allAfrica.com: Africa: Africa - "Diagonal" Health Financing (Page 1 of 4)

The dichotomy between "vertical" financing (aiming for disease-specific results) and "horizontal" financing (aiming for improved health systems) of health services in developing countries is both destructive and unnecessary, argue a team of health activists and researchers in a new peer-reviewed policy paper published in the journal Globalization and Health. They propose expanding a "diagonal" approach that recognizes the necessary complementarity between disease-specific programs and improvement in health systems, with costs shared by both international and domestic funding sources.

This AfricaFocus Bulletin contains excerpts from this article by Ooms, Van Damme, Baker, Zeitz, and Schrecker on the "diagonal" approach to Global Fund financing, published on March 25, 2008. The full article, with footnotes, is available at http://www.globalizationandhealth.com/content/4/1/6

For earlier AfricaFocus Bulletins on health-related issues, visit http://www.africafocus.org/healthexp.php

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The 'diagonal' approach to Global Fund financing: a cure for the broader malaise of health systems?

Globalization and Health 2008, 4:6 doi:10.1186/1744-8603-4-6

Gorik Ooms (gorik.ooms@scarlet.be), Wim Van Damme (wvdamme@itg.be), Brook K Baker (b.baker@neu.edu), Paul Zeitz

(pzeitz@globalaidsalliance.org), Ted Schrecker (tschrecker@sympatico.ca)

Submission date 14 November 2007 Publication date 25 March 2008

Article URL http://www.globalizationandhealth.com/content/4/1/6

This peer-reviewed article was published immediately upon acceptance. It can be downloaded, printed and distributed freely for any purposes.

Background

The potentially destructive polarisation between "vertical" financing (aiming for disease-specific results) and "horizontal" financing (aiming for improved health systems) of health services in developing countries has found its way to the pages of Foreign Affairs and the Financial Times. The opportunity offered by "diagonal" financing (aiming for disease-specific results through improved health systems) seems to be obscured in this polarisation.

In April 2007, the board of the Global Fund to fight AIDS, Tuberculosis and Malaria agreed to consider comprehensive country health programmes for financing. The new International Health Partnership Plus, launched in September 2007, will help low-income countries to develop such programmes. The combination could lead the Global Fund to fight AIDS, Tuberculosis and Malaria to a much broader financing scope.

Discussion

This evolution might be critical for the future of AIDS treatment in low-income countries, yet it is proposed at a time when the Global Fund to fight AIDS, Tuberculosis and Malaria is starved for resources. It might be unable to meet the needs of much broader and more expensive proposals. Furthermore, it might lose some of its exceptional features in the process: its aim for international sustainability, rather than in-country sustainability, and its capacity to circumvent spending restrictions imposed by the International Monetary Fund.

Summary

The authors believe that a transformation of the Global Fund to fight AIDS, Tuberculosis and Malaria into a Global Health Fund is feasible, but only if accompanied by a substantial increase of donor commitments to the Global Fund. The transformation of the Global Fund into a "diagonal" and ultimately perhaps "horizontal" financing approach should happen gradually and carefully, and be accompanied by measures to safeguard its exceptional features.

Background

The potentially destructive polarisation between "vertical" and "horizontal" financing of health services in developing countries has found its way to the pages of Foreign Affairs [1] and the Financial Times. [2] This debate is not new; Uplekara and Raviglione describe a pendulum that has swung between vertical and horizontal for decades. [3] However, the new International Health Partnership Plus (IHP+) gives renewed life and urgency to the debate. [4]

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