Global health donor agencies, as one might expect, are in the business of improving health – often indirectly through financial and technical support to governments, NGOs and charities. However, a recent trend has seen global health agencies being held accountable for achieving real impact on the ground.
Is this a good thing?
Take the Global Fund to Fight Against AIDS, TB and Malaria – a ‘global health partnership’ established in 2002 to fund and support low and middle income countries to provide treatment and prevention programmes related to HIV/AIDS, TB and Malaria. It started off with the clear intention of being a financing agency. But over time, it stopped being just a financing agency; and started being a strategic planning and priority-setting agency; with a more hands-on operational role. Soon it started to measure the impact of its own funding in low and middle income countries.
According to its 2012 Results Report, between 2002 and mid-2012, “Global Fund–supported programmes” saved 8.7 million lives through (a) antiretroviral therapy (ART); (b) direct observational therapy, short course (DOTS) for TB; and (c) insecticide-treated nets (ITNs) for malaria.
But how does the Global Fund calculate this number? Is it accurate and reliable? And how does it determine which lives were saved by its programmes; and how do the numbers tally with the number of ‘lives saved’ by governments and other agencies or donors? And what does the selective focus on measuring the impact of only ART, DOTS and ITNs do to other elements of Primary Health Care?
A paper, written by myself and Nele Jensen, attempts to answer some of these questions. The paper can be found here: http://www.aidspan.org/sites/default/files/publications/McCoy%20and%20Jensen_Saving%20Lives_Aidspan%20Report.pdf
In it, we describe and examine the methodology used by the Global Fund to arrive at the 8.7 million ‘lives saved’ figure. We criticise the Global Fund for not publishing uncertainty ranges associated with the estimated number of lives saved; and argue that the methods may produce an over-estimation of the number of ‘lives saved’ by ART, DOTS and ITNs. We also argue that the selective approach to impact measurement may have some unintended and negative consequences.
Finally, we discuss the issue of attribution. We describe how the number of ‘saved lives’ which have been attributed to “Global Fund–supported programmes” far exceeds the financial contribution of the Global Fund to overall financing. For example, while about 45% of global ART results are credited to ‘Global Fund–supported programmes’, the contribution of the Global Fund to total AIDS programme financing in low- and middle-income countries is only 10%. We therefore propose a different approach to measuring the Global Fund’s impact in terms of ‘saving lives’.