How have Global Health Initiatives impacted on health equity?

Abstract

This review examines the impact of Global Health Initiatives (GHIs) on health equity, focusing on low- and middle-income countries. It is a summary of a literature review commissioned by the WHO Commission on the Social Determinants of Health. GHIs have emerged during the past decade as a mechanism in development assistance for health. The review focuses on three GHIs, the US President's Emergency Plan For AIDS Relief (PEPFAR), the World Bank's Multi-country AIDS Programme (MAP) and the Global Fund to Fight AIDS, TB and Malaria. All three have leveraged significant amounts of funding for their focal diseases - together these three GHIs provide an estimated two-thirds of external resources going to HIV/AIDS. This paper examines their impact on gender equity. An analysis of these Initiatives finds that they have a significant impact on health equity, including gender equity, through their processes of programme formulation and implementation, and through the activities they fund and implement, including through their impact on health systems and human resources. However, GHIs have so far paid insufficient attention to health inequities. While increasingly acknowledging equity, including gender equity, as a concern, Initiatives have so far failed to adequately translate this into programmes that address drivers of health inequity, including gender inequities. The review highlights the comparative advantage of individual GHIs, which point to an increased need for, and continued difficulties in, harmonisation of activities at country level. On the basis of this comparative analysis, key recommendations are made. They include a call for equity-sensitive targets, the collection of gender-disaggregated data, the use of policy-making processes for empowerment, programmes that explicitly address causes of health inequity and impact assessments of interventions' effect on social inequities.