The Global Aid Architecture for Health: Road Map for achieving MDGs?

It is 2010, five years left to 2015- the timeline set for achieving Millennium Development Goals (MDGs). There is a sudden rash by actors in the global and national health system to step up efforts to improve maternal, newborn and child health, and to combat malaria, TB and stop the spread of HIV/AIDS. Sub-saharan African (SSA) countries like Uganda have committed to reach the MDGs, and created the Abuja target of 15% of public spending going to health. Developed countries committed to reach 0.7% of GDP going to Official Development Assistance (ODA). Africa has the highest disease burden, yet the lowest level of financing on health. 41 SSA governments allocate less than 15% to health. Out of Pocket Spending (OOPs) dominates private financing in most countries. In Uganda for example, the per capita expenditure on health is US $ 10, of which half is provided by government and the other half if OOPs.

In the recent past, many initiatives including PEPFAR and the Global Fund to fight AIDS, Tuberculosis and Malaria (GFTAM) have come up to fast track the race to achieve the MDGs. Others include the International Health Partnerships and related initiatives including, the Harmonization for Health in Africa (AHA), the Catalytic Initiative, (CI), the Providing for Health (P4H) Initiative, GAVI’S Health System Strengthening (HSS), the Global Fund-National Strategy Applications, The Health Metrics Network, (HMN), the Global Health Workforce Alliance (GHWA), MDG Africa Initiative. Other initiatives include the Millennium Challenge Corporation (MCC) and Millennium Challenge Account (MCA).

In 2008/2009, the High Level Taskforce on Innovative health financing (HLTIF) chaired by UK Prime Minister Gordon Brown and World Bank President Robert Zoellick supported the global advocacy for more funding to strengthen health systems for MDGs 1,4,5 and 6.The HLTIF Identified a menu of innovative financing mechanisms to complement traditional aid and bridge the financing gaps which compromise attainment of the health-related Millennium Development Goals (MDGs). Now the World Bank, GAVI and GFTAM are proposed yet another platform for Health Systems Strengthening. Moreoever, new ODA commitments have been announced:
• A US$1 billion expansion of the International Finance Facility for Immunization (IFFIm)
• US$360 million worth of debt conversions – Global Fund's Debt2Health Initiative
• The launch of a VAT tax credit pilot scheme called De-Tax, expected to raise up to US$220 million a year in VAT resources
• A new mechanism for making voluntary contributions when buying airline tickets, expected to raise up to US$3.2 billion by 2015
• US$515 million for results-based funding programs for health (RBF)
To crown it all, the United States Government has introduced a new legislation, the Global Health Act, to “establish a strategy to coordinate health-related US foreign assistance, to assist developing countries in improving delivery of health services, and to establish an initiative to assist developing countries in strengthening their indigenous health workforces.”

But how do these initiatives translate to the national level? Who is really benefiting? Is aid the solution to Africa’s problems?To some extent, aid has contributed to the health of people in SSA and Uganda in particular. PEPFAR and GFTAM are primary funders of ART. PEPFAR providing $38.6 million for ARVs. Uganda has scaled up ART for approximately 170,000 adults, including 16,000 children. However, more than 350,000 people (including 50,000 children) are in urgent need of treatment. There have been some successes scored for child health. However in terms of Maternal Mortality, progress is very slow. MMR in Uganda has been stagnant at 435/100,000 for the past decade.
However, aid must not be viewed in isolation. What countries like Uganda require is increased and better allocated domestic for strengthening their national health systems in order to achieve the MDGs. Aid is not the solution to Africa’s problems. Most resources should come from countries’ contributions. There is therefore need for domestic advocacy to raise attention to national budgeting processes and channel private spending into risk pool in avoid over spending by individuals. It is therefore importance for external aid to be only catalytic and temporary with a focus on results and efficiency gains. SSA countries need to grow economically in order to have higher GDPs that will enable them take care of the health of their people. What SSA countries need are free markets to sell their cotton, coffee, tea, and other products. The discussion of the global health architecture must not be in isolation, but in the broader context of economic development and growth.