New pooled finance represents an opportunity to better prepare vulnerable and underfunded health systems for future health threats. Ahead of our online panel event featuring the World Bank, the Gates Foundation and the Global Health Council on December 5, Emily Wegener explores how challenges in global health financing and development aid affect the Fund, and how these can be overcome.  

If there is one principal lesson to be learnt by the global health community following the COVID-19 pandemic it is that health systems were – and remain – nowhere near well-prepared to respond to a pandemic. Whilst COVID-19 may no longer be a priority for many governments and multinationals, the Ebola outbreak in Uganda and the global spread of the Mpox virus show that health emergencies will continue to break out and we must be ready. That means strengthening weak and under-funded health systems around the world so they can respond rapidly and effectively.

To achieve this we need dedicated financing for pandemic preparedness. The World Bank’s new Pandemic Fund, a financial intermediary fund (FIF) to strengthen pandemic prevention, preparedness and response (PPR), seems like a step in the right direction. Launched at the G20 in November, it aims to raise at least US$10.5 billion per year over the next five years to support low- and middle-income countries strengthen their health systems so future global health threats can be better mitigated.

Financial Intermediary Funds (FIFs) are entities that pool funding from a variety of public and private sources. They then hold and redistribute these funds to recipients based on decision-making processes coordinated by its governing body. FIFs support the financing of a specific topic which has been identified as a global priority by the international community, such as PPR.

So far, so good. But the disbursement of such a large amount of funding brings inherent corruption risks, and the governance structure of the Fund raises concerns about who it will really help; the nations in need or the donors. Our scoping report and its accompanying policy brief, recently published as part of a partnership with the University of Leeds, establishes areas threatening to undermine the impact of the fund. The red flags are numerous:

• misaligned aid allocation
• insufficient and overly complex anti-corruption, transparency, accountability (ACT-A) mechanisms
• lack of country ownership
• donor fragmentation
• lack of multistakeholder representation

Competitive funding landscape

The Pandemic Fund is neither the first nor the only health financing mechanism to focus on pandemic preparedness and response (PPR). Prior to the announcement of the Pandemic Fund, several Civil Society Organisations (CSOs) advocated for funding for PPR to be covered by an existing FIF, namely, the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). The Global Fund is getting additional funding this year. CSOs had hoped that by giving PPR a bigger weighting in the new Global Fund Strategy (2023-2028), the instalment of a new financing mechanism could be avoided.  Instead, there is now yet another financing mechanism that has been created to compete for funding in a landscape in which the willingness of governments to give overseas development aid is rapidly declining.

The World Bank has made it clear that the purpose of the Fund is not to divert funding away from other health funding sources, but rather to bring in additional money that can fill the gaps on PPR in the funding architecture. Still there is little indication as to how exactly the Pandemic Fund will interconnect and complement other PPR initiatives, or how it will ensure that the Fund does not steer money away from other established financing mechanisms.

The dangers of top-down governance and opaque policy-making

Another concern is the Pandemic Fund’s top-down governance structure and its – so far – vague language on ensuring transparency and accountability. After criticism about the Governing Board being too donor-dominated, the structure was amended to include an equal number of representatives from donor countries and so-called ‘co-investor governments’, i.e., governments of countries that could potentially receive funding through the Fund. But what remains largely absent is civil society engagement: Only two out of the 21 voting seats on the Board are reserved for representatives of CSOs. There are no civil society observers or other civil society engagement mechanisms.

It currently remains unclear if or how CSOs will be able to contribute to the funding proposals or receive funding through the Fund. That there are no clear stipulations for CSO involvement is worrying. CSOs have in the past been dependable and effective implementation partners in cases in which governments did not have the capacity or the know-how to implement projects themselves, or were no longer seen as reliable due to cases of corruption and other forms of mismanagement. Furthermore, it reduces country ownership and risks funding priorities being removed from local needs.

How can the Pandemic Fund realise its potential? 

Health financing mechanisms have historically failed to achieve what they set out to achieve due to corruption, lack of country ownership and limited multi-stakeholder engagement. Fragmentation of the global health financing landscape has compounded matters, with multiple, isolated funding mechanisms fighting over a shrinking pool of resources.

To ensure the US$10.5 billion targeted for the Pandemic Fund is allocated in a transparent and efficient manner, supporting efficient delivery, Transparency International Global Health has published a policy brief containing a number of recommendations to the World Bank, including but not limited to:

• Ensuring equal representation of high, middle- and low-income countries in planning, technical advisory, operational and governance processes of the Pandemic Fund
• Including non-governmental, civil and academic stakeholders in the decision-making processes of the funding priorities through a broad set of engagement activities
• Making information on how to participate in project implementation funded by the Pandemic Fund easily accessible and widely communicated to organisations

To further discuss how the Pandemic Fund can overcome governance and accountability challenges and ensure that the Fund is a success, register here to join us online for a panel discussion on 5 December at the forthcoming International Anti-Corruption Conference. The event will feature insights from the Bill and Melinda Gates Foundation, Kelin, the Global Health Council, Transparency International and the World Bank.

 

Emily Wegener is Research and Reporting Officer at Transparency International Global Health.