Many have heard the cry for child and maternal survival and health. Since the early years of the child survival revolution, global partnerships for health, often financed through private sources, have proliferated and reinvigorated the field. Global programmes in health, whether in partnerships or through the individual actions of single organizations and donors, have become an important tool of development assistance, with bilateral donors, multilateral institutions and private foundations providing rapidly increasing levels of financing for service delivery at the country level. Depending on the definition used, it is estimated that there are over 100 global health partnerships. Some examples are the Flour Fortification Initiative, the Global Alliance for Improved Nutrition, the GAVI Alliance, the Partnership for Maternal, Newborn & Child Health, Roll Back Malaria and the Special Programme for Research and Training in Tropical Diseases. They are a diverse group, with functions ranging from advocacy to implementation, and they vary in nature, scale and scope. The vast majority focus on communicable diseases – particularly AIDS, tuberculosis and malaria. Some partnerships also promote nutrition interventions, such as early and exclusive breastfeeding and vitamin A supplementation, or improved water and sanitation.

A number of these partnerships have proved remarkably effective in offering communities free or reduced-cost medicines whose quality is assured, along with vaccines. Others are improving national policymaking and supporting institutional reforms. Still others are contributing to the establishment of norms and standards in treatment protocols.

Yet, in their single-mindedness to produce results, it has been argued that global partnerships are often donor- and product-driven rather than country- and people-centred. Moreover, a frequent focus on single diseases has sometimes meant an over-reliance on vertical interventions and insufficient emphasis on integrating services and strengthening national health systems. This may leave governments with little flexibility to reallocate funds according to their own priorities or to fund health-system costs and investments such as salaries and facilities. Furthermore, the rapid creation of such new institutions in health is proving challenging for developing countries to keep track of, let alone to manage and coordinate. New initiatives may also complicate efforts to harmonize and coordinate actions at the global level in support of maternal, newborn and child survival and health.

Increased unity in global health partnerships

To address some of these concerns, the Paris Declaration on Aid Effectiveness of March 2005, is providing a framework through which donor and developing country partnerships can fully exploit their potential. The principles it endorses have now been adopted by the boards of a number of global health partnerships. In addition, the OECD Development Assistance Committee has reviewed a ‘Good Practice Guidance for aligning global programs at the country level’. Both sets of principles and practices include a focus on country ownership, harmonization and alignment, and mutual accountability of programmes. The application of these good practices will be monitored and reported on at the High Level Forum on Aid Effectiveness to be held in Accra, Ghana, in September 2008.

The message that has been widely heard – and heeded – is that developing countries must take the lead and ‘own’ the solutions to their health problems. Global partnerships for child health and survival are beginning to move towards greater harmonization and alignment with developing countries’ own priorities, systems and procedures.

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