Beyond the Global Fund, the UK needs to lead on global health

The UK is a leader in global health. Its commitment to the Global Fund to Fight AIDS, TB and Malaria, announced by Theresa May at the G20 in Tokyo, shows that it also makes smart investments with UK taxpayers’ money.

A fully-funded Global Fund can save 16 million lives and avert 234 million new infections by 2023. Considering that almost one million people died of AIDS-related illnesses last year and new HIV infections remain stubbornly high at more than 1.5 million per year, the Global Fund will be a vital partner in the next stage of the epidemic.

Through the Sustainable Development Goals (SDGs), world leaders have set a specific target to “end the epidemics of AIDS, tuberculosis and malaria…. by 2030.” If achieved, these goals have the potential to change the course of human history.

Looking to 2030

So, almost a third of the way into the SDGs, how are we getting on?

On 17 June, the UK government published its long awaited voluntary national review (VNR) of progress towards achieving the Sustainable Development Goals (SDGs). The UK report’s chapter on Goal 3: Good health and well-being outlines the impact of multiple financial contributions at an international level, notably that in 2017 the Global Fund ensured 17.5 million people received antiretroviral therapy for HIV .

Through its strong support for the Global Fund, the UK is helping to build a healthy, equitable and prosperous world for all. We hope other governments will follow the UK’s lead.

The UK’s VNR also highlights its political commitment to global health through the hosting of a number of important global meetings, including the first Global Ministerial Mental Health Summit and a Global Disability Summit, both of which Frontline AIDS welcomes as we scale up our work on quality of life of people living with HIV. The UK also invests approximately £1 billion a year in maternal and child health across its bilateral programmes.

Towards health for all

Universal health coverage (UHC) is broadly seen as underpinning the success of SDG3. Achieving UHC is a means of achieving the ultimate goal of healthy lives and wellbeing for all, yet the UK’s VNR contains just four sentences on the subject. UHC means ensuring that everyone receives the essential health services they need without discrimination or financial hardship, the latter of which can be avoided through equitable financing.

Half the world’s population lacks access to essential healthcare, while 100 million people are pushed into poverty each year by paying out of pocket for health. In our joint report, we highlighted the example from Indonesia, which uses an inequitable health insurance financing system. To obtain health insurance coverage, including access to HIV and AIDS services, families must present their “family card” and enrol everyone mentioned on that card together. However, many of those most affected by HIV – key populations such as transgender women, men who have sex with men, people who use drugs and sex workers – have been rejected by their families and live away from the place where they are registered and have difficulty accessing health care.

The next opportunity for the UK to demonstrate leadership on UHC will be at the High-Level Meeting (HLM) on UHC in September. Frontline AIDS is working with partners from around the world trying to ensure that the political declaration from the HLM includes commitments to comprehensive HIV services, including HIV prevention and sexual and reproductive health and rights, within UHC.

We want to see governments taking proactive steps to ensure access for people living with HIV and those most affected and at risk, including criminalised and marginalised groups.

Making the most of the UK’s global health leadership

As international civil society organisations, our role is to hold the UK government accountable for its global leadership on UHC and HIV. As civil society, we need to ask the following questions:

• How is UK government ensuring consistent quality of aid for health, especially given the increase in health aid channelled outside of DFID (including through the private sector) and a corresponding decline in health systems-focussed approaches?
• Without direct budget support, how is the UK compensating for the loss of investments for core health systems?
• What concrete outcomes are required to address the specific issues concerning mental health, as in the VNR the Global Summit is referred to as a stand-alone activity?
• What is the UK doing to address the interlinkages between HIV and other SDG targets, beyond sexual and reproductive health? Analysis by Frontline AIDS and partners shows the strong interconnectedness between the SDGs with HIV and the impact of ignoring these ultimately means the global social, economic and environmental transformations, driven by the SDGs, will not happen.
• What is the UK doing to protect and ensure the rights of the most marginalised and criminalised people, such as sex workers, people who use drugs, trans people, men who have sex with men and adolescent girls and young women, who are most affected or at risk of HIV?

Going forward we would like to see an action plan from the UK government on how to deliver all the SDGs, clear analysis and review of progress against targets, key milestones, resource allocation and transparent annual reporting.

To find out what else we would like to see the UK report on, listen to the recent Bondcast episode on the SDGs. Read Bond’s parallel report on the UK’s voluntary national review of implementing the SDGs.