Rx for Survival

Politics & Global Health

Other Multilateral Organizations

Other multilateral organizations that draw on pooled contributions from several countries exist entirely apart from the UN. These include regional development banks, international non-governmental organizations, and global alliances and funds that function as public-private partnerships.

Regional Development Banks

Like the World Bank, regional development banks provide loans and grants, sometimes accompanied by advisory services, to individual countries or regional bodies to support work in the areas of social and economic development, including health initiatives. Their overarching goal is to build market economies and promote private sector-led development. In addition to lending to governments, some regional development banks also provide loans and equity investments to private sector projects in less developed countries where the risks are too high for private sources of financing.

The four largest regional development banks are the Inter-American Development Bank (IDB), the Asian Development Bank (ADB), the African Development Bank Group (AFDB), and the European Bank for Reconstruction and Development (EBRD), although the EBRD is not very involved in health-related matters. The first regional development bank, the IDB, was established in 1959. Today, the regional development banks combined provide a similar level of resources as the World Bank, and a significant percentage of their loans are health-related.

These banks raise funds through bond issues on the world's capital markets, as well as relying on member contributions and the repayment of loans. Each bank has a broad membership of both borrowing developing countries and developed donor countries. Member governments are also the shareholders. Each bank has a Board of Governors comprised of one representative from each member nation, and though each bank has its own legal and operational status, they engage in a high level of cooperation with one another because they have such similar mandates. Their activities are increasingly focused on the poorest countries, with poverty reduction as the overall goal.

Non-Governmental Organizations

Non-governmental organizations, or NGOs, are any of the world's thousands of organizations that are independent from any government and have a strong advocacy mission. Most are based locally and operate within a single country. The largest NGOs in the areas of international health, relief, and development aid, however, are multilateral organizations with a broad membership. They include Care International, Oxfam International, Catholic Relief Services, Save the Children, Médecins Sans Frontières (Doctors Without Borders), and the Red Cross and Red Crescent Movement. (The last two are especially active in refugee assistance and disaster relief.) These are operational NGOs, which mobilize the resources (such as funds, labor, and materials) to sustain their programs, as opposed to campaigning NGOs, which focus their activities on lobbying.

The structure and sources of funding for NGOs vary. Some NGOs are based in one country but operate transnationally. Some are headquartered in one country but have regional or country offices. Some are umbrella organizations for groupings of like-minded, smaller organizations and professionals, and include such groups as the Global Health Council, Consumers International, and the People's Health Movement (PHM). They provide information and advocacy regarding the global health issues addressed by their members, and provide an outlet by which members of the public can obtain current information on a wide range of policies and programs. These organizations also lobby governments and international institutions regarding key health issues.

For funding, an NGO generally relies on a combination of membership dues, grants from private foundations, contracts from governments and international institutions, and donations from corporations and individuals.

Global Funds and Alliances

New partnerships, structured as global funds and alliances and involving both the public and private sectors, are forming around specific health areas, especially disease control and eradication. Those who call for the creation of these partnerships do so because they feel that many of the existing efforts to tackle and eradicate the major communicable (and poverty-related) diseases of the world such as AIDS, tuberculosis, and malaria are poorly financed and coordinated, and that the eradication of these diseases would be a truly global good, with major worldwide social and economic benefits.

These partnerships vary greatly in membership and scope of programming, but each one is founded on a set of principles that dictates what the funds or services are for, who is eligible to receive them, and how they should be used. Those partnerships designated as funds focus on mobilizing financial assets, leaving actual program implementation to others. Those designated as alliances or initiatives tend to be primarily aimed at implementation, although some also play a financing role.

The amounts mobilized are significant: the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), for example, has committed $3 billion in 128 countries since its foundation in 2002. Grants are often performance-based: a country or organization must demonstrate a clear need in its initial proposal, and then program success in order to receive continued funding.

The members in these partnerships often include certain United Nations programs, such as the World Health Organization or UNAIDS. In fact, the GFATM came into being as a result of a UN Secretary General Kofi Annan's call for such an initiative. Others operate entirely outside of the UN. All of the partnerships, however, involve collaboration between a combination of multilateral and bilateral organizations, NGOs, corporations, and foundations. In addition to the GFATM, other significant partnerships include the Global Alliance for Improved Nutrition (GAIN), the Global Alliance for Vaccines and Immunization (GAVI), the Global Forum for Health Research, the Partnership for Maternal, Newborn & Child Health, and the Roll Back Malaria Partnership.