Ooms, Van Damme and Temmerman have recently argued that country support from the Global Fund to Fight against AIDS, TB and Malaria (GFATM) should address health workforce gaps so that the situation â€œMedicines without Doctorsâ€ does not lead to misuse or non-use of live saving drugs. The authors express how that the existence and commitment of the GFATM signifies the possibility of sustaining a commitment to funding a health workforce that poor countries cannot achieve due to varying challenges ranging from budgetary problems to the brain drain. This takes sustainability to a different level and involves all countries, especially the richerÂ industralized ones, in sustaining health for all.
These authors focus more on human resources for HIV/AIDS. What are the special workforce needs for malaria? For example, there is need to have adequate staff who understand how to procure, manage, prescribe and counsel on ACTs.Â In-service training (IST) may be part of the picture, but quality training is needed. This brings to mind a story about â€˜jamboree trainingâ€™ described by one colleague where over 300 district health staff were assembled and told everything about the GFATM project in just a couple days in order to meet promised training targets, which in turnÂ one hoped wouldÂ enable the meeting of ACT distribution targets. Workforce enhancement needs to be multidisciplinary â€“ pharmacy, clinical, records, disease control and health education staff have different but interrelated roles to ensure that malaria interventions are planned, delivered and monitored. Districts not within the current scope of the GFATM project often do not get training on current or new national malaria guidelines, and the human resources in private sector are often left out.
Fortunately, attention to Health Systems Strengthening recommended by Ooms et al., is addressed in guidelines to countries applying for Round 7 of the GFATM. This may not solve the problem.Â GFATM is not an unrelenting spigot of funding.Â Securing a project does not guarantee that it will run for the proposed five years. As the end of the second year approaches, projects are reviewed, and if they are not performing – i.e. meeting indicators, they are not renewed for Phase II. Â Similarly, just because a country wins a grant one year does not guarantee it will be lucky in securing future and continuing grants as Ooms et al. would hope. GFATM is ‘performance based.’
Clearly the global community has responsibility for preventing death and disability arising from malaria and other tropical diseases. Â The GFATM offers hope, but is not yet the magic solution. Â Of course this does not mean that we should accept the current reality, but instead should try to push the boundaries of the commitment to eliminating malaria by both endemic and donor nations.