IPN Health Blog

The Global Fund: failing to reverse AIDS, Tuberculosis and Malaria

        One of the biggest players in the development arena is the Global Fund for Aids, Tuberculosis and Malaria, which has spent around $20bn over the last five years fighting these diseases.

It is good, then, that the Fund has released an internal evaluation of progress made in these last five years. 

In our view, the success of the Fund should be judged against its progress in reducing the incidence of these diseases.  After all, that is its primary reason for existing.

But as the the FT reported last week, the Fund has made no such progress.  In some cases - notably AIDS - things have got worse.

Here, in more detail, is what the evaluators found:

1. while HIV treatment had been boosted considerably, there was little evidence of large-scale change in the behaviour of people most at risk;

 

2. the Fund had failed to think about how to assess the effectiveness of its programs from the very start and should have built impact evaluations into its activities;

 

3. the Fund's support has strengthened existing TB programs but shown little evidence of accelerated progress since 2003;

 

4. it praised progress in distributing bed nets and spraying to tackle malaria, but said there was litle progress in providing drugs and only a few countries provide evidence of reductions in parasite prevalence;

 

5. nonetheless, while judging the Fund's impact as positive, the study was based on a sample of just 18 countries in part because they had shown good grant performance. Two countries with the greatest burden of infectious disease--South Africa and India did not participate.

So there we have it: after 5 years of failure and billions spent, we have precious little to show for it. The Fund trumpets the resources it spreads around and the skill with which it manages itself, but it has not managed to reduce disease.

And still they ask for more money to continue on this failing path.  Sounds a bit like the US auto industry...

Why is the Global Fund rejecting donated drugs?

There was a jubilant note from an Oxfam lobbyist today over at the e drug listserv, rejoicing at the news that the Global Fund will no longer take "in kind" donations of medicines. The Oxfamista claims that the  "the decision was based on solid evidence that developing countries did not want donations", based mainly on the idea that donations would undermine competition in local drug markets.

Based on its track-record, one can see why the Global Fund doesn't like donations. As we know, the Fund has often procured drugs that fall short of even its own lax quality standards.  Donated drugs tend to be of more verifiable quality, thereby exposing this double standard.  In particular, donated drugs lessen the need to import untested copy drugs from India.

There is also the issue of UNITAID, of which the Global Fund is a supporter.  Since UNITAID is a main financier of drug products, donated drugs eliminate the commission that WHO receives from groups like the Clinton Foundation and Medecins Sans Frontiers who procure drugs.

In other words, donated drugs are a threat to the Fund's entire modus operandum.

Instead of simply rejecting donated drugs, how about this as a solution. Countries could forward their needs for donated drugs (other than ARVs) to the Global Fund, which would then act as a clearinghouse to find a company willing to make a donation. When a match is made, the Fund would step away and let the transaction proceed between the company and the country.

 This would free up more Fund money to actually fight AIDS, TB and malaria, and the country could also get drug donations for diseases such as cancer.