Global health donor proliferation without coordination raises questions of redundancy, inefficiency, burdens to hosts — and impact

In basic numbers, this is some of what the last decade of donor awakening has totaled up to across the global health landscape:

  • 37 donors responding to HIV in 143 countries;
  • 22 donors responding to tuberculosis in 109 countries;
  • 27 donors responding to malaria in 86 countries;
  • 36 donors responding to family planning and reproductive health needs in 147 countries.

That is a sampling of the data a Kaiser Family Foundation series of analyses, Mapping the Donor Landscape in Global Health yielded, and it is data that raised new questions. What exactly is each of those donors accomplishing? Are they duplicating each others’ efforts? Are they burdening the countries they are seeking to bolster with work that doesn’t take realities on the ground into account? And in all of that, are they using their resources efficiently?

These were among the questions at group of global health response leaders gathered to answer at the Kaiser Family Foundation in Washington, DC today, during a panel discussion on The Challenge of Donor Coordination in Global Health – What’s at Stake?

In an environment of shrinking budgets and growing momentum toward a shift in aid to “country ownwership,” more than ever is at stake in figuring out who is doing what where, and what the actual outcomes of each effort are, discussion moderator Jen Kates, Kaiser Vice President and Director of Global Health and HIV Policy noted.

That is why transparency — sharing information of spending, targets of that spending, and whether those targets are being achieved — as well as inclusion of advocates, activists and workers on the ground in efforts are more important than ever, said Matthew Kavanagh, senior policy analyst at Health Global Access Project.

Kavanagh is the author of a recently released report on the outcomes of the U.S. President’s Emergency Plan For AIDS Relief shift from direct HIV service provision in South Africa. The report found that no accounting existed to discover if patients remained in  care and on treatment in the process, an estimated 19 percent of patients may have been lost to care, Kavanagh said today. Guidance from civil society would have helped ensure the process was planned with accountability of its outcomes, he added.

That guidance may also answer whether “in some ways we have crowded out local investment,” as Dr. Ariel Pablos-Méndez, Assistant Administrator for Global Health at the U.S. Agency for International Development put it.

If impact, rather than output is tracked, Shu-Shu Tekle-Haimanot, of the Global Fund to Fight AIDS, Tuberculosis and Malaria agreed, the knowledge gained might bring the understanding that “sustainability is not synonymous with complete domestic takeover.”

Tekle-Haimanot and Kavanagh saw at least one outcome of improved communication, planning, and input differently. To Tekle-Haimanot, more information could inform the “hard choices,” to be made in the austere times ahead. To Kavanagh, the information not being gathered now could feed arguments for more, rather than fewer future resources: “How do we make the case,” he said, “for what impact we could have?”

Source: Science Speaks

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By Antigone Barton

Published: April 22, 2014, 9:16 p.m.

Last updated: April 23, 2014, 1:19 a.m.

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