Special Advisor for Global Health Partnerships Addresses Complexities of Global Health Funding

Shatreen Masshoor, Yale College ’12

As part of the Global Health Seminar series, Special Advisor for Global Health Partnerships under the U.S. Department of State, John Monahan recently spoke at Yale. During his talk, he highlighted that the U.S. is the largest donor to the Global Fund, in their partnership with the Global Fund to Fight AIDS, tuberculosis and malaria. With 3.2 million people receiving antiretroviral treatment, 8.2 million cases of tuberculosis treated and detected, and over 190 million bed nets distributed, the Global Fund results are staggering.

As a student interested in global health, I had never realized the interdependence of U.S. government bilateral programs and Global Fund initiatives. For example, the Global Fund allows for purchases of antiretroviral drugs, while PEPFAR (President’s Emergency Plan for AIDS Relief) has programs that support test kits, training, and delivery of these antiretrovirals to patients.

Juxtaposed with these examples of successful initiatives were questions about the Global Fund. In recent months, the Global Fund was rocked by scandal regarding mismanagement of funds. Monahan addressed this by discussing how the High-Level Independent Review Panel on Fiduciary Controls and Oversight Mechanism was convened. This panel was formed to assess the current management of funds within the Global Fund and to make recommendations. Monahan echoed the panel’s sentiment that the “failure of the Global Fund would be a global health catastrophe.” Both the panel and Monahan recognized that three trends would create change within the Global Fund: austerity, accountability, and innovation.

After hearing Monahan speak, I emerged with a better understanding of the relationship between the United States and the Global Fund, as well as a sense that the Global Fund is attempting to reform itself. As such powerful players in the global health field, both the United States government and the Global Fund must be self-reflexive and open to reform, to ensure sustained advances in global health.

Revisitng Work in Ethiopia

Erika Linnander, associate director, Yale Global Health Leadership Institute

Each time I visit Ethiopia, I witness the growth and deepening impact of GHLI programs. Recently, I visited Addis Ababa University (AAU) to teach health economics to the first group of students in the Master’s of Healthcare Administration (MHA) program at AAU. The passion and drive of the students in the MHA program is inspiring. One student shared that he travels three days to get from his hospital to the university for class, a sacrifice he said he is willing to make because he has seen how what he learns in class directly applies to making improvements for the patients at his hospital. Despite the student’s challenges of balancing the demands of full-time school with running a hospital in a limited resource setting, they all demonstrated a positive attitude and interest in what they were learning.

The students are preparing to start their capstone projects – culminating experiences that will test their ability to apply their training to a real world challenge in hospital management. The Ministry of Health, has recently endorsed a set of 36 key performance indicators (KPIs) to measure hospital performance over time. Together, these indicators are designed to serve as a sort of “balance scorecard” – a tool we use in the U.S. to assess organizational performance from multiple, balanced perspectives. The students will lead efforts to measure the KPIs in their own health care facility.

When GHLI began the Ethiopian Hospital Management Initiative (EHMI) seven years ago, we worked with 16 hospitals to help find ways to improve their management systems and organizational structures, with an emphasis on a strong mentoring model for capacity building. Since then, thanks to the continued support from the Ministry of Health and from great partners like the Clinton Health Access Inititative, we have seen vast improvements in the management of hospitals across Ethiopia. The next step in the evolution of EHMI is to develop a quality alliance to promote networking and the sharing of best practices among the emerging critical mass of health care executives to eventually create a health system that offers efficient, high quality care for patients across the country.

Being able to see such positive progress on our work with each visit inspires me and the GHLI team to continue with our endeavors, supporting the Ministry of Health in fulfillment of their vision.