The GPG concept, discovered by the aid community in the late 1990s, can be a powerful tool in promoting global health because it marshals arguments of self-interest. It can be used to identify areas in which global collective action is needed, specify where the costs and benefits will rest and communicate to the public why spending to promote health thousands of kilometers around the world is not a waste of their tax dollars. Yet, we find that the GPG perspective has been a mixed blessing.
We looked at two acknowledged GPGs related to health, namely R&D and communicable disease control. While recognition of the need for global collective action has supported a large number of new initiatives, it remains to be determined what the result is in terms of additional funds. Those funds that have been generated have come from traditional philanthropic and public sources. The proliferation of infectious disease initiatives has promoted a vertical, "stovepipe" approach, to the detriment of broad health sector strengthening.
We then looked at two of the major global innovations in health, the GFATM (and, closely related, PEPFAR) and the re-packaging of traditional health concerns in the form of MDGs. We concluded that both can be more easily understood as addressing weaknesses in traditional humanitarian aid – red tape, lack of country ownerships, insufficient stakeholder involvement, need for results-based management, etc. – than as addressing problems of GPG provision.
All of the new initiatives we have discussed here, and many that we have not mentioned, are funding or doing valuable work. How might the GPG perspective strengthen them and lead to other efforts, as well?
First and foremost, within existing programs and when proposing new ones, the aid community should adhere to the strict economic definition and avoid the temptation to use the GPG 'tag' as a general-purpose fund-raiser. If we focus GPG logic on those goods and services where global collective action really is needed, that action is more likely to be achieved. Where humanitarian grounds, not rational self interest, are the main motivation for action – as in providing subsidized treatment for AIDS sufferers in poor countries – we should say so without equivocation. Where general health system strengthening is required to guarantee access to GPGs such as immunization or tuberculosis control, this should be stated explicitly, even if it means that budgets for GPG provision strictly defined may be reduced as a result.
Second, the aid community should stress to policy makers that, where the GPG label is appropriate, as in the case of communicable disease control, what is needed is not only new packaging/labeling of existing resources, but resources additional to those already being made available, which means mobilizing innovative sources of financing. The current elevated level of concern over emergent diseases, including pandemic influenza, is an ideal context in which to press for a more pro-active response. So is the rapid development of financial engineering tools related to aid, such as advance purchase commitments, collateralization future aid commitments in the bond market so as to "frontload" aid, etc.
Third, the relative ease of financing disease-specific actions, as opposed to broad sector strengthening, should not be allowed to distort health sector policy or dictate the structure of support. Where sector support serves an "access" function, the argument that it is a prerequisite for provision of GPGs (essentially, communicable disease control) can be used to strengthen its claim on resources.
The aim of this paper was to provide an introduction to the key concepts, and to consider some innovative developments in global health from the GPG perspective. Hopefully this has illustrated the potential and limitations of the concept, and provided a foundation for further discussion of these.