Japan announces $560mn contribution to the Global Fund

In advance of the Hokkaido G8 summit in July, Japan just announced last week a new contribution to the Global Fund of $560mn, spread out over an unspecified period of years. This is the second reasonably large pledged contribution from Japan since then Prime Minister Koizumi pledged $500mn back in 2005. Here is summary from the Kaiser Foundation’s news archive:

Japan on Friday announced that it had pledged $560 million to the Global Fund To Fight AIDS, Tuberculosis and Malaria, AFP/Google.com reports. Prime Minister Yasuo Fukuda said the funds will be allocated “in the coming years” from 2009, but he did not specify over how many years the aid will be disbursed. A foreign ministry official said that the pledge aims to “demonstrate Japan’s diplomatic efforts to help Africa” as Japan prepares to host an internal conference on aid to the continent next week, as well as the Group of Eight industrialized nations summit in July. According to AFP/Google.com, Japan hopes to make Africa a primary focus while it chairs the G8.

The Japanese appear to be wanting to make a big splash at the upcoming G8 meeting. These summits seem to occasions in which international donors like to fall over themselves to make grand promises. Germany did something similar last year when it hosted the G8 Summit. Campaigners have done a good job making global health a popular development cause, and this may prove to be a more politically tractable issue for the Japanese to garner international prestige compared to climate change, which has been touted as another signature issue for the Japanese at the upcoming G8 meeting (lots of luck there with the Bush Administration!).

Japan’s changing position on international AIDS funding is interesting. They have lagged behind other contributors, as I’ve written about here. They are just coming out of a long recession, during which Japan’s ODA contributions declined dramatically. Anybody with an inside story of these transformations in Japan’s approach to global AIDS funding (which still seems largely directed multilaterally rather than bilaterally like other donors) should e-mail me.

I have written on the particular salience of international cooperation for the Japanese in my piece on debt relief that came out in International Studies Quarterly last year. On the issue of AIDS, the Japanese appear to be particularly proud that the idea for the Global Fund came out of a meeting hosted in Japan by Prime Minister Mori in 2000. I also have a draft manuscript on the politics of HIV/AIDS donors that I’ve been working on for about three years. Get in touch if either piece is of interest.

As promising as this change in Japan’s policy promises to be, there is some concern in the advocacy community about the ambiguous time frame for when Japan will actually make good on its pledge. Japan’s move I understand may also signal a renewed concern from the donor community to address support for health systems, as I have previously supported here on this blog before (see here, here).

On that theme, Michael Reich and his co-authors have an important article in March 2008 Lancet on Japan opportunity to boost support for health systems at the upcoming G-8 Summit. They write:

The G8 summit in Toyako offers Japan, as the host government, a special opportunity to influence collective action on global health. At the last G8 summit held in Japan, the Japanese government launched an effort to address critical infectious diseases, from which a series of disease-specific programmes emerged. This year’s summit provides another chance to catalyse global action on health, this time with a focus on health systems.

However, as optimistic as they are about this emerging direction of the donor community, it is unclear if anybody actually knows how to build health systems. It seems like the record on this may be as poor as the one on broader development and good governance. Reich et al. write:

What can be done when a health system is broken—ie, when a health system is unable to deliver its services effectively, or efficiently, or fairly? Governments around the world (in both rich and poor countries) have struggled with this question for decades. One conclusion is clear: there are no easy solutions to the problems that arise in health systems. National efforts aimed at reforming such systems have achieved mixed results.

The mechanics and politics of health systems support requires much greater development. The U.S. Congress, for example, strongly supports treatment programs in part because you can scale up quickly, in part with American contractors, and track the number of people on drugs. How can you judge success in health systems capacity? It’s not, as Reich et al. note, just a function of training doctors and counting them up. This is a huge task, and one that foreigners may fail at markedly, particularly in places where the quality of governance is so bad.  I think this is why Senator Coburn, as short-sighted as his logic may be, wants to support treatment so heavily as part of PEPFAR. From his perspective, money spent on health systems will get siphoned off in ways that ultimately don’t generate capacity, only graft and consultancy fees.

One interesting question is how can islands of excellence be established? I’m reading Tracy Kidder’s account of Paul Farmer’s clinics in Haiti. Certainly, some people have more success than others in building local capacity. Are these scale-able? We’ll certainly revisit this topic.

Be Sociable, Share!

Comments are closed.