Price, quality, and market dynamics of malaria rapid diagnostic tests: analysis of Global Fund 2009–2018 data

Background Rapid diagnostic tests (RDTs) for malaria are a vital part of global malaria control. Over the past decade, RDT prices have declined, and quality has improved. However, the relationship between price and product quality and their larger implications on the market have yet to be characterized. This analysis used purchase data from the Global Fund together with product quality data from the World Health Organization (WHO) and Foundation for Innovative New Diagnostics (FIND) Malaria RDT Product Testing Programme to understand three unanswered questions: (1) Has the market share by quality of RDTs in the Global Fund’s procurement orders changed over time? (2) What is the relationship between unit price and RDT quality? (3) Has the market for RDTs financed by the Global Fund become more concentrated over time? Methods Data from 10,075 procurement transactions in the Global Fund’s database, which includes year, product, volume, and price, was merged with product quality data from all eight rounds of the WHO-FIND programme, which evaluated 227 unique RDT products. To describe trends in market share by quality level of RDT, descriptive statistics were used to analyse trends in market share from 2009 to 2018. A generalized linear regression model was then applied to characterize the relationship between price and panel detection score (PDS), adjusting for order volume, year purchased, product type, and manufacturer. Third, a Herfindahl–Hirschman Index (HHI) score was calculated to characterize the degree of market concentration. Results Lower-quality RDTs have lost market share between 2009 and 2018, as have the highest-quality RDTs. No statistically significant relationship between price per test and PDS was found when adjusting for order volume, product type, and year of purchase. The HHI was 3,570, indicating a highly concentrated market. Conclusions Advancements in RDT affordability, quality, and access over the past decade risk stagnation if health of the RDT market as a whole is neglected. These results suggest that from 2009 to 2018, this market was highly concentrated and that quality was not a distinguishing feature between RDTs. This information adds to previous reports noting concerns about the long-term sustainability of this market. Further research is needed to understand the causes and implications of these trends.

Analisis Kebijakan Pembiayaan Program Pengendalian Penyakit Tuberkulosis di Provinsi Daerah Istimewa Yogyakarta

Masalah pembiayaan TB masih menjadi kendala besar di Dinas Kesehatan Provinsi maupun Kabupaten/Kota terutama saat sumber dari pendonor semakin turun jumlahnya dan tidak menutup kemungkinan dihentikan. Tujuan penelitian ini adalah untuk mengidentifikasi permasalahan dan strategi pembiayaan program TB. Rancangan penelitian menggunakan mixed method (kuantitatif kualitatif) dengan desain studi kasus. Subjek penelitian 11 orang dari Dinas Kesehatan, BPJS Kesehatan, rumah sakit dan puskesmas. Hasil analisis didapatkan bahwa sumber utama anggaran TB di Dinas Kesehatan Provinsi berasal dari pendonor lebih dari 50% global fund. Dinas Kesehatan wajib (1) menyusun standar, mengesahkan, dan mensosialiasikan standar alur rujukan TB yang wajib dilakukan oleh pelayanan kesehatan swasta dalam rangka penegakan diagnosis TB; (2) melakukan sosialisasi tentang tanggung jawab dan batasan pelayanan kesehatan yang dibiayai oleh JKN dan pemerintah ke seluruh jajaran kesehatan dengan melibatkan pihak BPJS Kesehatan. Puskesmas dapat melakukan lobbying, negosiasi, dan advokasi ke pemerintah desa untuk sharing pembiayaan program pengendalian penyakit TB. Peran lintas sektor serta pemberdayaan masyarakat dalam bentuk Gerduda TB tetap dipertahankan. Strategi pembiayaan TB dilakukan dengan menganalisis berbagai revenue collection yang melibatkan public-private mix untuk mem-backup kegiatan yang semula dibiayai oleh pendonor sehingga tujuan prioritas kesehatan nasional dapat dicapai sesuai dengan target para pengambil kebijakan.

Promoting Access to Health Technologies in the Post-pandemic Era: Gavi, Global Fund, Unitaid, and Access to COVID-19 Tools Accelerator (ACT-A) Programs

Purpose: Global collaboration to accelerate development and equitable access to COVID-19 tests, treatments, and vaccines was launched with the name of the Access to COVID-19 Tools Accelerator (ACT-A), and this initiative owes its expertise to the lessons learned of the global health organizations. To date, the comprehensive mechanisms and potential effects of the initiative remain largely unknown. Methods: This study reviewed the programs of Gavi, the Global Fund, Unitaid, and ACT-A, which mitigating barriers to greater use of health technology with an analytic framework. Results and conclusion: The study findings are as follows. First, programs to alleviate the absence of necessary technology include the International Finance Facility for Immunization and Covax Facility. Second, Pooled Procurement Mechanism and Accelerated Order Mechanism are examples of mitigating the inability to access technology. Third, programs to overcome reluctance to adopt accessible technology include health system strengthening efforts such as the capacity-building health workforces. Further actions of Korea are needed to collaborate with the initiatives to enhance health outcomes.

The Influence of Decision-Making Quality on Perceptions of Foreign Grant Accountability

The Indonesian government and several other non-profit organizations have received many foreign grants, one of which is the Global Fund AIDS Tuberculosis and Malaria (GFATM) grant. As an institution that receives a Sub Recipient TB Care of ‘Aisyiyah East Java grant, it has an absolute obligation to account for the funds received, one of which is an accountable financial report. However, achieving accountability is not easy, you have to go through a long process with strict terms and conditions from donors. Because this sometimes makes institutions and even providers of financial reports such as accountants feel bored and accountability is increasingly difficult to realize. Factors of human resources, tasks and the environment are the benchmarks for an accountant of foreign grants to have a strong view of the perception of accountability. The purpose of this study is to determine the perception of accountants in assessing financial statement accountability as an expense or an asset. This study uses a qualitative method with an emphasis on interviews. The results of the study show that the accountability of financial statements is considered an intangible asset because apart from the benefits of funds for the beneficiaries of the grant, there are also non-financial benefits for the implementers of the grant, including the financial staff. The finance staff not only benefited from intangible wealth in improving the quality of the accounting field, but also gained a general understanding of TB health and extensive networking with various sectors.

