The future of the global health initiatives

Dr Sophie Witter, Institute for Global Health and Development, Queen Margaret University Edinburgh

We are submitting as IGHD as this is an important policy topic, which key members of the Institute worked on as part of a research consortium in 2023, contributing research[1] which fed into global consensus-building on this topic.

Why should the International Development Committee examine this area?

A number of global funding platforms were established after 2000 to address high priority challenges in health, including to address the priorities in the Millenium Development Goals. They have since grown in number and roles and now provide a significant amount of the support received at national level for health (a recent estimate[2] put the contribution of just two of them – the Global Fund for AIDS, TB and malaria and the Global Vaccine Alliance (GAVI) - at 14% of total development assistance for health. They are major players in the global health architecture yet how they support country health systems has been critiqued, as they typically support very siloed components of the health system in ways that fragment and often undermine country-led universal health coverage (UHC).

The UK puts a significant part of its development assistance for health through these GHIs and has a strong interest in ensuring that they use resources optimally to support long term health and health system gains, especially in resource-dependent settings such as low income and fragile or conflict affected settings.

Why is it the right time for the Committee to examine the area?

An initiative called the Future of the GHIs[3] was established in 2022, with support of the Governments of Norway and Kenya and managed through the Wellcome Trust secretariat. Research and consensus-building led to the Lusaka Agenda[4] in December 2023, which highlighted a range of needed reforms. These are now under active debate within GHI Boards and other multilateral and bilateral organisations, with the African Union also taking up leadership in implementation[5], and some proposals being launched for close tracking[6] of reforms to ensure accountability. It is a crucial time to ensure that this is not just another failed coordination initiative but is followed through with action, especially as some of the major GHIs, like the Global Fund and GAVI, seek fund replenishment in 2025.

Why would this area benefit from parliamentary scrutiny?

UK development aid has been reduced and there is pressure to ensure that all resources are used most effectively. The Foreign, Commonwealth and Development Office (FCDO) has played an active role in the FGHI and Lusaka Agenda process but it is not clear how it is now using its various avenues for influence, including on the board of organisations like the Global Fund, to push for real reforms. This would benefit from scrutiny by the committee, ensuring that well planned but serious changes are made by GHIs.

Why does the Government need to act in this area?

The UK has an interest and strategic priority in health security and UHC globally, and the GHIs are an important mechanism for delivery. These are facing pressures for greater accountability to countries, alongside new health challenges from non-communicable diseases, mental health and climate change, while also needing to continue to generate funding in an increasingly divided world. This is a risky moment, and the UK government needs to take a concerted approach to ensure the GHIs are made fit for the current context.

How could Government policy in this area be developed or improved?

The government should adopt a clear position across its relevant agencies on reform of the GHIs – in particular, to ensure that they work in a more aligned way with country health systems to reduce costs, improve allocation to country priorities, increase transparency and contribute more effectively to health system strengthening – and follow through using its funding and representation consistently in 2025 and beyond.