Funding &Health Systems Bill Brieger | 01 Feb 2009 05:50 am
Global Fund Gap – implications for high burden countries
We have commented on the consternation expressed over the shortfall of money to fund the current crop (Round 8 ) of Global Fund applications. It is useful to bring this problem to life looking at an actual grant proposal that is held in limbo. Unfortunately Nigeria is one example – unfortunately because Nigeria probably has the highest burden of malaria.
Specifically the GFATM notes Nigeria’s Round 8 Application stands in limbo because certain …
Round 8 proposals … have been approved by the Board in principle and will be presented to the Board for funding approval, according to the comprehensive funding policy and as / when funding becomes available. The Global Fund Secretariat will be working with countries to find efficiencies in all Round 8 proposals to bring the total approved (Phase 1) funding for Round 8 at or below US$ 2.75 billion and to reduce the amount of Phase 2 funding (to be addressed during the Phase 2 renewal process).
The actual funding requested in Nigeria’s Round 8 proposal was nearly $600 million, of which $334 million was for phase 1. These figures look large in relation to the $74 million allocated for the Round 4 Malaria grant (which had been combined with Round 2), but when one considers the population of 140 million people combines to only about $4 per person, which is small considering the cost of nets, ACTs, logistics, health systems strengthening and the like.
One needs to remember that Nigeria has over 800 ‘health systems’ if one counts the 774 Local Government Areas (LGAs) (districts), 36 states (plus one Federal Capital Territory) and federal system of tertiary level facilities. The NGO and private sectors may even represent their own systems in the eyes of some. Constitutionally each level has its distinct health responsibilities, and LGAs are where primary health care and most of malaria services are delivered through government and a variety of formal and informal private channels.
It is these front line LGA ‘systems’ that need the most strengthening. While people may question the way LGAs spend their fundes, most of which come from federal subventions (read oil money), the reality is that the bulk of their expenses are recurrent ones, especially personnel. Infusions of support from the Global Fund, World Bank, DfID, USAID and others will only create a critical mass of malaria control action if these LGAs are strengthened and then correctly manage malaria commodities and resources.
Delayed funding for high burden countries like Nigeria not only delays critical systems building but also delays saving of lives. 2010 is so close and yet so far away.