9 Aug 2019

A new report from the Global Fund Advocates Network (GFAN) proposes a broadly framed approach to advocacy for financing priorities across all health issues related to the Sustainable Development Goals (SDGs), taking as a starting point the interdependence of the health and development goals within the SDGs.

The core of the concept note is a “unified framework for sustainable health financing advocacy” (SHFa), encompassing advocacy across “multiple health priorities and in multiple health financing contexts”.

The ‘unified framework’

The purpose of the unified framework is to address specific aims of Sustainable Development Goal 3 (the ‘health’ SDG: ‘Ensure health lives and promote well-being for all at all ages), such as ending the epidemics of HIV, TB, and malaria, while encompassing and coordinating across multiple SDG3 aims and health priorities, including universal health coverage, accessibility and affordability of essential medicines, access to sexual and reproductive health services, access to harm reduction, domestic resource mobilization, and other overarching issues influencing each of these areas, such as poverty, gender equality, justice, and human rights.

Recognizing the interdependencies between the targets within SDG3, the report acknowledges that along with governments, a variety of agencies and organizations are ostensibly working towards multiple targets together, often with complementary strategies and overlapping priorities. The framework is intended to help global health advocates align their efforts, understand the linkages and synergies between their work, and “avoid being caught in fragmented siloes of work”.

The report also lays out the contexts of health financing, starting with a summary of the amount required to achieve the SDGs in low- and middle-income countries (an estimated $371 billion per year); a summary of domestic financing’s stake in current investments in health (the majority); emphasis on the need to mobilize “increased and improved domestic funding for health”; and advocating for universal health coverage (UHC).

Some useful tables outline countries with high burdens of preventable disease and their needs for improved health services (Table 2); economic and health financing indicators that are shaping the targets of advocacy (Table 3); and types of political environments that shape advocacy, grouping countries according to one of four types (Table 4).

Supporting advocacy itself

A section on priorities for investing in SHFa makes the point that advocacy for sustainable financing for health is itself in dire need of broader support and more funding. The concept note proposes three priorities for investment in advocacy: investing in people – health financing policy analysts and strategists, health financing advocates, activists, and organisers, health providers and consumers – as well as investing in advocacy structures and resources, and in international advocacy support. The concept note makes the point that the potential impact of effective advocacy for SHFa (97 million premature deaths averted) far outweighs the financial cost of the resources required to do it.

GFAN told the GFO that an underlying rationale for this paper was the lack of funding specifically for advocacy in Global Fund-supported countries. While the paper’s primary intent is to situate advocacy for AIDS, TB and malaria within broader health advocacy, a secondary goal for this piece of work was to make the case for investing in advocacy itself, especially in implementing contexts. There needs to be broader recognition, GFAN said, that advocacy to ensure adequate financing for AIDS, TB and malaria (with a focus on programming and services that have the most impact) is “woefully underfunded”. As a global community, GFAN said, “we risk losing gains if efforts to support community and civil society advocacy do not go alongside it.”

Starting point for the concept note

As the Global Fund has continued to broaden the scope of the issues and themes within which it situates itself, so GFAN has also been broadening its own approach to Global Fund-related advocacy. While the focus of GFAN’s work remains advocacy to fully fund the Global Fund – most immediately for the upcoming Sixth Replenishment, which is seeking ‘at least $14 billion’ to fund the next cycle of Global Fund grants, but for which GFAN is calling for $18 billion – GFAN says larger questions remain around how the Global Fund raises the resources required for its own work (and targeted outcomes) within the context of the growing movement towards universal health coverage (UHC), which has its own, larger set of outcomes around health system strengthening ad the inclusivity of services, which are in turn linked to the SDG objectives.

In early 2018, GFAN commissioned an initial document that summarized the existing literature about different types of advocacy, and related successes and challenges. For this concept note, which is intended to be complementary, GFAN and the Civil Society Engagement Mechanism (CSEM) for the 2030 goal of Universal Health Care, together issued a call for input. This was to ensure that constituencies beyond GFAN members, partners and AIDS, TB and malaria sectors were consulted. The document was then further developed by GFAN together with a lead author, Sam Avrett.

Intended use and next steps

While acknowledging that this (or any single) report will not on its own resolve the complex issues around siloed ways of working, GFAN says it is using this report as an opportunity to reach out beyond its traditional membership, and especially to engage UHC actors.

By doing so, GFAN hopes to stimulate dialogue between advocates about the approaches to advocacy described in the concept note, as well as to promote further resource mobilization, aiming to develop “convergent work across multiple areas of health advocacy,” covering HIV, TB, malaria, sexual and reproductive health, harm reduction, universal health coverage, and more; to develop similarly convergent work across multiple areas of financing advocacy; and building new partnerships, training, technical support and funding initiatives.

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