Everyone currently working in the development work is asking the big question on daily basis: “What should the global health architecture look like? And how do we finance that architecture?”. No one seem to have come up with an answer, nor should they. The global health architecture depends fully on global political and economic climate – of which both are at tipping points. The growing populism and conservatism that seem to be happening in every corner of the world affect discussions on access to healthcare like it never before. Similarly, emergence of new economic power signaled critical changes to the dynamics of relationships between countries and within them. While economic inequalities seem to be slowly reduced between countries, the income gaps of within countries seem to widen and put a spotlight on different dimension of inequalities, including poverty and access to health care.
Many of the global institution that focus on development areas are slowly waking up to this reality. Global health financing institutions such as Global Fund and PEPFAR struggled to secure resources from their donor governments, and when they managed to secure some of very much needed resources, many donors prioritize lower income countries (for one or many reasons)– which left middle income countries in “shock” due to significantly reduced resources.
These abrupt changes in the tone of global financing of disease responses often resulted in political and programmatic denial among implementing countries. Some of the donors continue to believe that as countries becoming richer, they are able/willing to finance their own disease response, while most of implementer countries still believe that donors will continue funding them one way or another. For decades, the relationship between donors and implementers are mainly dominated by donors’ agenda. Donors came in, set priorities, change them, and criticise them without long term sustainability plan or exit strategy. All these happening while the implementer governments focusing on developing proposals, implementing programs and writing ridiculous amounts of reports. While donors mainly focus on ever changing areas of focus due to government administration changes, implementing governments experience similar trends in their administration and the combination between the two resulted in severe lack of domestic ownerships of disease responses.
Based on these realities, that global health financing landscape is changing and there is a lack of in-country preparation for what to come, global financing institutions started to develop a transition strategy. The Global Fund Board approved a Sustainability, Transition and Co-Financing proposal in 2016 – 5 years after the first set of countries fell out of Global Fund eligibility list in 2011. PEPFAR released PRPFAR 3.0 which include Sustainability Action Plan in 2014, which encourage countries to include in the Country Operational Plan (COP) a plan to ensure sustainability in financing the national disease response. While these two policies were formed by the best thinking in the development worlds, fact remains that the days of aid glories seem to long gone and we are relearning how to continue ensuring people’s rights to health are guaranteed in this new development world.
While a number of case studies, papers and recommendations on specific areas on STC have been done by various actors, there is a need to stock take and comprehensively document some of the things that we (collectively) already learned and those knowledge gap that we still need to fill in. The intention of this publication is to collect those knowledge already available and to synthesize those knowledge into different sets of recommendation, categorised by areas and scope of work all of us are doing.
Furthermore, the publication will highlight distinctions between available evidence, assumptions and gaps of knowledge that exist on issues surrounding sustainability of disease response and transition to new model of financing – with the aim to encourage more actors to continue documenting some of the knowledge in these areas.
An additional objective is to concentrate all available information resources on STC to a single pool: CSSN Resource Library