Overcoming Challenges in Global Health

By Mark Dybul, Executive Director

in Voices on 24 May 2016

Partners in global health have made tremendous progress in the last decade in the fight against HIV, tuberculosis and malaria. By working together and involving people affected by the diseases, civil society, the private sector and governments, we have seen progress way beyond what seemed possible only a few years ago. But achieving impact was relatively easy: The need was so great that almost anything we did had impact.

Today we face very serious challenges in global development and the road ahead calls for new thinking, more nuanced investments and more strategic partnerships. The fight against the three diseases is more important than ever in a world increasingly affected by natural disasters, conflict and economic crises. The worst refugee crisis on record is affecting all parts of the world – and as people move, so do diseases. This new reality is why the Global Fund has prioritized challenging operating environments– countries that experience disease outbreaks, natural disasters, armed conflicts and weak governance. The Global Fund was created as a partnership to end three of the most devastating infectious diseases to hit humanity. How we evolve as a partnership to the changing landscape and adjust our way of working in different contexts so that no one is left behind will determine our success in the future.

As countries move along the development continuum – the trajectory of development that occurs in different ways at different speeds in each country – we need to develop differentiated approaches based on the specific circumstances to better serve the people in need. This is particularly the case in challenging operating environments. The Ebola crisis in West Africa and the ongoing refugee and migration crisis have revealed unique problems in providing access to health care in challenging operating environments. To provide prevention, treatment and care, we need to follow the people – regardless of their status, circumstance, or ethnic and religious background. We have to think beyond the disease or development paradigms, and focus on the person.

The Global Fund is putting a stronger focus on challenging operating environments with the aim of increasing coverage and reaching key and vulnerable populations, particularly women and girls, migrants, people living with HIV, and marginalized groups like people who use drugs, sex workers and men who have sex with men. In challenging operating environments, these groups are even more likely to be pushed to the margins – making it even more important to ensure they have access to health care, no matter where they are. Investing in challenging operating environments has been identified as one of the Global Fund’s strategic priorities. Challenging operating environments are particularly critical to the Global Fund’s mission and objectives, as they account for one third of the global disease burden for HIV, tuberculosis and malaria – and one third of Global Fund investments. Between 2014 and 2016, the Global Fund has directed US$4 billion to programs in challenging operating environments.

Last month, I travelled to Sierra Leone, a country that was hugely affected by the Ebola crisis. During the peak of the outbreak, the Global Fund tapped into a special emergency fund to support the mass drug administration of artemisinin-based combination therapy to treat people with malaria. Patients with Ebola and malaria display common symptoms such as fever, headache and aching joints. Decreasing incidence of malaria reduced the burden of malaria on already overstretched health systems – and with fewer malaria patients, we also reduced the chances of misdiagnosis of Ebola. The effort, in partnership with the World Health Organization and UNICEF, reached over 95 percent of targeted households. The Global Fund partnership has supported similar initiatives in Liberia and Guinea, countries also affected by Ebola.

I was also deeply impressed by Sierra Leone’s efforts, led by President Dr. Ernest Bai Koroma, in developing a strategy to build resilient and sustainable systems for health. The Ebola outbreak clearly showed that countries with stronger health systems are better able to manage ongoing health threats like AIDS, TB and malaria – and emerging threats like Ebola.

The Global Fund partnership is also using a differentiated approach in the Middle East, which is suffering the effects of conflict and coping with humanitarian crises and large numbers of internally displaced people and refugees. Earlier this year, I visited the Zaatari refugee camp in the Jordanian desert. In cooperation with local and international partners, the Global Fund partnership is supporting the provision of essential TB prevention, diagnosis and treatment to Syrian refugees in Lebanon and Jordan. In refugee camps, preventing and treating diseases not only protects already weakened refugees from falling ill, it frees up critical resources to provide other health services and prevents diseases from spreading.

The only way to maximize the impact of our investments and end these epidemics is by reaching everyone, empowering communities and removing human rights-related barriers to services. The Global Fund is not a humanitarian organization, but as a partnership created to end the three epidemics while building resilient and sustainable systems for health we are committed to upholding the principles that safeguard humanity. The 2017-2022 Global Fund Strategy commits to increase the Global Fund’s impact in fragile contexts over the next six years. This commitment is supported by the first Global Fund policy on challenging operating environments to use an innovative and flexible approach to increase our impact.

We have the tools to defeat HIV, TB and malaria, but the diseases are still with us. Putting human beings at the center of our response means going beyond the work we have already done. We have to work hard to reach key populations and cater to each country’s unique stage and context, enhancing our flexibility and responsiveness and strengthening our partnership. We must grasp the historic opportunity to become better people and societies built on the firm foundation of an inclusive human family.

Mark Dybul is the Executive Director for the Global Fund to Fight AIDS, Tuberculosis and Malaria.