URGENT ACTION: Sign-on the CSO Red-Lines on the Future of Global Health Initiative (FGHI)

GFAN has been following and engaging in conversations among civil society around the Future of Global Health Initiatives (FGHI). We are concerned that without some basic acknowledgement of core principles – or Red-Lines – the direction of where this process goes in terms of recommendations and commitments may not be as productive and constructive or reflective of priority areas for affected communities and civil society organisations as they could be. For background, GFAN has recently published a blog and a statement on the Future of Global Health Initiative report that was circulated in August 2023 and held a call on September 6th with GFAN members (recording here). The report is a key piece of background material that is the subject of a meeting at Wilton Park (October 4th-6th 2023).

Please use the form here to sign on to this CSO Red-Lines statement. This civil society sign-on statement is intended to be used the week of October 4th-6th 2023 by those in Wilton Park and to influence the revised statement of accountability and action that is meant to be published at the end of November, and later to ensure that the FGHI secretariat is aware that advocates are paying attention.

Future of Global Health Initiatives: Redlines from communities and civil society  

For the past 20+ years, affected communities and civil society organisations have worked hard – alongside global health institutions (GHIs) sometimes aligned but not always exactly alike – to make GHIs nimble, inclusive, accountable and driven by evidence. Just as there is no doubt that there is room for improvement, there is equally little doubt about the positive impacts of GHIs in terms of lives saved, and infections and diseases averted through prevention and the introduction of new tools.   

While the eco-system of GHI’s may appear bewildering to some and as new challenges appear there is often a period of adjustment to find the value-add and strengths of each organization, nonetheless, the impressive record of results in their core mandate of saving lives through prevention and access to treatment, their ability to pivot during times of crisis and in challenging environments, their ongoing work in partnership with other established actors which contributed to trying something new and bold in response to COVID-19 specifically and their willingness to adapt and change generally cannot be ignored and should not be under-valued.   

The Future of Global Health Initiatives – a project to examine six GHIs and consider ways in which they can adapt and change – has objectives as lofty as its title. Thus far it has produced one draft document for consideration that provides recommendations that range from small, easy to implement tweaks to the system (more KPIs on partnership, more transparency across GHIs, more ownership by governments implementing GHI funded programs) and complete overhauls of the global health infrastructure (alignment of replenishment and grant timelines across all GHIs and mergers of their country teams). It has also produced a lot of concern and even some anger over the approaches taken. 

Notwithstanding GFAN’s many concerns with the methodology of the report (read our blog on this here) which, in short, we believe glosses over the impact of the GHIs and presents un-sourced assertions disguised as evidence garnered via a (not totally un-impressive but undeniably rushed and incomplete) set of consultations, GFAN and the signatories below are interested in an open, constructive dialogue about the future of GHIs.

However, in order for such a dialogue to be open and constructive, we must get past the superficiality of the recommendations suggested to date and examine and build on the changes GHIs are already leading on and build new ways of working that fully exploit their possibilities within a fuller examination of the global health ecosystem. 

GHIs have brought unique and successful models and approaches to health. Several of the GHIs included in the FGHI’s focus are much further along in terms of simple but effective and inclusive governance, inclusion of affected communities and civil society, and innovative approaches that provide value-for-money and incentivize domestic resource mobilization to support delivery of country defined priorities than many of the member state driven global health institutions.   
 
A number of representatives from the GHIs and other partners in global health including civil society, the private sector, donor and implementing governments and others are gathering for an exclusive conversation at Wilton Park in early October. During this set of meetings and ahead of the expected next iteration of recommendations for next steps within the FGHI at the end of November, civil society organisations from around the world are signing on to the following list of non-negotiable red-lines in the FGHI process:  

NO COMPROMISE ON GHI MANDATE: We will not compromise on the core mandate of Global Health Institutions to have as their foremost objective to produce results; results that can be categorized in terms of catalyzing research, development and deployment of new tools in service of the prevention and treatment of the health challenges of today with significant, sustained results in terms of lives saved and reduced mortality while contributing to the building of systems for health.  

MEANINGFUL INCLUSION OF AFFECTED COMMUNITIES AND CIVIL SOCIETY: We will continue to call for all GHIs to ensure meaningful inclusion of affected communities and civil society in all levels of their work from identifying issues or problems, providing the evidence and expertise to analyse and develop programs or solutions for them to implementing and monitoring the impact of the work of GHIs.  

EQUITABLE AND AFFORDABLE ACCESS TO HEALTHCARE: over the last 20 years our understanding of the need to center human rights and equity approaches to delivering healthcare has increased significantly. These must continue to be the base for all approaches. Universal and primary health coverage are only possible when each persons right to affordable, accessible healthcare is enshrined at all levels of health service delivery.  

INCLUSIVE COUNTRY-LED RESPONSES: Country-led responses – not simply government-led responses – must become the norm. FGHI must adopt a more clear understanding of the distinction between country-led and government led healthcare. Delivering on the promises of global health accords, treaties, declarations etceteras must be undertaken under a new compact where all decide and all are involved. This must mean meaningful and long-term, supported engagement of all actors and contributors to health outcomes from varying levels and sectors of government, regional bodies and entities, global institutions, funds and initiatives, affected communities and civil society alongside others such as donor governments, the private sector (particularly those who benefit and profit materially from the existence of GHIs), philanthropies and foundations. While government-led and sustainably funded universal and primary healthcare is the objective, we cannot ignore the value of non-government led service delivery particularly in challenging environments such as disasters and conflicts and where government-led delivery of healthcare excludes or denies certain people the right to health.  

INCREASE DONOR FUNDS: As part of the FGHI, donors and funders must increase and invest significantly more new funding in all actors in the global health eco-system. The often unsaid truth is the same as it has always been: all the adjustments and commitments to improvement will come to naught without significant, sustained increases in investments. Funding should be new, significant, complementary and the burden on implementing partners should be as low as possible while ensuring results are being achieved.  

EVIDENCE-BASED APPROACHES TO REFORM: The work of international/external actors providing funding for healthcare must be seen as complementary and actors should strive to meet the challenges identified by governments, affected communities and those delivering healthcare when it comes to multiple, overlapping, overly complicated, un-aligned models for grant-making and reporting. We need an overhaul of how we approach these issues, but we cannot resort to superficial, buzzword-laden, facile commitments that are rushed and not derived from evidence or equity and rights-based approaches.  

FIND SYNERGIES; DON’T BACKTRACK ON COMMITMENTS. We reject the implied tradeoff between outcomes in disease-focused areas and “sustainability of health outcomes.”  This sets the world up for backtracking on infectious diseases (that we know will resurge). Instead, FGHI should push for growing the financing pie, finding the synergies and efficiencies – not pitting progress on health systems against progress on the biggest infectious disease killers. It should not be a zero sum game but instead be about more efficiency, more synergy, more investment and much better outcomes across health needs. 

We the under-signed organisations ask those engaged in the FGHI to consider these red-lines and encourage all stakeholders and decision-makers in the FGHI process to take a more measured approach to develop recommendations and a process that will not be overly drawn-out but will take the time to properly examine the full global health ecosystem and not simply six institutions and engage with broader groups of stakeholders such as those mentioned in our country-led approach.   

SIGNATORIES (sign on here to have your organisations name added, 119 signatories as of October 17th at 10:30 am ET) 

Global Fund Advocates Network (GFAN)