Category Archives: Health finance

Data, priorities and global health

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I spent part of January working on my book manuscript, The Uncounted: Politics of Data in Global Health. When I began writing this in 2017, I was just interested in the data paradox: in which criminalized, stigmatized key populations, who lack data to prove they exist, get no funding for programs that save their lives, reinforcing the lack of data. But as I get deeper into the work, I’m noticing the growing dominance of cost-effectiveness language and tools, and how economic values are shaping how we think about priorities in global health finance.

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AIDS 2018: Debates over best use of global funds

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(L-R) Chris Beyrer, Michel Kazatchkine, Anka Van Damm at EECA Roundtable. ©Sara L.M. Davis
The last in a series of four articles on AIDS 2018 for Health and Human Rights.

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July 26, 2018

Steadily growing rates of HIV infection in Eastern Europe and Central Asia (EECA) are at the heart of a debate roiling health aid at AIDS 2018. While US funding for the global HIV response increased in 2017, that trend is unlikely to continue and most other donors cut back, according to a new report from Kaiser Family Foundation and UNAIDS.

The Global Fund to Fight AIDS, TB and Malaria and PEPFAR argue that given the limited global funding for HIV, they should prioritize investing in Sub-Saharan African countries to reach the largest number of people living with HIV. Middle-income countries are increasingly left to “transition” out of aid and foot their own bill. But critics say EECA governments do not fund services for criminalized populations such as people who use drugs. As a result, 39% of new HIV infections are now occurring amongst people who use drugs in the EECA region, says UNAIDS.

“International aid, and the Global Fund in particular, should not behave like development banks. We should fight AIDS wherever it is, and fund what governments are not willing to fund at the time,” said former Global Fund executive director Michel Kazatchkine. While he congratulated a Russian health official sitting beside him at a roundtable, who asserted that Russia had increased its funding for HIV, Kazatchkine countered, “Funding for prevention in Russia is far from where it should be, and still not at scale.”

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Key populations: Lost in the data desert

Along_the_rail_road_-_Iran_-_Shahroud_-_panoramioI’m writing a book on the politics of data for key populations, and it’s led me to think about “data deserts” – areas where no data is produced, so no programs or social services are provided.

It’s a particular problem for key populations (sex workers, men who have sex with men [MSM], people who inject drugs, trans* people and prisoners) in low-income countries. But surprisingly, it’s a problem for countries with higher income too.

Out of the 58 countries that the World Bank classifies as upper-middle income:

  • 17 countries had NO official HIV prevalence data for ANY key population group
  • 8 countries have HIV prevalence data for only ONE key population, but not the others

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Changes to the Global Fund Eligibility Policy: An overview

Lorrie Graham Assignment for Ausaid China 2006

Harm reduction outreach in China. Photo: Lorrie Graham/AusAID

On May 9-10, the board of the Global Fund to Fight AIDS, TB and Malaria will meet in Skopje, Macedonia to approve a new policy on which countries are eligible for funding.

I’ve been immersed in this labyrinthine policy as a consultant for the three civil society delegations on the board of the Fund: Developing Country NGO Delegation, Developed Country NGO Delegation and Communities Delegation. They came together to press for an overhaul of the policy. For a variety of reasons, that didn’t happen.

But there has been some progress; there are some big questions for civil society to weigh in on before May, and some critical areas to monitor if the current version is approved.  Here’s an overview: heads up, it’s a long blog.

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Aid eligibility in a mobile, high-velocity world

 

Wealthy countries need to invest every penny they can to combat global epidemics. Massive inequity in access to health care means that millions of people die each year of preventable, treatable diseases like HIV, TB and malaria. But who should be eligible for global health aid? Not so easy to answer. We’re stuck with some 20th century tools that don’t fit our high-velocity, globalizing world.

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TB, Human Rights and the Law: “Tell it like it is”

GroupStop TB Partnership’s workshop on TB and human rights this week fired up a diverse group with plans for action. The meeting brought lawyers and community activists together with UN agencies and donors to brainstorm ways to use the law and community empowerment to mobilize faster action on TB.

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Global Fund KPIs: Accountability and the hall of mirrors

img_0591About two weeks ago, the Global Fund Observer, a newsletter that reports on the Global Fund to Fight AIDS, TB and Malaria, published an article about the Fund’s Key Performance Indicators (KPIs). The article raised concerns about the process of developing the KPIs, citing a letter written by the 10 country and NGO constituencies on the Global Fund Board that implement grants (the “Implementers Group”) to the chairs of the committee that are developing KPI targets.

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