Global health partnerships

Over 70 global health partnerships (GHPs) currently exist. AID instruments and the very poor: the case of global health partnerships argues that GHPs tend to fall into four main categories as follows:

• research and development GHPs (e.g. new drug development)
•  technical assistance or service support GHPs (provide drugs, TA, support to increase access to services)
• advocacy GHPs (raise profile of a particular disease or issue)
• financing GHPs (provide funds for specific disease programmes).

Major initiatives include the Global Aids Vaccine Initiative (GAVI -www.vaccinealliance.org) and the Global Fund for AIDS, Tuberculosis and Malaria (GFATM -www.theglobalfund.org).
The strengths of GHPs are recognised as:

• GHPs have improved the overall allocation of funds to health.
• More GHP money goes to the poorest countries than other forms of OECD financing.
• GHPs are targeting the diseases of the poor.
• GHPs support evidence-based interventions and are therefore cost-effective.
• Some GHPs focus on neglected diseases (such as trachoma, schistosomiasis, lymphatic filariasis) and are therefore helping to challenge the narrow focus of the global health targets. The Schistosomiasis Control Initiative (www.schisto.org) in particular could bring treatment to a huge number of people.
• Some commodity prices have fallen as a result of GHPs (e.g. ARVs and TB).
• There is evidence at global level that GHPs have stimulated better information about commodity pricing and have streamlined procurement processes. There is also a very clear role for GHPs in mitigating the effect of supply constraints of artemisinin combination therapy (ACT), a treatment for malaria.
• Health programmes will benefit from new technologies developed as a result of GHP funding.

Weaknesses of GHPs include:

• GHPs lack pro-poor objectives; increased coverage is used as a proxy indicator for reaching the poor, and a trickle down effect is assumed.
• Funding to GHPs is crowding out funding to public health systems (and these have the potential to reach the very poor).
• Coverage of the traditional six vaccines has not gone up in GAVI countries; undue emphasis is being paid within GAVI to increasing access to new vaccines.
• The reduction in commodity prices is not translating into cheaper commodities at local level.
• Some commodity purchases cannot be sustained financially after the funding period.
• The high transactions costs associated with engaging with GHPs at country level undermine already weak health systems.
• GHPs such as GFATM and GAVI exclude the weakest countries with the weakest capacity to access funds.
• The 'light touch' approach of GHPs is inappropriate in contexts where systems are weak - sending in donated drugs and expecting weak health systems to be able to deal with them is short-sighted.
• Few governments feel they have the scope to steer GHPs in an appropriate direction without running the risk of loosing funds.

Some argue that criticising GHPs for failing to deliver on issues that lie outside their comparative advantage (i.e. their lack of direct contribution to systems development, and the fact that they are not targeted directly to the poor) is unhelpful. They need to be seen as providing part of the solution. Entry points for donor agencies include the following:

• At global level, focus on how to leverage more pro-poor ways of delivering GHPs.
• At country level, support GHPs to develop more explicit poverty objectives.
• Focus on complementary interventions - for example if GHPs do not contribute directly to systems development, what complementary support can be provided to systems strengthening efforts?
• Identify areas where global alignment on political/technical issues can be supported. For example, DFID could feed into the debate about the costs and benefits of reaching the poor with insecticide-treated nets (ITNs) to protect against malaria. This could help to address issues such as the impact of voucher schemes on development of the commercial bednet sector, or on the effectiveness and sustainability of ITN social marketing programmes.
• Lobby for improvement in the evidence base on how specific GHP-supported programmes (e.g. TB control) are reaching the poorest.