Hey Changemakers, |
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The Global Fund to fight Aids, TB and Malaria, which has raised nearly $20bn since its creation in 2002, must focus more on preventing the spread of the diseases and get better value for the aid dollars it spends, a new study has found.
The first detailed independent evaluation of the fund, which pools government donations to battle three infectious diseases that kill the most people, concludes it has made “extraordinary” progress during its first five years. The fund is the largest multilateral agency pooling money to fight the three fatal diseases on a global level.
While largely supportive, the $17m (€12.5m, £11.2m) evaluation questioned the “demand-driven” model on which the fund is based, with countries seeking money proposing how to spend it. It said adjustments were needed to focus resources on cost-effective prevention and treatment tailored to local conditions.
For example, it found that while HIV treatment had been boosted considerably, there was little evidence of large-scale change in the behaviour of people most at risk from infection, which would be necessary to reduce the growing numbers still contracting the virus.
The analysis – discussed by the fund’s board last week – said the fund had failed to think about how to assess the effectiveness of its programmes from the very start and should have built impact evaluation into its activities.
Michel Kazatchkine, the executive director, welcomed the study as a vindication of the fund’s work. “It’s clear that there is a pre-global fund and a post-global fund era when it comes to tackling HIV, TB and malaria in poor countries,” he said.
The evaluation said the fund’s support had strengthened existing TB programmes but shown little evidence of accelerated progress since 2003. It praised progress in distributing bed nets and spraying to tackle malaria, but said there was little progress in providing drugs and only “a few countries provide evidence of reductions in parasite prevalence.”
It argued that while basic health services in the countries where the fund operated still contained “major gaps”, there was “no evidence of adverse changes in coverage for maternal and child health interventions or in child mortality” because it displaced efforts into HIV, TB and malaria.
While judging the fund’s impact as positive, the study was based on a sample of just 18 countries in part selected because they had shown good grant performance. Two countries with the greatest burden of infectious disease – South Africa and India – did not participate.
Rifat Atun from the fund stressed that the evaluation was conducted too soon to show much impact since most of the $7bn disbursed had been distributed since 2007. “Behaviour change takes a long time,” he said. “We are still grappling with which interventions work. Expecting a magic bullet within two years is perhaps rather ambitious.”