Strengthening Health Systems Strengthening: An analysis of coordination among the Global Fund, the Global Financing Facility and Gavi (3Gs)

There has been a proliferation of global health initiatives (GHIs) over the past two decades. These aim to raise and disburse funds mainly for combating infectious and non-communicable diseases and strengthening health systems in low- and middle-income countries (LMICs). Such initiatives have massively increased the volume of resources for health. However, despite good intentions, weak mutual cooperation and alignment with national governments may challenge national leadership and disrupt policy and implementation processes in recipient countries. A belief that better cooperation among GHIs is needed and would lead to more efficient fund utilisation, better outcomes and strengthened health systems at country level is not new. The timeline below shows how this understanding has developed.
The COVID-19 pandemic has demonstrated that the effectiveness of joint efforts is determined by the weakest link in a health system. This has renewed interest in strengthening health systems and advancing international cooperation. This paper reviews three GHIs: the Global Fund to Fight AIDS, Tuberculosis, and Malaria (henceforth referred to as ‘the Global Fund’); Gavi, the Vaccine Alliance (‘Gavi’); and the Global Financing Facility (‘the GFF’). These are referred to as ‘the 3Gs’. During the GFF Investors Group meeting in 2019, the 3Gs presented a paper on their positioning within the global health architecture and the opportunities for closer collaboration. In addition to their own mandates, universal health coverage (UHC), health system strengthening, and domestic resource mobilisation (DRM) rank high on the 3Gs’ agenda, as does country ownership through country-led programmes. The Global Fund and Gavi both have seats at the GFF investors group and collaborate on a number of platforms. Following this momentum, at the September 2019 United Nations High-Level Meeting on UHC, Gavi, acting on behalf of the GFF and the Global Fund, declared the 3Gs’ future commitment to closer collaboration in supporting country governments in relation to sustainable health finance under the Sustainable Financing for Health Accelerator (SFHA), one of the GAP’s seven accelerators. The other six are: Primary Health Care (PHC); community and civil society engagement; determinants of health; innovative programming in fragile and vulnerable settings and for disease outbreak responses; research and development, innovation and access; and data and digital health. The 3Gs have signed the GAP1 , with Global Fund, Gavi and the World Bank leading the SFHA. Discussions around better aligning funding cycles to allow for more coordinated health system strengthening investments started in 2018/19. To sensitise country-facing staff, Gavi, Global Fund and the GFF in collaboration with the other members of the GAP’s SFHA organised a webinar in April 2020 for country teams in partner countries to familiarise themselves with each organisation’s instruments, present best practices/blueprints for collaboration, identify key barriers/levers for alignment and devise joint solutions, build stronger “joint country teams” between the organisations by getting to know each other and discuss opportunities for closer collaboration.

This briefing paper explores how the 3Gs coordinate their activities at global level and identifies areas in which coordination can be improved, as this is key to ‘building back better’. We zoom in on six specific topics:
1. health finance;
2. human resources for health;
3. health data and information systems;
4. supply chain management;
5. community
6. gender.