Globalization and Health Volume 4

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unintended consequences

david egilman   (03 June 2008)  ghets

Your paper ends by warning that "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."

This implies that your vertical programs can just be funded willy nilly (as they have been) without much if any thought (never mind study) about unintended adverse consequences. These take many forms, only one of which you mention (health budget substitution).

An anecdote may suffice here. Haitian HIV education programs suffer since many Haitians have realized that becoming HIV positive is their best hope for survival. They then qualify for food, job training & a job and all kinds of other services.

Trickle down is not working either. In Haiti HIV rates have dropped in half while every other health indicator has gotten worse.

As Maren wrote the road to hell is paved with good intentions. Why should one potentially fatal disease be sexier than another assuming the lost years of useful life are the same?

David Egilman MD, MPH

degilman@egilman.com

www.15by2015.org calling for 15% of all aid to go horizontal

Competing interests

None declared

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