When is eradicating a major disease a disaster for healthcare?

January 30, 2018

     By Duncan Green     

Guest post from Laura Kerr, Senior Policy Advocacy Officer (Child Health), RESULTS UK

The world is on the brink of a historic breakthrough – the eradication of polio. Cause for celebration, right? Well yes, in terms of getting rid of a killer disease, but because of the way the aid business has distorted health systems around the developing world, the end of polio could tip many countries into a health disaster.

The fight against polio has mobilised big bucks for over 30 years, polio funding has been used by the poorest countries around the world to support critical aspects of their health systems, such as health workers and disease surveillance, to the tune of around $1billion a year. The Global Polio Eradication Initiative (GPEI) is one of the world’s largest health partnerships and planned spending by the GPEI will halve between 2017 and 2019 – a reduction of over $300million in 3 years. What happens now as polio money disappears and who is responsible for filling the gaps which will be left?

Since donors have ultimately created a situation where health systems have become reliant on polio funding, what can they do now to prevent these systems collapsing? Do we need a new vertical financing mechanism or streams to fill gaps which will most certainly be left? After years of a narrow disease eradication approach, now is the time to have a frank conversation about how the donor community can better support health systems in a sustainable way.

This is the subject of our new report, in A Balancing Act: risks and opportunities as polio and its funding ends which looks at what needs to happen now if the victory over polio is not to be overshadowed by a looming health crisis that can be averted.

But what are the gaps and why are we so worried? A few examples include:

  • 70% of global funding for disease surveillance comes from GPEI. An area which is already underfunded, there is an existing need for increased investment.
  • 40% of all WHO staff who work in the African region are funded through GPEI. Most will work on a whole range of health issues beyond polio.
  • 702 GPEI funded staff in South Sudan are the backbone of the health service. Spending only 27% of their time exclusively on polio eradication, the rest of their time they deliver routine immunisation and basic health services.

Addressing these (and many other) gaps exposes the fundamental challenge of shifting disease specific eradication efforts in global health towards a systematic approach that builds and finances strong health systems which are able to provide health services to all of those who need them. We do not need another disease specific fund or initiative.

However, the problem we face is that donors prefer to fund things which are easier to track numerically – children immunised and lives saves is much easier to document a return on investment on compared to the long-term impact of training of health workers or improvements to disease surveillance or the cold chain. What makes sense for the donor often does not make sense for developing countries and their inhabitants.

Continuing with the same “business as usual” approach, with donors filling disease specific funding gaps, will do nothing but stick a plaster over existing gaps in health systems. This is unsustainable, especially in the context of other global health donors who are also beginning to transition away from certain countries (see quick analysis of this here). Worryingly, there is limited acknowledgement of the scale of the gaps which will exist, what comes next, or a desire to tackle the wider issue of sustainable financing for health systems.

When over 20% of WHO’s budget and 35% of UNICEF’s immunisation staff supported through GPEI, there are some serious structural barriers that need to be addressed. This poses a serious conflict of interest that could lead GPEI partners to shy away from a frank and honest conversation about the future financing of global health.

As things stand now, the potential crisis caused by the wind down of GPEI is not fully realised. This limits the ability of the global health community to have the much-needed frank conversation about what comes next after GPEI. Without leadership from the five GPEI partners to realistically address the imminent challenges which are currently presenting themselves, we’re walking straight into a preventable health financing crisis and it’s the most vulnerable in the world which will be left suffering.

And for more on Oxfam’s policy work on health, visit the Global Health Check blog

January 30, 2018
Duncan Green