Comment of the Week - July 31

by Mariam Mostamandy · 2009-08-03 23:07:00 UTC
Topics:

Our comment of the week is from Theo Smart on the Against A Global Fund for Maternal Health post. Theo offers a new perspective on global funding for maternal health. He points out that any health care intervention will have its complexities. But before a country with an already poor health care system can invest its own resources, new policy is needed. If this can happen, a global fund may work.

Here is the comment:

Although there clearly have been cases where programs with a single-issue focus have weakened health systems, I don't think that necessarily HAS to be the case. The Global Fund/PEPFAR were established to catalyze an emergency response and at the start, perhaps too little thought was put into how to set up HIV programmes without throwing already fragile health systems off-balance. But we know better now; and these institutions are evolving to adopt a health systems strengthening lens when planning and implementing programmes and interventions. To fulfil their mandate, this has to happen anyway, because HIV care and treatment programmes will only be sustainable, equitable and universal when they are decentralised to the primarycare level. It simply can't be done without strengthening the health
system.

RE a Global Fund for maternal-child health: True, MCH also requireshealth systems strengthening & there is a very long laundry list of essential MCH activities. But many of the complexities you mention are
just part of delivering any healthcare intervention in resource-limited settings (specialised human resources, often equipment (at least re diagnostics/lab), accessibility, financial/social barriers to care, transportation -- though rarely emergency). Addressing gender inequity, reproductive rights and sexual autonomy are also critical for the HIV prevention programmes being implemented by PEPFAR/Global Fund. These programs aren't just distributing pills.

However, I think setting up a Global Fund for maternal-child health could inadvertently transfer to the new multilateral much of the national government's responsibility for providing essential MCH services (just as some 'focus' countries leave HIV to PEPFAR). And if you can't convince countries to allocate adequate resources for the health and survival of mothers and children, there is little hope of getting them to invest in 'health systems.' Of course, because of the sorry state of health systems, these countries do need help — starting with debt forgiveness and other policies to get countries to invest sufficient resources in their own health systems. This should lead to programmes that are home-grown and not dependant upon the whims of international donors.

Theo, please contact me to choose where you would like your charity gift sent.

Mariam Mostamandy
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