Effectiveness of global health partnerships: will the past repeat itself?

a Swiss Centre for International Health of the Swiss Tropical Institute, PO Box, 4002 Basel, Switzerland; Medicus Mundi Switzerland-Network Health for All, http:// www.medicusmundi.ch. Correspondence to Nicolaus Lorenz (e-mail: [email protected]). doi: 10.2471/BLT.06.033597 (Submitted: 1 June 2006 – Accepted: 18 July 2006) Introduction It is to be hoped that past mistakes are not going to overshadow the effectiveness of global health partnerships (GHPs), as they provide valuable lessons that should be taken into account. The Bulletin publishes a fascinating series of public health classics, consisting of a commentary doing a reality check on what has happened since publication of major public health landmarks. In 2005, Anne Mills commented on a landmark paper on mass campaigns and general health services of 1965.1 One could get a bit depressed reading her article, because the bottom line is that not much has changed in the past 40 years, which have confronted believers in vertical and horizontal approaches. The terminology has changed, though. Some 20 years ago the topic shifted from vertical versus horizontal programmes to the dispute over the advantages of comprehensive versus selective primary health care. In the 1990s, this discussion cooled down and a combination of the two approaches was translated into health sector reform efforts, with widespread consensus to integrate health actions at district level. This development has been supported by changes in aid modalities such as the sector-wide approach (SWAp) funding mechanism. This evolution has come under threat, however, with the appearance of global health initiatives at the beginning of this millennium,2 which have brought back this “old” controversy opposing today’s approaches: those that have a more systemic focus or those with a more selective, often disease, orientation. With more than 70 GHPs in existence today, the former selective/ vertical party is seemingly gaining the upper hand again. The difference from before, however, is that aid effectiveness is now receiving more attention. It is noteworthy that in 2005, for the first time, a large group of donor and recipient countries, international organizations and also civil society organizations agreed in the Paris Declaration on Aid Effectiveness to set targets for aid effectiveness and to define a set of indicators to measure progress towards these targets.3 The main argument of this paper is that we should avoid the conflicts of the past. We must strive to achieve a balance between the selective approach of many GHPs and the strengthening of health systems, as they are interdependent.