Global Health Initiatives (GHI) funding for HIV/Aids, Tuberculosis and Malaria has had positive impacts on overall health sector financing and related reforms, among them significant increases in resources for the health sector and the ability to afford expensive, but life-saving technologies and interventions.

But findings from a recent study, "Financing for HIV/Aids, Tuberculosis and malaria in Uganda: an equity analysis", raise concern regarding equity issues.

"Routing GHI resources in project mode does not allow for effective co-ordination and harmonisation, and not all GHI resources are aligned to sector priorities," wrote the study authors. "This is likely to promote gender and geographic inequities, considering that project funds and some GHI funds are usually spent on selected geographic areas, the selection of which might not be always based on equity considerations, such as need."

The authors of the study by the Regional Network for Equity in Health in East and Southern Africa (Equinet), further note that although each GHI creates a relatively large risk pool, there is limited integration between the different GHIs. They add: "The lack of integration is likely to lead to inefficiencies, such as through an overlap in funding from different donors for certain areas or interventions."

According to the World Health Organisation, Global health initiatives are an emerging and global trend in health that focus on partnerships and are considered to be one of the benefits of globalisation. They (GHIs) are programmes targeted at specific diseases and are supposed to bring additional resources to health efforts. The Global Fund (to fight Aids, TB and Malaria), the US President's Emergency Plan for Aids Relief (Pepfar), the US President's Malaria Initiative and the World Bank's Multi-country Aids Programme (Map), are the most prominent financing GHIs. Basing on their findings, the authors of the Equinet study published in June this year made several recommendations to the Ministry of Health (MoH) to improve co-ordination and harmonisation of all development aid, including support from GHIs.

"Government will need to design mechanisms that will help integrate GHIs resources to allow for greater cross-subsidy and to reduce overlaps and inefficiencies. We suggest that the Ministry of Health negotiates with development partners to channel GHI resources through one common structure within the ministry," they suggested.

But while setting up this structure, the study authors added that the Ministry of Health would need to address the transparency and accountability concerns of the partners and other stakeholders.

"We further propose that the MoH monitor equity in the health sector, including health financing equity, equity in access to care, geographical equity and gender equity" they added. "Initially, special equity studies could be conducted but regular equity indicators should be developed and reported on in the annual health sector performance reports."

Similarly, it was argued that technical programmes in the MoH should undertake in-depth spending assessments for HIV, Aids, TB and malaria, including an assessment of private spending on these diseases.

The author is a fellow with the Makerere University School of Public Health - Centers for Disease Control HIV/AIDS fellowship Programme.