I recently sat down with Sophie Delaunay, Executive Director of the United States section of Doctors Without Borders/Médecins Sans Frontières (MSF), to discuss the intersection of innovative mechanisms in global health financing, advocacy, accountability, and civil society. An excerpt of the interview is below, and the full transcript can be read on the Humanitarian and Development NGOs Blog at the Hauser Center for Nonprofit Organizations.
Rahim Kanani: Explain a little bit about the intersection of global health financing and health priorities, and from there we can move into new ways or new mechanisms that are being explored to address this enormous gap.
Sophie Delaunay: Let's start with malnutrition, for example. Malnutrition is affecting millions of children worldwide. A study conducted by the World Bank last year estimates that $12 billion a year is necessary to address childhood malnutrition. At the moment, the overall spending on malnutrition is 350 million dollars a year. MSF is actually one of the five largest contributors. We alone cannot respond to all the needs.
In terms of HIV/AIDS, the gap is so abyssal that it's hard to provide detailed data, but the fact is that there are only five million people on treatment today when 15 million need to be on treatment. Among those who are on treatment today, the vast majority resides in sub-Saharan Africa, and they can only access a less expensive stavudine based first line regimen that we now know has numerous side effects and is no longer recommended by the World Health Organization for this reason. So the gap is not just about the amount of additional treatments needed, but also about reducing the double standard and making new, more effective treatments accessible to these countries. The Global Fund estimated that they needed 20 billion dollars in order to be able to scale up their commitments to the countries for the next three years and move forward with an aggressive response; they needed $13 billion just to keep their doors open with their existing commitments. However, the recent Global Fund Replenishment Conference ended up with less than 12 billion of pledges from the countries, so this is very disappointing to see that these needs won't be covered.
And here we have just described the needs for malnutrition and HIV/AIDS, but there are many other global health issues like neglected tropical diseases, mother and child healthcare, etc. that receive insufficient resources. It's quite ironic that on one hand there has never been such strong mobilization and acknowledgement of global health needs, and still, the funding and policies do not proportionately match the momentum or awareness.
RK: The trend line for global health funding has drastically increased over the last decade, so is the issue one of awareness or budgetary constraints of foreign aid?
SD: It used to be a problem of awareness and now it's less a problem of awareness and more a problem of concrete mobilization, and it's also closely related to political agendas. Most of the funding mechanisms that we've put in place over the past few decades are in fact dependent on other agendas, making the recipient vulnerable and at the mercy of political climates. For example, the economic crisis has definitely been used as a reason to retract from previous commitments. For many years, this kind of volatility has actually been dominant in the area of global health financing.
RK: And, as you very well know, a very, very small percentage of a country's GDP is spent on foreign aid, let alone global health in specific.
SD: Right, so what we are trying to look at is if, in addition to government's ODA (that should be maintained), we could support some innovative ways to develop more sustained funding, a mechanism that makes the funding stream and the resources more predictable. This type of mechanism would be welcome in the field of global health if we could rely for the next 10 years on a steady influx of resources to support these needs that we know, will not eradicated over night.
RK: And how did MSF get in the business of looking for and evaluating new mechanisms for global health financing, given the core expertise of the organization falls in the realm of emergency medical assistance?
SD: You are right that we are not experts in health financing, and our core activities will always remain the provision of medical care. So we have to rely on others' expertise for the choice of the best possible instrument. However, we can definitely support this effort by documenting the needs and advocating for more appropriate resources. Ten years ago, when we created the Access Campaign for Essential Medicine, we did not have much knowledge about the whole system of intellectual property and licensing rights but we could see the practical consequences that this system had on access to much needed drugs in the field. Again, we feel that we need to challenge the current paradigm and push for innovative solutions.
RK: And what are some examples of new and innovative ways to finance global health priorities, which have been proven to be effective or are the most promising moving forward?
SD: Some innovative funding mechanisms already exist in the form of UNITAID, which takes its resources from a tax on airfares. This is a facility that has been totally devoted to health, and the added value of these kinds of mechanisms is that you take a very, very tiny percentage of a large volume of transactions, so it has a very minimal impact for those who pay, but maximum impact for those who receive. For us, a Financial Transaction Tax (FTT), if properly constructed and directing significant resources towards health needs, would meet these goals. With a minuscule levy on financial transactions, and given the volume of financial transactions worldwide, it would provide a substantial revenue stream for global health needs, among other priorities.
Continue reading on the Humanitarian and Development NGOs Blog at the Hauser Center for Nonprofit Organizations.
Future interviews include the President of Tufts University, the President of Harvard University, the Dean of Harvard's School of Public Health, the Director of the London School of Economics, Tony Blair, among many others. Follow me on Twitter to be notified of their publications.