The 'diagonal' approach to Global Fund financing: a cure for the broader malaise of health systems?

Gorik Ooms¹ , Wim Van Damme² , Brook K Baker³^,4 , Paul Zeitz⁵ and Ted Schrecker⁶

¹Médecins Sans Frontières Belgium, Dupréstraat 94, 1090 Brussels, Belgium

²Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium

³Northeastern University, School of Law, 400 Huntington Avenue, Boston, MA 02115, USA

⁴Health GAP (Global Access Project), 429 West 127th Street, 2nd Floor, New York, NY 10027, USA

⁵Global AIDS Alliance, 1413 K Street NW, 4th Floor, Washington, DC 20005, USA

⁶Institute of Population Health, University of Ottawa, 1 Stewart Street, Ottawa, Ontario K1N 6N5, Canada

author email corresponding author email

Globalization and Health 2008, 4:6doi:10.1186/1744-8603-4-6


Published:	25 March 2008

Abstract

Background

The potentially destructive polarisation between 'vertical' financing (aiming for disease-specific results) and 'horizontal' financing (aiming for improved health systems) of health services in developing countries has found its way to the pages of Foreign Affairs and the Financial Times. The opportunity offered by 'diagonal' financing (aiming for disease-specific results through improved health systems) seems to be obscured in this polarisation.

In April 2007, the board of the Global Fund to fight AIDS, Tuberculosis and Malaria agreed to consider comprehensive country health programmes for financing. The new International Health Partnership Plus, launched in September 2007, will help low-income countries to develop such programmes. The combination could lead the Global Fund to fight AIDS, Tuberculosis and Malaria to a much broader financing scope.

Discussion

This evolution might be critical for the future of AIDS treatment in low-income countries, yet it is proposed at a time when the Global Fund to fight AIDS, Tuberculosis and Malaria is starved for resources. It might be unable to meet the needs of much broader and more expensive proposals. Furthermore, it might lose some of its exceptional features in the process: its aim for international sustainability, rather than in-country sustainability, and its capacity to circumvent spending restrictions imposed by the International Monetary Fund.

Summary

The authors believe that a transformation of the Global Fund to fight AIDS, Tuberculosis and Malaria into a Global Health Fund is feasible, but only if accompanied by a substantial increase of donor commitments to the Global Fund. The transformation of the Global Fund into a 'diagonal' and ultimately perhaps 'horizontal' financing approach should happen gradually and carefully, and be accompanied by measures to safeguard its exceptional features.