Jaevion Nelson: Health support and the drying up of global funding
The Global Fund to fight AIDS, tuberculosis and malaria has taken a decision that can quite possibly jeopardise the response to the three diseases in several countries and yield a loss on the investments it has made over the years. Despite pushback, largely from civil society and communities of people who are living with or affected by the diseases, it has taken a decision to transition countries largely based on their gross national income and disease burdens', which might have consequences for millions of people.
Developing countries like Montenegro, Macedonia and Serbia are at risk or have already stopped receiving financial support from The Global Fund. Based on the current policy, Jamaica is expected to transition in about two years' time. While there have been noticeable increases over the last few years in government spending, Jamaica is still largely dependent on external resources to fund its HIV response. On average, the country spends about US$20 million per year, of which less than 30 per cent comes from domestic sources annually.
Since January 2010, The Global Fund has contributed around US$70 million to Jamaica's HIV response. These funds have been disbursed to a number of government ministries and agencies and civil-society organisations. For many NGOs in this field, particularly those that provide services to gay men, transgender persons and sex workers, the Global Fund is often the main source of funding.
Countries that are transitioning, and will transition, are in a precarious position as they do not always have the ability and capacity to fully fund their response to the diseases. Do you think a country like ours - an upper-middle income country that is highly indebted - would be able to fund the AIDS response at the current level if it transitions in 2017? Further, what would happen to organisations that depend on The Global Fund for funding to implement programmes for key populations?
Evidence from the Eurasian Harm Reduction Network shows that the government did not include funding for key populations and a mere three per cent of its budget is allocated for prevention. The programmes for 3,000 people who inject drugs, in seven cities, are reported to have been drastically cut or have stopped.
One can certainly appreciate that governments must be encouraged to take greater ownership and demonstrate their expressed commitments to ending the three epidemics by increasing annual allocation for HIV, TB and malaria. This is especially so for countries who have been experiencing economic growth over the last couple of years. The complexities and nuances of the economic situation in the country - beyond its gross national income - must, however, not be ignored.
Let us consider two implications of improved country income:
- When a country's income status changes to one that is higher, they may lose their ability to access preferential prices for drugs needed to put and retain people on treatment.
- Who will support civil society, particularly those advocating for and working with criminalised populations, namely sex workers, transgender persons, drug users, gay and other men who have sex with men, that are antagonistic towards them? Do we have no responsibility to support these entities in countries that may be transitioned? Does the board really expect that governments in such countries to provide them with funding?
The Global Fund was established in 2002 and has today become one of the most successful funding mechanisms worldwide. Last year, it had investments in over 100 countries in Latin America and the Caribbean, Eastern Europe, Asia, sub-Saharan Africa, and North Africa.
The Global Fund has been successful in saving 17 million lives and is on track to reach 22 million by the end of 2016. Since 2002, it has managed to reduce the number of people dying from HIV, TB and malaria by a third because it has invested millions of dollars to put 8.1 million people on antiretroviral treatment for HIV and treatment for tuberculosis for 13.2 million people and has distributed 548 million mosquito nets through programme for malaria.
It is quite reasonable to say The Global Fund has been so successful because it listened to the cries and pleas of people living with and affected by the three diseases. It didn't seem to matter if the people who needed these live-saving programmes and treatment were living in middle-income or low-income countries. What mattered was that there was a need which required an innovative response.
The TB (tuberculosis) Europe Coalition recommends that The Global Fund's 'actions and support be sustainable after' withdrawal from countries, 'be involved in the planning and implementation of the transition, by providing political and technical assistance and guidance to the governments,' and 'maintain funding for key populations even after the transition period, especially when key populations are criminalised'.