Medicines without Doctors: Why the Global Fund Must Fund Salaries of Health Workers to Expand AIDS Treatment

0605 The Global Fund to Fight AIDS, Tuberculosis and Malaria (“the Global Fund”) was created to fi ght three of the world’s most devastating diseases. Since its creation in 2002, it has struggled with the diffi cult task of focusing on three diseases, and at the same time supporting the fragile public health systems that are supposed to implement this fi ght on the ground. Recent internal comments from the Global Fund suggest an intention to focus more on the three diseases, and to leave the strengthening of health systems and support for the health workforce to others. This could create a “Medicines without Doctors” situation in which the medicines to fi ght AIDS, tuberculosis, and malaria are available, but not the doctors or the nurses to prescribe those medicines adequately. We believe that this would be a strategic mistake, as the Global Fund has an advantage that makes it a key actor in the fi eld of supporting health workforces. Most other donors are forced to aim for sustainability in the conventional sense (implying that benefi ciary countries should gradually replace international funding with domestic resources); the Global Fund has been promised sustained funding by the international community, allowing it to make sustained commitments to benefi ciary countries. This is what some of the countries most affected by AIDS, tuberculosis, and malaria need to increase their health workforce. Their health workforce challenges are too big to consider a gradual replacement of international funding with domestic resources. We also believe that the debate about this intention should be public, and we hope to launch the public debate with this article. We use the examples of two countries—Mozambique and Malawi— trying to fi ght against a full-blown AIDS epidemic with a fragile health system, to underline the crucial role of Global Fund support to the health workforce.