Abstract
Public health campaigns are used in many countries to maximize the number of people reached with interventions to prevent, control, eliminate or eradicate diseases. Campaigns have historically been organized within disease-specific (vertical) programs, which are often funded, planned, and implemented independently from one another and from routinely offered primary health care services. Global health agencies have voiced support for enhancing campaign effectiveness, including campaign efficiency and equity, through collaboration among vertical programs. However, standalone campaigns have proliferated over the past 25 years, even amidst the call for integration, or mainstreaming, emphasized in global strategy and guidelines.
We conducted a health campaign financing landscape analysis with the aim of shining a light on the financial barriers and disincentives at the global and country level to integration or collaboration among campaigns related to neglected tropical diseases, malaria, vitamin A supplementation, and vaccine-preventable diseases, including polio, measles, meningitis and other diseases. The landscape analysis included a qualitative research study conducted between February and May 2022 including 51 semi-structured interviews with key informants representing these program areas and including funders, implementing partners, and program managers from countries with many externally financed campaigns. We complemented these interviews with a review of global strategy and guidance documents.
The barriers and disincentives we surfaced through this analysis are organized into seven themes. First, there are fundamental issues in the way global health is structured and financed which enforce verticalization and fragment the system. Second, there is unproductive competition for scarce resources and priority among agencies and health programs, with these power dynamics resulting in a redistribution of resources at the global level. Third, there is fragmentation of financing, nonstandard payment rates, and inefficiencies from overlaps, duplications, and misalignment of campaign functions. Fourth, there is little incentive to change the status quo as there are no immediate negative consequences; inefficiencies are hidden from each funding channel and program (i.e., the tragedy of the commons). Fifth, there are powerful disincentives to integration and collaboration, and multiple staggard campaigns have some obvious benefits. Sixth, limited intra and inter communication leads to lack of coordination on strategies, alignment of funding streams, and integrated planning. And finally, integration is complex and leadership for change is hard, with country absorptive capacity limited with competing priorities and an overburdened workforce.
In addition to identifying financial barriers and disincentives through the interviews with experts, we surfaced opportunities and practical actions to overcome these challenges, and to strengthen collaboration among agencies and health programs and to increase integration with health systems. Among a long list, the most promising opportunities relate to collaborating to introduce various health systems and financing interventions in specific geographies, including: 1) aligning and coordinating funding to support integrated planning and harmonization of payment rates, supported by a pooled financing mechanism; 2) optimized incentive arrangements at various levels of the health system to encourage campaign integration and program coordination; and 3) functional integration to address inefficiencies through investment in joint health system functions and tools across campaigns of different health interventions or antigens.