The Global Fund: why anti-corruption, transparency and accountability matter

Background The creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria, also known as the Global Fund, was prompted by the lack of a timely and effective global response, and the need for financing to fight against three devastating diseases: HIV/AIDS, tuberculosis, and malaria. During the formation of the Global Fund, necessary anti-corruption, transparency, and accountability (ACTA) structures were not put in place to prevent fraud and corruption in its grants, which resulted in the misuse of funds by grant recipients and an eventual loss of donor confidence in 2011. The Global Fund has instituted various ACTA mechanisms to address this misuse of funding and the subsequent loss of donor confidence, and this paper seeks to understand these implementations and their impacts over the past decade, in an effort to probe ACTA more deeply. Results By restructuring the governing committees in 2011, and the Audit and Finance; Ethics and Governance; and Strategy Committees in 2016, the Global Fund has delineated committee mandates and strengthened the Board’s oversight of operations. Additionally, the Global Fund has adopted a rigorous risk management framework which it has worked into all aspects of its functioning. An Ethics and Integrity Framework was adopted in 2014 and an Ethics Office was established in 2016, resulting in increased conflict of interest disclosures and greater considerations of ethics within the organization. The Global Fund’s Office of the Inspector General (OIG) has effectively performed internal and external audits and investigations on fraud and corruption, highlighted potential risks for mitigation, and has implemented ACTA initiatives, such as the I Speak Out Now! campaign to encourage whistleblowing and educate on fraud and corruption. Conclusions From 2011 onwards, the Global Fund has developed a number of ACTA mechanisms which, in particular, resulted in reduced grant-related risks and procurement fraud as demonstrated by the decreased classification from high to moderate in 2017, and the reduction of investigations in 2018 respectively. However, it is crucial that the Global Fund continues to evaluate the effectiveness of these mechanisms; monitor for potential perverse impacts; and make necessary changes, when and where they are needed.

Price, Quality, and Market Dynamics of Malaria Rapid Diagnostic Tests: Analysis of Global Fund 2009–2018 Data

Background: Rapid diagnostic tests (RDTs) for malaria are a vital part of global malaria control. Over the past decade, RDT prices have declined, and quality has increased. However, the relationship between price and product quality and their larger implications on the market have yet to be characterized. We sought to use purchase data from the Global Fund together with product quality data from the World Health Organization and Foundation for Innovative New Diagnostics (WHO-FIND) Malaria RDT Product Testing Programme to understand three unanswered questions: 1) Has the market share by quality of RDTs in the Global Fund’s procurement orders changed over time? 2) What is the relationship between unit price and RDT quality? 3) Has the Global Fund procurement market become more concentrated over time?Methods: We merged data from 10,075 procurement transactions in the Global Fund’s database, which includes year, product, volume, and price, with product quality data from all eight rounds of the WHO-FIND program, which evaluated 227 unique RDT products. To describe trends in market share by quality level of RDT, we used descriptive statistics to analyze trends in market share from 2009–2018. We then applied a generalized linear regression model to characterize the relationship between price and panel detection score (PDS), adjusting for order volume, year purchased, product type, and manufacturer. Third, we calculated a Herfindahl-Hirschman Index (HHI) score to characterize the degree of market concentration.Results: Lower-quality RDTs have lost market share between 2009-2018, as have higher-quality RDTs. We find no statistically significant relationship between price per test and PDS when adjusting for order volume, product type, and year of purchase. The HHI was 3,570, indicating a highly concentrated market.Conclusions: Advancements in RDT affordability, quality, and access over the past decade risk stagnation if health of the RDT market as a whole is neglected. Our results suggest that this market is highly concentrated and that quality is not a distinguishing feature between RDTs. This information adds to previous reports noting concerns about the long-term sustainability of this market. Further research is needed to understand the causes and implications of these trends.

Role of the Global Fund in national HIV/AIDS response in Myanmar: a qualitative study

Background The Global Fund has been a major funding source for HIV/AIDS programs in Myanmar. In this qualitative study, we aim to understand the impact of Global Fund on national HIV/AIDS response in Myanmar during the era of Millennium Development Goals (MDGs). Methods We conducted individual in-depth interviews by recruiting key informants through purposive snowball sampling. The respondents were engaged in the national/subnational response to HIV/AIDS in Myanmar and worked for the United Nations agencies, non-governmental organizations (NGOs), and civil society. Interview questions were organized around the role of Global Fund in strengthening national response to HIV/AIDS in the six building blocks of the Myanmar’s health system. Transcripts from the key informants were synthesized into specific themes through a deductive approach. Results We found that the Global Fund has provided substantial support to (1) finance the national HIV/AIDS response in Myanmar, and (2) strengthen leadership and governance at the central level through improving coordination and collaboration, including more stakeholders (e.g. civil society, NGOs) in decision making process, and catalyzing policy changes on scaling-up key interventions. Yet, its role remains limited in addressing new demands at the township level in terms of capacity building, staffing, and medical supply resulting from rapid scale-up of HIV interventions and decentralization of service delivery in the public sector. Conclusion There was a missed opportunity for Myanmar to capitalize on the use of the Global Fund’s funding to strengthen the health system. Deliberate planning is required to optimize the use of those scarce resources to provide universal coverage for HIV/AIDS.