The Global Fund and South African taxation

The UN news service just reported that the Global Fund FINALLY released funds for South African AIDS treatment, and several leading actors are quoted expressing profound relief, citing a long delay from promise to payment. Of course, the context is a country with the world’s largest number of people infected with HIV and in need of treatment.

Meanwhile, the SA finance minister just proclaimed the good health of the country’s economy and announced a series of tax breaks.

Hmm, do I smell a recipe for donor resentment? Maybe SA should be footing a bit more of the bill for AIDS treatment and let extremely scarce global fund monies go to countries where there is little economic base or potential for tax collection? Good governance should not be punished, but in a moment of increasingly scarce resources for a critical problem, maybe some budget adjustments would be in order?

Global fund for HIV, TB, Malaria at crossroads

The Global Fund‘s executive director, Michel Kazatchkine, resigned from his post this week amidst a witch’s brew of political conflict and funding shortfalls. In response, Laurie Garrett penned a nice analytical essay — which I re-post here — about what all this means not just for the fund, but for global health more generally.

To be sure, the history of international aid efforts is littered with failed and even harmful initiatives, and these have led many to become aid-skeptics. But the global fund has been a spectacularly successful vehicle for efficiently converting rich country dollars into usable public health resources, especially essential medicines, in the world’s poorest countries. While I have been somewhat critical of the organization’s over-emphasis on multiple-stakeholder governance, which at times has contributed to accountability and efficiency failures, the big picture is one of remarkable success during a period in which the devastation of AIDS could have been even worse than it’s been.

Like in American politics today, where there is little enthusiasm for the notion that our economy could have been worse with a different response to the global economic meltdown, my sense of international support for public health counter-factuals is similarly tepid. But in a globalized world, in which infectious diseases are transmitted rapidly across borders, and our financial and physical health is so inter-dependent, we require effective global governance institutions. And the global fund has been generally well run, lean, and effective.

It is extraordinarily difficult to parse out the individual efforts and impact of the myriad global actors involved in the campaign to fight global infectious diseases over the past couple of decades. But Garrett highlights that a full two thirds of all malaria funding is now dependent on the fund… and the incidence of malaria has dropped precipitously in recent years.

Out in Davos, the global health celebrities — Bono, Clinton, Gates, and others — are celebrating the 10th anniversary of the fund. Hopefully they will be able to shmooze world leaders to maintain commitments to this important institution in the years to come.