A group of African parliamentarians hoisted the red flag at the UNITE Global Summit on Tuesday, leaving delegates feeling ignored at best and even “used” at worst by the Global Fund to Fight AIDS, Tuberculosis and Malaria. said. of medical services in their country.
“Do African parliamentarians only get involved when it is convenient for our colleagues when we have to appeal?” Tanzanian parliamentarian Neema Rugangira said, “Global Fund after 7th replenishment – parliament In a remark at a session titled “The Role of Legislators and Domestic Health Financing,” I asked:
According to Lugangira, she was asked over the summer to represent the Global Fund in a fundraising appeal to the UK Parliament via video. I believe it played an important role in persuading me to do so. Then, despite being in New York in September for the Global Fund’s “replenishment” event, where donors pledged funds for the next three years, she was not invited to attend.
The Global Fund instead invited 18 heads of state and government, as well as many dignitaries from civil society and the private sector, to a 400-person event held in the city.
“Some of my colleagues in the Ministry of Health were surprised I wasn’t invited,” Lugangira said because of the video she provided and her deep involvement in Tanzania’s public health. .
“We are not invited when the time comes for a glorious moment,” she said.
Rugangira said that if the Global Fund were to work more closely with parliament and work with civil society, the Global Fund would be able to generate more matching domestic money and distribute that money more effectively.
“Civil society was not chosen by British MPs to record the clip and appeal to parliament. It was me, a member of the African Parliament,” she stressed. “It is empowering to hear the voices of African parliamentarians who represent the people.
“Don’t take advantage of us at your convenience. Include us in your entire chain,” Ruganguila continued. “Members of parliament should be involved at all levels and be recognized for the influence and power we have.”
Lugangira had been asked to speak at a panel hosted by the fund. The panel was meant to celebrate nearly $16 billion raised in the fall and examine the positive health impact of her more than $55 billion distributed over the past two decades. and save lives.
In Tanzania alone, the Global Fund has invested $3 billion between 2002 and 2022 to tackle HIV, tuberculosis and malaria.
Lugangira said HIV and viral infections have decreased by 68% since the fund became involved in her country, and people living with HIV enrolled in treatment programs have increased by 68%, from 18% to 86%.
Thus, when Lugangira and several subsequent parliamentarians accused the Global Fund of failing to adequately utilize local parliamentarians and called for a change in that paradigm, the Global Fund’s senior specialist for parliamentary affairs Scott Boor said he was “confused and surprised”.
“At least one member of parliament hinted at the feeling that the Global Fund will only be used when it needs to raise money,” Boole said. “The Global Fund should be a partnership.”
“You put us in handcuffs”
Some MPs expressed concerns about the global funds model, including the establishment of a “Country Coordination Mechanism” (CCM) committee to help distribute funds. Boor said the Global Fund mandates that the CCM have broad representation not only from governments, but also from civil society, including members of communities affected by the three core diseases.
In some countries parliamentarians participate in the CCM, but many are not required to do so. Additionally, members of Congress are not eligible to receive funding to fund their roles on these committees.
Zimbabwe MP Ruth Labourde is one such MP.
She is a member of her country’s CCM but says she rarely attends meetings due to lack of transportation and funds. She only goes when parliament is in session and has to be in the capital anyway for her job otherwise it would be “too expensive” for her to attend, she told Health He told Policy Watch.
“The CCM has decided not to fund parliamentarians while they fund members of civil society, the private sector, or other sectors,” Labode said. “Funding shortage shows global funds are not committed [to the parliamentarians]I don’t think we need MPs. Yet, when it comes time for replenishment, they quickly find MPs to lobby for the cause. “
During the discussion, she told Boole, “It’s time to advocate for every CCM in every country to have a seat in parliament … If you tell them to reserve a seat for a member of parliament, that’s one thing. It will happen in the evening,” he said.
Another complaint is that many parliamentarians are not educated about the Global Fund’s work and its outcomes, which could help them drive further domestic healthcare funding.
“Without information, resources cannot be mobilized,” said MP Peter Njume of Cameroon. “You are working. [directly] And we expect governments to hold them accountable. But MPs are not involved.
“You talk about the importance of democracy,” Jumet continued. “We represent democracy, but you handcuff us and make us vulnerable and powerless. How do you want us to function?”
“We need to be well-informed and educated to manage this agenda,” Rugangira added as well.
Njume requested a Global Fund earmark loan for parliamentary education programs.
“Healthcare financing is a political decision.”
