The recently published Global Fund Results Report highlights the devastating impact the COVID-19 pandemic has had on the fight against HIV, TB and malaria in 2020. HIV and TB treatments and services have been hit particularly hard, though the story is more positive for malaria where prevention activities have remained stable since 2019.¹ There is no question that the pandemic will continue to exert pressure on health systems and inhibit progress towards global health goals, which makes it more important than ever that the Global Fund and the global health community work together to implement the most appropriate strategies and approaches, and remain on track.
This new evidence makes the Global Fund’s upcoming five-year strategy, which is entering the final stages of development, especially timely. The strategy sets out how, from 2023, it aims to help drive progress towards the ambitious 2030 goals for HIV, TB, malaria and health more broadly. Malaria Consortium acknowledges several key positive decisions that have been taken so far during the process, such as commitments to data-driven action and strengthening a data use culture; a new and timely COVID-19 pandemic response; and people-centred approaches and community leadership. However, to ensure that those working to alleviate the burdens caused by these diseases are able to continue making progress, there are several further improvements that we recommend the Global Fund make to the strategy.
Malaria elimination in both Asia and Africa: The Global Fund strategy framework refers only to Africa in its objective around driving towards malaria elimination and facilitating the prevention of reestablishment of the disease. In fact, the Greater Mekong Subregion (GMS) and most of Asia Pacific countries (some are still supported by the Global Fund) aim to eliminate malaria by 2030. The GMS, once a hub for Artemisinin-resistant malaria, aims to eliminate Plasmodium falciparum malaria by 2023. The cost of elimination in this last mile will be higher than the cost in control phase, therefore Global Fund investments are needed now, as countries progress towards elimination along the transmission continuum.
Prioritise adaptive, responsive, and cost-effective surveillance approaches: The Global Fund should support countries to establish strong surveillance systems that they can operationalise to the lowest levels of delivery to guide response activities.² It is especially important to strengthen surveillance systems at district level where timely actions can be initiated. This requires emphasis on a dynamic data-driven adaptive management approach that rapidly identifies areas of attention for timely action.
Increase the role of the Global Fund in future pandemic preparedness (PP): The Global Fund is well placed to contribute to PP, through continued support for surveillance and response, effective community engagement and digital solutions. Evidence from the last 16 months has shown that accurate real-time local surveillance, together with robust health services are needed to effectively tackle disease outbreaks. This will require community health workers (CHWs) to be trained to report any new diseases of concern and the reporting systems used by CHWs to be improved. CHWs are critical in ensuring the continuity of essential services during pandemics like COVID-19 when the services are either scaled down or overwhelmed or both, as is often the case in resource constrained settings.
Support countries to transition to integrated Health Management Information Systems (HMIS) and data utilisation at all levels of health systems: Countries supported by the Global Fund tend to have vertical HMIS which creates fragmentation and data-accessibility issues. Integrating data from across different diseases will streamline processes and enable health workers to work more efficiently.
Expanding the vector control toolbox: Using core prevention tools such as insecticide-treated bed nets (ITNs) and indoor residual spraying (IRS), the Global Fund should support countries in expanding their vector control toolbox, tailored to individual transmission settings. In particular, the introduction of outdoor prevention tools should be accelerated. Both biological threats (insecticide resistance) and non-biological threats (programme planning, user uptake) of current core tools need to be optimised. Additional concerns, such as the environmental impact of widespread ITNs and the rising threat of arboviruses outside of the three vertical disease programmes, should be investigated.
Strengthen community-led response: As a consequence of the COVID-19 pandemic, the Global Fund is now better positioned to respond to health challenges beyond AIDS, TB and Malaria. Evidence has shown that CHWs – critical enablers to achieve Universal Health Coverage (UHC) goals – can step up to address other health challenges if they are well trained and supervised. The Global Fund should support countries to deploy more effective community engagement strategies rather than educating and informing through traditional approaches. Several new social and behaviour change communication (SBCC) interventions, including positive deviance and community dialogues, have been shown effective in increasing community participation and could be part of the solution.
Collaborative working with other donors: The Global Fund can maximise the impact of the current level of funding by working more closely with other donors and implementing organisations that the Global Fund has close relationships with. An important part of this approach should be to strengthen institutional capacity, for example, establishing sustainable public-private partnerships where the government is in a position to steward this process.
We believe these improvements are necessary to help to ensure that the Global Fund is well equipped to address the global challenges of HIV, TB and malaria, as well as being in a position to drive a more holistic, integrated approach to Universal Health Coverage and Primary Health Care that will contribute to the achievement of the 2030 goals.
¹https://reliefweb.int/report/world/global-fund-results-report-2021
²Arantxa Roca-Feltrer Et al, 2021. The Role of Adaptive Surveillance as a Core Intervention to Achieve Malaria Elimination (https://www.intechopen.com/chapters/75830)