Global Fund: AIDS, Tuberculosis and Malaria

Lord Parekh Excerpts

Wednesday 4th July 2012 Lords Chamber

[Lord Parekh]

My Lords, I thank the noble Lord, Lord Fowler, for securing this debate and for introducing it so well. Since he has provided a large number of relevant statistics, I am spared the trouble of having to rehearse them.

I think that the Global Fund has been doing excellent work, largely because of its overall strategy. It is innovative and engages in demand-driven financing. Its funding is based on performance, it engages local communities, and it receives contributions from the private sector as well as voluntary organisations and the Government. All that gives it a certain strength. As it is in the process of revising its strategy for the next few years, I want to propose three or four important ideas that it might like to consider.

First, the fund used to do a little more than it has done so far to negotiate with manufacturers to reduce drug prices, which eat into its funding and limit its capacity to help the 150-odd countries that are its members. Secondly, it needs to concentrate a little more than it has done on strengthening health systems. Currently it allocates about 36% of its investment to that. I feel that it needs to do a little more in this area and to reconsider its priorities. In terms of strengthening health systems it needs to pay more attention to raising public awareness of the three major pandemics with which it is concerned, concentrating as much on prevention as on cure, making sure that the nursing staff and others are well trained and that there is an international exchange of experts from developed countries to the poorer countries. It has almost completely ignored that area and my experience is that there are a lot of people who could be persuaded to go to developing countries and help to train staff.

Thirdly, regional results are uneven. Grants for TB were achieving between 82% and 100% of their targets, but for malaria the figure fell to between 59% and 82%. Why are the malaria-related grants performing less well than those for TB? One could say that in some parts of the world there has been a growth of parasites that are resistant to artemisinin—for example, in south-west Asia. That by itself would not explain it and one would like to see some monitoring of those uneven results. Finally, although the Global Fund has been involving civil society organisations, as the noble Lord, Lord Fowler, pointed out, perhaps there is scope for greater civil society intervention in terms of planning strategy, putting pressure on Governments and monitoring the harmful industrial activities that resulted in these three pandemics in the first instance. That kind of work can be done only by civil society organisations, because the Global Fund by itself is seen as an external body and cannot be seen to be interfering in the internal politics and activities of the receiving countries.