The world is focused on the Ebola crisis, with the most affected countries, donors, and partners scrambling to find ways to reduce new infections within countries and prevent a global epidemic. The short-term response to provide mobile treatment centers, personal protective gear, and medical supplies has been substantial. But the weakest immediate link has been the lack of a resilient health system staffed with well-managed health workers trained to respond to such an outbreak.

This is not something that can be done solely with money or as a quick fix. Health worker needs must be addressed over the long term.

The need to have response capability and disease surveillance has long been on the global health agenda. The WHO approved its International Health Regulations in 2005 with all WHO member countries committing to having a plan to put response and disease surveillance systems in place by 2012. But few have done so, and certainly not countries with very weak economies and low ratios of health workers to population, such as those in West Africa struggling to contain Ebola.

Health worker needs must be addressed over the long term.

The Ebola crisis was recently addressed at the UN Security Council and in the General Assembly. It is a clear global security threat. In response, there is an effort to create a massive new “International Fund for Health Crises” that would serve as an emergency system to be activated during a global health crisis. Contingent agreements would be established between donors and possible recipient countries. While some donors have signaled their readiness to participate, it will take time to establish principles, reach agreements with recipient countries, formulate operational systems, and test the mechanism in a crisis setting. Experience shows that getting from creation to effective application can take years.

We do not have years.

In the interim, could the existing Global Fund be the lead international mechanism to funnel substantial new investment for building human resources capacity in biosurveillance planning and implementation?

I think it could, if its board recognized that expanding assistance to strengthen health systems so that they also have the capability to address hemorrhagic fevers like Ebola is not an unreasonable addition to its mandate.

The Global Fund already has programs in place to strengthen health systems.

the Global Fund already has programs in place to strengthen health systems. - See more at: http://www.intrahealth.org/blog/can-the-global-fund-help-address-new-hea...the Global Fund already has programs in place to strengthen health systems. - See more at: http://www.intrahealth.org/blog/can-the-global-fund-help-address-new-hea...

The Global Fund was established in 2001 to fight the three most deadly infectious diseases identified at the time: AIDS, tuberculosis, and malaria. Since then the Global Fund has channeled billions of dollars in pursuing its three-disease mission, basing its assistance on grant applications from countries. And the Global Fund has evolved over time. In 2010 a High Level Independent Review Panel reviewed its fiduciary structure and in 2011 the Global Fund began implementing a new strategy with a shift to a new model of “investing for impact.” In November 2013, a Global Fund Corporate Key Performance Indicator Framework for 2014-2016 was approved to monitor performance against the strategy. At the end of 2013, Global Fund expenditures for the year was over US $3.0 billion, of which 15% was for human resources and 9.3% was for training. Indeed “A world free from the burden of AIDS, tuberculosis, and malaria” requires health workers who are trained, supported, and present, and the Global Fund already has programs in place to strengthen health systems.

Clearly the existing Global Fund has also put in place governance practices that give it credibility in operating with transparency and accountability. A first step could be to review existing Global Fund investments in health systems and human resources for health in the most distressed countries to provide a basis for assessing whether and how the Global Fund might take on a larger funding role over the next three years.

The Global Fund is recognized and experienced in providing grant funding to countries dealing with communicable diseases. It is well-positioned to contribute to the Ebola response.