On Monday, this foursome debated whether HIV aid was a good investment. Mead Over and Roger England, on the left, against the proposition, repeatedly emphasized that investments in clean water and malaria are better bargains for your health dollars. The implied suggestion was that better health outcomes would be achieved if the health aid portfolio were rebalanced. At the same time, the goals of the HIV community are to increase the number of people receiving ART, which would widen the gap between the allocation portfolio guided by the “best buys” and the allocation portfolio on the ground. This seems to be an irreconcilable tension, except that this panel has shown that there’s an approach that can makeall these people happy. An IPC would reduce costs *TO THE DONORS* to do what they are interested in doing anyways: increase testing, improve clean water access, distribute bed nets, and other high-value priorities.So why is it not being done?
More_with_Less? IPC Panel Discussion
More with Less? Extending the Reachof Development Assistance in an Era of Uncertainty Eran Bendavid Stanford University
The charge for AIDS 2012• The end of AIDS • AIDS-free generation• Turning the tide • www.2endaids.org/ AIDS Assistance from Donor Governments, Bn$ $8.7 $8.7 $8.7 $8.8 $7.7 $7.7 $7.6 $6.9 $6.6 $5.6 $4.9 $4.3 $3.9 $3.6 $3.5 $2.8 $2.0 $1.6 $1.6 $1.2 02 03 04 05 06 07 08 09 10 11 02 03 04 05 06 07 08 09 10 11 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 Commitments Disbursements
A no-brainer!• In Kenya, the targets of aid agencies include: • Increase home-based and voluntary testing (PEPFAR and Global Fund) • Increase possession and use of insecticide-treated bed nets and long-lasting insecticidal nets (President’s Malaria Initiative and Global Fund) • Testing and implementing clean water technologies (USAID and CDC). • What if all these separate activities were implemented in sync?
Why it is hard to coordinate?• Donor institution targets are tightly tied to specific diseases. For example: “The goal of PMI is to reduce malaria-related deaths by 50 percent in 19 countries in Africa that have a high burden of malaria by expanding coverage of four highly effective malaria prevention and treatment measures.”• The US Global Health Initiative aimed to bring the various US institutions involved in health aid under one umbrella. “We cannot simply confront individual preventable illnesses in isolation. The world is interconnected, and that demands an integrated approach to global health.” Barack Obama, May 2009• But the GHI lacked statutory or budget authority, and, to date, failed to eliminate parallel structures in the major health aid agencies
The challenge: getting past no-brainers• A common fund for cross-agency priorities, managed by the Global Health Diplomacy office…• Funding specific aspects of ministry campaigns could promote the breadth and ownership of ministry activities while keeping donor priorities and outlays aligned.• The google approach: dedicate 10-20% of funds to develop creative (and disruptive) approaches to improve global health.