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What Male Circumcision Taught Us About the Future of Funding for Global Health

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Private capital is needed to test and develop proof that existing health solutions can be adapted to a developing world context. Once this proof is established, the solution has the power to unlock the large-scale government funding needed to dramatically improve health across the developing world.

As demonstrated in a new report released this week by PSI's Impact magazine and Devex, in partnership with Fenton Communications, the landscape for global health financing has changed dramatically. High-income governments that provide foreign aid for health have steadily increased their support over the last decade. That support is now leveling or shrinking due to budget constraints. Governments are under increased pressure to reduce risk and ensure that all public funds for foreign aid are invested in solutions that guarantee results.

As a result, corporations, foundations and philanthropists are now taking an active role to help protect the progress already made against serious threats to health and economies like HIV, malaria, tuberculosis, pneumonia, and lack of access to family planning, which remain as urgent as ever. They are providing private capital to fund the type of innovation that governments cannot afford to advance on their own.

Today, private entities and individual philanthropists are creating hands-on, long-term relationships with their nonprofit partners to develop and deliver development solutions that produce a social -- and in many cases -- an economic return on investment.

A prime illustration of this impact opportunity revolves, interestingly, around one of history's oldest medical practices: male circumcision.

An Innovative Approach to HIV Prevention

Six years ago, the World Health Organization and UNAIDS approved voluntary medical male circumcision as a powerful tool to reduce the risk of HIV infection. Randomized controlled trials proved that circumcised men are 60 percent less likely to acquire HIV from a female partner.
This discovery did not immediately lead to an increase in funding for male circumcision services in regions with a high HIV/AIDS prevalence. On the contrary, many global health experts were skeptical that men in the developing world would want the procedure. Even if demand for the service could be created, many believed it would be impractical and too costly to make it widely available, particularly across sub-Saharan Africa where the HIV epidemic maintains a stronghold.

The health experts at my organization, PSI, were more optimistic. We raised $500,000 through fundraising campaigns such as YouthAIDS, and piloted a circumcision program in Zambia. Using targeted communication channels, PSI and its partners demonstrated that we could create demand for circumcision among young males and provide the service safely and efficiently. In its first year, PSI and its partners circumcised more than 2,100 men. The results of the pilot drew the attention of the Bill & Melinda Gates Foundation and the U.S. government, who, in partnership with the Government of Zambia, helped take the program to scale nationwide in Zambia.

Within five years, the initial investment of $500,000 leveraged more than $31 million from large donors, making it possible to reach more than 170,000 men across Zambia with circumcision services.

Unlocking New Funds

The success of the pilot program in Zambia created a powerful multiplier effect. To date, PSI has leveraged more than $77 million from donors to replicate this model across Southern and Eastern Africa. As a result, PSI alone has been able to provide circumcision services to approximately 400,000 men in seven countries -- Kenya, Lesotho, Mozambique, South Africa, Swaziland, Zambia and Zimbabwe. Using the World Bank-approved DALY metric, these interventions added 1,480,637 years of healthy life.

Combined with efforts from other health organizations, local governments and with support from international donors, more than 1.1 million African men have been circumcised -- moving us even closer to an AIDS-free generation.

Applying the Formula to All Health Areas

The story of male circumcision in Southern and Eastern Africa illustrates the power of private investments, and their ability to unlock the funding that is needed to bring existing health solutions to the hardest to reach areas of the developing world. There are no shortages of known health solutions that have the potential to revolutionize global health.

We need to find a way to deliver pediatric doses of pneumonia treatment to caregivers so they can protect their loved ones from the leading cause of death among children, globally. We need to find a way to deliver home-based HIV tests for individuals who fear being discriminated against for getting tested in a public facility. We need to find a way to offer clean delivery kits to mothers who are not able to give birth in a health facility. To date, these and many other effective health solutions remain out of reach for too many people.

With the right investments and partnerships, we can create the leverage to change that.