Summary (English)

This article takes account of two significant developments: firstly the decision of the Global Fund board to consider comprehensive country health programmes for financing in April 2007 and secondly the creation of the new International Health Partnership Plus; which will help countries to develop such programmes, in September 2007.In this context the possibility has been raised for the Global Fund to expand its activities to include the support of the hiring and training of an expanded health workforce, to incorporate broader measures for the reinforcement of shared health systems, and to support the integration of sexual and reproductive health as well as child and maternal health services with AIDS treatment. These developments would effectively signify the transformation of the Global Fund to fight AIDS, Tuberculosis and Malaria into a Global Health Fund. The authors consider that the adoption of this "diagonal approach" would help to overcome the long-term challenges faced by the current "vertical" approach based on disease-specific interventions (largely dysfunctional health systems, critical lack of human resources). However, the authors lay emphasis on the importance of exploiting the distinctive features of Global Fund financing if the diagonal approach is to succeed. They argue that the conventional approach to health system development, which assumes that foreign assistance should be gradually withdrawn, has led to the persistence of critically low spending on health in developing countries. The Global Fund on the other hand does not require that applicants demonstrate financial self-sufficiency although countries are not permitted to reduce their own spending on health care. The authors perceive however, a considerable obstacle in the current policies of the IMF, which is able to impose significant restrictions on the spending of general budget support or health sector budget support (restrictions which do not apply to vertical financing through targeted interventions). It is argued that the success of the diagonal approach hinges on two critical factors: the obtainment of additional and sustained contributions at a time when the Global Fund is starved of resources and the continued ability of the Global Fund to bypass IMF policies. Should these two conditions not be met, however, the adoption of this approach could seriously jeopardise the future of the Global Fund.