Shotgun Weddings and Health Systems

(photo credit: qthomasbower)

The Center for Global Development has put up what may be my favorite blog post ever. Ruth Levine writes about a new effort by the World Bank, the Global Fund, and the GAVI alliance to work together on health systems strengthening. I have mentioned before that systems strengthen is the trend du jour, something I totally approve of.

Too many aspects of global health are connected for focusing on one diseased to be successful. We've all seen the data on HIV funding - it can actually reduce capacity to deal with other health problems if it's not used very carefully. Focusing on the capacity of the health system to handle all forms of health care is by far the best approach.

The idealistic among us would think that the World Bank, the Global Fund, and the GAVI alliance want to work on supporting health in the best way possible. Especially for GAVI and the global fund, who are used to focusing on single health issues, being part of an alliance could help them to build their capacities to do better system strengthening work.

Cynical types might well observe that if the donors are turning away from single-issue funding, the global fund and GAVI are in some trouble. It makes good tactical sense to start teaming up and broadening their focus.

Levine looks at the proposed alliance, and finds it somewhat odd:

"To start with, it's not immediately evident that GAVI and the Global Fund - two entities that epitomize disease- and intervention-specific funding...They also unfortunately don't have an unblemished record of success, either in their main line of work or more recent health system strengthening... And then there is the World Bank. While arguably better positioned by virtue of engagement with national policy and self-proclaimed comparative advantage in financing and systems issues, the Bank itself does not exactly have an enviable track record..."

Go read the whole post. It's an education.