Global Fund’s Alex Winch admitted that “funding healthcare is a political decision.”
A specialist in the Global Fund’s advocacy and health financing team, he said it was important to understand that the majority of the fund’s resources come from governments that prioritize money.
“80% of the funding comes from the G7 and the European Commission,” Boole explains. “11% come from other governments around the world, and he’s 9% from the private sector.”
To date, the Global Fund provides 30% of global funding for HIV, 76% for tuberculosis and 63% for malaria. The foundation provides more funding for the fight against tuberculosis and malaria than anyone else in the world. Additionally, about a third of that funding will reward strengthening the underlying healthcare system.
Fundraising is effective, at least according to the data. For example, life expectancy has increased as a result. In sub-Saharan Africa alone, life expectancy jumped from 52.3 years in 2002 to 66.7 years in 2019. This is mainly due to fund initiatives.
Approximately 12.5 million people received HIV prevention services in 2021 in countries and territories in which the Global Fund invests. Her 670,000 mothers living with HIV received drugs to keep her alive and prevent her passing HIV to her baby. An additional 5.3 million people were tested for tuberculosis. 110,000 people were treated for drug-resistant tuberculosis. Efforts were made to protect families from malaria, including the distribution of 133 million mosquito nets.
“All of this is made possible by our replenishment,” Boole told Health Policy Watch. “Every three years, we fund the next three years.”
This year’s replenishment took place in New York on September 21, 2022. About 47 public and 27 private donors have pledged $15.7 billion out of the $18 billion target the organization has set to raise over his 2023-2025 period.
Boole said efforts are continuing to close the gap.
“We are stopping investing in health”
But Zimbabwe’s Daniel Morokele believes that although the results are surprising, African governments are “too dependent” on the Global Fund.
“I don’t think over-reliance on the Global Fund is good for Africa,” Morokele said.
He said the Global Fund would close the gap and free up governments that don’t need to commit to funding their country’s health. said.
“We are stopping investing in health,” Morokele said.
Bourr explained that to receive grants from the Global Fund, beneficiary countries must provide a certain percentage of matching money, but the fund is more flexible to low-income countries in terms of meeting its goals. He said that despite the economic challenges facing the world in the aftermath of COVID-19, the fund will use domestic medical funds from recipient countries as war rages in Ukraine. He said it increased by about 30% across the board.
“It was ambitious”
Another concern raised by the floor came from French MP Jean-François Mbaye, who said that France had invested $1.6 billion towards a target thought to be $18 billion. disappointment”, but said it was not achieved.
“It was ambitious,” Boule admitted to Health Policy Watch. “We raised $15.70 for her, which is by far the largest amount we’ve raised to date.”
This gap is due to some of the Global Fund’s largest contributors not increasing their giving by the 30% the fund expected.
“The United States, Germany, Japan, Canada and the European Commission all increased by 30%,” said Boule. “France increased her by 23% and Italy increased her by 15%.
“The only country among our largest donors to decline was the UK, which still pledged $1.2 billion,” Boule continued. received strong support from
On the other hand, weak exchange rates and the replenishment seven months after the start of the Ukraine war amid rising interest rates had a negative impact.
“If the pledge session had been held on Feb. 23, when we had our preparatory meeting, we would have had more than $600 million in funding,” Boole explained. “In October 2019 he would have had about $1 billion more in exchange rate alone if we had the same exchange rate as when he did his sixth replenishment.”
In general, Winch said it is becoming increasingly difficult to achieve funding in the current financial environment.
Citing a recent report by the World Bank, he emphasized that more and more countries find it difficult to invest in health or even sustain existing levels of health investment. “The uncertain global macroeconomic environment threatens domestic financing for health,” he said.
“More resources need to be focused on health”
Boole plans to bring some of the parliamentarians’ concerns back to Geneva, including providing resources for parliamentarians to participate in the CCM and establishing permanent parliamentary positions on the committee. said.
“I didn’t know that the honorable Ruth Labord was speaking from Zimbabwe and that other members of the CCM had some support and she didn’t,” Boole said. I was.
He also said he was interested in finding ways to better involve parliamentary feedback as another means of ensuring that the fund is asking the right questions and allocating resources in the best possible way.
“Our good results are due to the fact that many African political leaders, including parliamentarians, have actually built and maintained the political will to make health a priority,” Boole said. “Food insecurity, debt crises and rising interest rates make this even more difficult now. But we still stress that more resources need to be focused on health.”
Image Credit: Maayan Hoffman, Screenshot.
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