ABSTRACT

The health sector is one of the under-resourced areas in most developing countries. The  advent of human security following the 1994 UNDP report has increased the recognition of health in a security dimension and promoted further investments in the sector. In the last decade, Global Health Initiatives (GHIs) like the Global Fund have changed the landscape  and architecture of health investments in most developing countries. The Global Fund currently plays a dominant role in the fight against three major infectious diseases in the world. This study analyses the contribution of the Global Fund in the health sector of developing countries using Ghana as a case study. The qualitative research approach was employed to gather, analyse and interpret data. In all, five interviews were conducted, and these respondents were carefully selected for the study. Based on interviews and secondary sources, the study identified several gaps in Ghana’s health sector, which have provided room for the Global Fund to contribute to the health sector. The research identified the entire population, including key populations like Female Sex Workers as focus groups of Global Fund operations in Ghana. From the study, the Global Fund has made significant  contributions such as assisting the government to reduce disease burden, promoting human resources for health, refurbishment of facilities and empowering civil societies, in the health sector. The study further revealed that the Global Fund contributes indirectly to  health policies of Ghana and identified inadequate skilled personnel, occasional conflicts of interests, issues of programme sustainability and cultural beliefs as factors inhibiting the Global Fund’s interventions in Ghana. The study recommends that the government and Global Fund should increase dialogue, intensify health education and cooperate to enhance health personnel capacity. The government should further regulate health staff transfers and increase health budget allocation to promote health development in the country.

CHAPTER ONE

INTRODUCTION

     Background to Research Problem

The growth and development of every country can be assessed from the quality of life and health status of her citizens. Historically, international relations recognised  state activities with the acquisition and maintenance of power, with issues of health occupying the lower echelons of national priorities (Katz & Singer, 2007). Poor health has caused adverse grief  and destruction to humanity. This can be recalled from the vast death tolls caused by the  Black Death or Plague between 1346 and 1353, the contraction of Asian flu around 1957, Smallpox in 1967 and discovery of infection Human Immunodeficiency Virus infection and Acquired Immune Deficiency Syndrome (HIV/AIDS) in 1981 (Benedictow, 2004; Henderson, 2009; Merson, 2006; Moore, 1993; Wang & Palese, 2009). These pandemics and the recognition of potential devastation of not prioritising health issues have triggered global sensitivity and catalysed actions to concert efforts in promoting better global health.

The Post-Cold War period has experienced intense responsiveness attached to health security on the international scene (Agyapong, 2017). The end of the cold war accompanied by the demise of superpower conflict predicated on military capacity created an intellectual and political room to consider other threats of non-military nature. Health Security is now recognised as part of the several fields of human security after it was highlighted in the  United Nations Development Programme (UNDP) 1994 Report (Lo & Thomas, 2010).

The establishment of The Joint United Nations Programme on HIV/AIDS (UNAIDS) by the United Nations Economic and Social Council (ECOSOC) resolution in 1994 to mount and

support an expanded response to HIV/AIDS demonstrates global efforts to achieve better public health. Also, the UN resolution to create the UN Mission for Ebola Emergency Response (UNMEER) tasked with the responsibility of treatment of infected people, containment of the disease and maintenance of stability after the 2013 outbreak of the Ebola virus disease which caused significant mortalities in West Africa further remarks global efforts to achieving better global health. Policymakers now recognise the harmful impacts  that health crisis may have on global welfare.

Efforts from various angles are therefore put in place to advance quality global health to  avoid poor health. The activities of both state and non-state actors have been strengthened  and expanded overwhelmingly in the provision of resources to support research studies into health and in the fight against diseases, particularly in developing countries. For example, non-state actors like the civil society played extremely significant roles to ensure the scale of antiretroviral therapy (ART) in Thailand not only through lobbying but also in the actual development and implementation of health policies in this regard (Tantivess & Walt, 2008).  It is therefore not surprising that significant progress in the fields of science, public health methods and technology have been made over the last few decades than in several years before the twentieth century (Fielding, 1999; WHO, 2000). Despite all the increased roles and advancement in technology, health care gaps still exist in developing countries especially Sub-Saharan Africa (SSA) due to inadequate health expenditure, lack of sophisticated health equipment, lack of modern health facilities, disease burden, insufficient trained medical professionals, weak health reforms and non-availability of drugs (Bryan, Conway, Keesmaat, McKenna, & Richardson, 2010; Kirigia & Barry, 2008). This deficiency on the part of most African governments has increased the reliance on the generosity of donors and other development partners to complement their efforts in the health sector (Novignon, Olakojo, & Nonvignon, 2012). Substantial financial assistance and grants have been provided by several

international organisations to support the domestic governments’ inadequate budgetary allocation to the health sector (Farag, Nandakumar, Wallack, Gaumer, & Hodgkin, 2009). Novignon et al. (2012) indicate that the expenditure on public health in SSA is vastly financed by resources from grants and loans.

The emergence of Global Health Initiatives (GHIs) has transformed the landscape and architecture of health funding in resource-poor countries, particularly in Africa (Mwisongo & Nabyonga-Orem, 2016). GHIs have emerged as funding mechanisms out of the need to advocate, and mobilise funding to address some critical health problems facing the globe. GHIs fund, shape, implement and evaluate several global health programmes and policies. GHIs thus respond to high-impact infectious diseases in low and middle-income countries. Such international financing organisations work together to advance public health outputs, offer technical expertise, and also adopt innovative approaches to improve the continually evolving public health practice. The Global Fund to Fight AIDS, Tuberculosis and Malaria or simply the Global Fund is a form of GHI that is designed to accelerate the end of AIDS, Tuberculosis (TB) and malaria. It was established in 2002 after global political will to enhance coordinated efforts to combat the world’s deadliest infectious diseases received tremendous global momentum leading to the creation of a fund to channel resources into public health initiatives (Duran & Silverman, 2013). This was also undertaken following substantial death tolls of the HIV/AIDS endemic which affected several people in the late 1990s, especially in Africa and the desire by the international community to fight other  deadly infectious diseases. Former UN Secretary-General Kofi Annan in April 2001 called  for the establishment of a global fund, what he termed a ‘war chest’ committed to tackling HIV/AIDS and other infectious diseases and the UN General Assembly showed commitment to creating the Global Fund which was subsequently endorsed formally by the Group of Eight (G-8) in Genoa later in June 2001 (Duran & Silverman, 2013). The mission of the Global