Global health initiatives
Article Number: 2
In May a project on Global Health Initiatives was launched. It brings together a group of global health stakeholders – from governments and international and domestic financing partners to civil society, health organizations, and academics – in a time-bound process of consultation and research, to reflect on how GHIs can be optimized to best support national health priorities and countries’ progress towards universal health coverage. By the end of 2023, it aims to provide specific and actionable recommendations for more efficient, effective, and equitable ways of working, and to catalyse collective action to shape a global health financing ecosystem that is fit for purpose to 2030 and beyond. This article brings you highlights from its first newsletter.
The phrase ‘Global Health Initiatives’ (GHIs) has been bandied around for more than twenty years although it really only began to be used widely in the past few years. Aidspan’s new Strategy, launched last year, reflected the expansion of Aidspan’s mandate to include accountability and watchdog functions pertaining to all GHIs, and not just the Global Fund. But who and what do we mean when we use this term? Who are the key stakeholders? And why is it important to understand more about what is involved?
How the process came about
There is widespread recognition that countries should have ownership and control over their own health agendas. There is also acknowledgement that for low- and middle-income countries to effectively deliver on their health agendas and strengthen health systems, external resources need to be fully aligned in support of national health plans, with a pathway created for increased and sustainable domestic financing.
There is common agreement that there is some way to go to achieving this. Getting there will require reappraisal of, and greater alignment across, the global health ecosystem.
Building greater alignment, particularly around health systems strengthening and a more sustainable global health ecosystem, is even more urgent given increasing global epidemiological and demographic changes and health inequities: from aging populations to the growing burden of non-communicable diseases, mental health, and continuing and emerging challenges from infectious diseases; and rising threats from environmental degradation, climate change and new disease outbreaks. The COVID-19 pandemic has shown that many of these challenges cannot be contained within individual borders and that our collective health is dependent on the health systems in all countries.
Now is the time, while the lessons of the COVID-19 pandemic are still fresh, to take stock of how the global health system can best meet the health challenges of today and of tomorrow.
Over the last two decades GHIs have contributed to enormous progress in protecting lives and improving the health of people globally and improving on the Millennium Development Goals, including significant progress against individual diseases such as polio, malaria, and HIV, improving mother and child survival, and increasing the coverage of specific interventions like vaccines. There is, however, increasing recognition of the need for greater attention to overarching, system-level coordination and structure of GHIs and their interface with other actors to better align investment behind Agenda 2030 and Sustainable Development Goal (SDG) 3.
A new initiative
This understanding led to the creation of a new initiative for an evidence-based process which presents an opportunity for the global community to reflect on how the GHIs can be optimized, in the context of the wider global health architecture and global health financing system.
A new website, the Future of Global Health Initiatives, describes a time-bound (through 2023) multi-stakeholder process of dialogue, research, deliberation, and action. Its purpose is to identify ways to ensure GHIs are more effective, efficient, and equitable in complementing domestic financing to strengthen health system capacities and deliver health impacts, as part of country-led priority-setting processes and trajectories toward universal health coverage (UHC).
The organisations at the core of this process are: the Global Fund; Gavi, the Vaccine Alliance; the Foundation for Innovative New Diagnostics (FIND); Unitaid; the Global Financing Facility (GFF); and the Coalition for Epidemic Preparedness Innovations (CEPI). The process will also consider the roles, responsibilities, and ways of working of other global health actors and their interface with GHIs, to foster better alignment and coherence of all external health finance (multilateral and bilateral) and technical assistance to countries with the aim of strengthening national health systems and domestic health finance.
The process is co-chaired by Kenya and Norway. Steering Group members include representatives from Canada, Costa Rica, Democratic Republic of the Congo, Ethiopia, Ghana, Indonesia, Japan, the UK, and the US; the African Union’s Africa Centres for Disease Control and Prevention and the European Commission; Amref Health Africa, APCASO and Senderos Asociación Mutual; the Bill & Melinda Gates Foundation and Wellcome Trust. UNICEF, the World Bank and the World Health Organization are observers.
The process aims, by the end of 2023, to provide specific and actionable recommendations for more efficient, effective, and equitable ways of working, and to catalyse collective action to shape a global health financing ecosystem that is fit for purpose through to 2030 and beyond.
Highlights from the first newsletter
The process was launched in May when the UK’s The Telegraph, All Africa and Dagens Medisin published an opinion piece co-authored by Kenya’s Cabinet Secretary, Ministry of Health and Norway’s Minister for International Development. The Ministers called for a fundamental rethink of the global health system to meet the challenges of the world post-COVID and set out the need for the Future of Global Health Initiatives (FGHI) process to advance UHC. On 23 May, the FGHI hosted an event at the World Health Assembly, together with the University of Geneva.
The FGHI has commissioned new research to support the FGHI process and this is now well underway. The research consortium has completed a rapid scoping review and is progressing stakeholder interviews, country case studies and virtual consultations. A final consultation meeting will be held at the Africa Centers for Disease Control and Prevention in Addis Ababa, Ethiopia in mid-June.
The research consortium will deliver its final research findings and technical recommendations to the FGHI Steering Group at the end of July. Webinars and consultations will follow during August and September to present the findings and capture feedback from interested stakeholders.
When the final research report has been delivered, the FGHI Steering Group will request written feedback from stakeholders by mid-September. This feedback will inform Phase 2 – the development of the Steering Group’s recommendations designed to optimise GHI contributions to help countries advance progress on UHC.
The Co-Chairs of the FGHI Steering Group, Dr Mercy Mwangangi, former Chief Administrative Secretary of the Kenyan Ministry of Health, and Dr John Arne Røttingen, Ambassador for Global Health of the Norwegian Ministry of Foreign Affairs, want to ensure that the GHIs can work most effectively, efficiently, equitably, and sustainably, as they support countries to build capacities and strengthen the health system capabilities they need to respond to health challenges and push towards UHC. They encourage feedback and inputs from all interested parties. Throughout this year there is ongoing opportunity to:
a) feed into the research process (now to end July);
b) share feedback on the final research (July-mid-September); and
c) join consultations to inform the translation of the research into the Steering Group’s final recommendations which will be published at the end of this year (September – December).
If you are interested in attending the summer webinars, and/or sharing feedback on the research report itself please reach out to FGHI at Secretariat@futureofghis.org.
You can also visit the newly launched FGHI website for more information on the FGHI process, details on who is involved, and summaries of the Steering Group meetings.