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A wide range of global initiatives have emerged to galvanise support – financial technical and political – for a range of disease control programs in low-income countries. These have become known as Global Health Initiatives (GHIs).
The scope and aims of GHIs vary widely but they all seek to stimulate increased domestic resources and strengthen country capacity through the implementation of health programmes. They can be multilateral or bilateral such as PEPFAR and the Global Fund, or they can be public private partnerships such as Gavi the Vaccine Alliance .
Most of the GHIs focus on a single disease – AIDS, tuberculosis and malaria, immunizations, maternal and child health, tobacco use and nutrition – but a growing number are emerging to address other global challenges such as non-communicable diseases and epidemic preparedness. In addition, a number of them seek to increase the involvement of non-state actors (typically commercial and civil society organizations) in their work.
Nevertheless, the majority of GHIs remain independent from governments and operate as grant making agencies. They often employ parallel management structures to reduce fiduciary risks arising from the potential for mismanagement of funds. In addition, the current structure of international aid governance makes it difficult to sanction donors in the event of misbehaviour.
In interviews some interviewees explained that the rationale for the setting up of parallel mechanisms was to avoid delays in the implementation schedule of their activities caused by the need to run through government structures. This has been a major contributing factor to the frequent delay of disbursements and procurement by PEPFAR.
Many interviewees pointed to the need to enhance coordination between these initiatives in order to maximise their impact on country health systems. In particular, there is a need for greater convergence between programs supporting the same health challenges and better cross-referencing of data to improve monitoring and evaluation. Currently, there is little intentional convergence between the different GHIs in Nigeria for example.
The Center for Global Initiatives has begun to initiate this alignment effort by building on previous efforts at global engagement and on ongoing or recent initiatives like the global finance facility alignment working group and the global health partnership alignment working group. This effort will help to ensure that future financing streams for global health are aligned, more transparent and better accounted for. It will also encourage a greater balance and diversity of funding sources and promote mutual accountability between donor and recipient countries. In doing so it will contribute to a global health architecture that is more effectively, efficiently and equitably aligned in order to achieve universal health coverage.