global Fund will achieve its request in full.
The organisation, one of the largest funders of worldwide health programmes, is a critical player in the fight against Aids, a sustainable response to which will undoubtedly require greater investment.
But there is something far more valuable than $15bn alone – results.
The Global Fund's advocacy efforts claim impressive gains – 5.3 million people on antiretroviral therapy under its programmes, 30m bednets distributed, and 1.3m cases of TB detected and treated in the first half of 2013. But is this the same as 5.3 million lives saved, 30m cases of malaria prevented, and 1.3 million survivors of TB? No.
The Global Fund's headline figures are extrapolated from the number of products purchased or the number of services reported by funding recipients themselves. But encouraging as they are, they are not indicative of what investments are accomplishing in terms of lives saved.
Over the past two years, I have worked with a diverse group of experts to tackle the urgent question of how the Global Fund can save more lives with the billions it spends each year. Months of analysis and questioning led to the conclusion that the Global Fund tracks receipts better than it tracks results.
Partners do not get extra credit for measuring or achieving health improvements; resources are not targeted at the most vulnerable or suffering populations; the cost-efficiency of medicines and supplies is not analysed; and missed opportunities to expand coverage to the millions waiting for life-saving medication abound.
Most importantly, very little quality information exists on how and where Global Fund money is spent, and what it is accomplishing.
The Global Fund and its partners could make dramatic improvements with some very basic reforms:
• Allocate funding to the most effective products and ensure they get to the populations most in need.
• Pay for performance, not just distribution of funds and interventions.
• Track costs and centralise price information, especially for the most common medicines and treatments.
• Verify that self-reported data from recipients is accurate and representative of the populations served.
These reforms are not revolutionary. But they are necessary.
The $15bn the Global Fund is likely to receive this December is a sum equivalent to its budget for the entire past decade. This money, combined with relatively modest changes and the committed new leadership of Mark Dybul, can put the organisation on the path to ensuring that every pound, pula, and peso is spent on maximising health results.
Successful replenishment of the Global Fund – now and in the future – rides on the organisation's ability to show solid, verifiable results. This is more important than ever, since funding will undoubtedly come at the expense of other life-saving global health and development programmes as donor budgets flatline.
As Ezekiel Emanuel, vice-provost for global initiatives at the University of Pennsylvania, has written of the US Aids programme: "The fundamental ethical, economic, and policy question is not whether [the programme] is doing good, but rather whether other programmes would do even more good in terms of saving lives and improving health."
The Global Fund must put as much energy into getting results as delivering rhetoric, pursuing performance verification with no less vigour than advocacy. The war is won not when pledges come in, but when new cases of Aids decline and all those eligible for treatment receive it; when malaria is eliminated and tuberculosis under control.