The need for a better national health care system is a topic of discussion not only in the United States but in African countries as well. Among funders supporting development efforts in Africa, the impact of funding and the consequences of the lack of coordination is an on-going and mostly frustrating conversation.

AGAG has done two reports on the U. S. private funding landscape for health in Africa. The first in 2004, examined support for health continent wide, and the second, in 2007 examined funding for health and basic education programs for children and youth in ten southern Africa countries. Both reports reflect the concentration of disease specific funding and the lack of support for other areas including strengthening health care systems.

Two members of AGAG have recently announced a significant investement in improving health systems in African countries.

The Doris Duke Charitable Foundation (DDCF) launched the African Health Initiative in 2007, to fund partnerships between local governments in selected African countries, researcher, and practioners.

DDCF announced four partnerships. Three of them will be in Mozambique, Rwanda, and Zambia. The fourth will support two countries, Tanzania and Ghana, in sharing their innovative pilot programs in primary health care and hopefully addressing the difficulties both countries have encountered in scaling them up to a national level.

DDCF’s total investment if about $44 million and the programs will last from 5 to 7 years. The grants range from $ 8 million for Rwanda to almost $15 million for Tanzania and Ghana.

Another AGAG member, the Rockefeller Foundation (RF), also has a program to support health systems called the “Transforming Health Systems Initiative (THS).” The THS program launch was announced last month and includes two of the countries where DDCF will be working - Ghana and Rwanda. This program was launched with an initial investment of $100 million over five years for three countries (including Vietnam). The idea is to apply lessons learned to future programs.

In June, two articles in the journal The Lancet, raised some questions about the impact of global health funding in poor countries. The article on ” An assessment of interactions between global health initiatives and country health systems” addressed the charge that disease specific funding has weakened health systems in the poor countries. While inconclusive, it does encourage the opportunity to take advantage of opportunities to strengthen partnerships across areas of the health sector and among a range of actors — which is what both the DDCF and RF programs promote.

Another article in the same issue Financing of global health: tracking development assistance for health from 1990 to 2007 looks at the impact of the mix of old and new actors funding health.

Through the IROKO project, AGAG is seeking to bring together health funders to promote more dialogue and help funders to be more aware of each other’s efforts. I will be talking more about this project as it unfolds over the next few months. We are working on a landscape of health funders. If you fund health in Africa and would like to participate, please send me an email to info at africagrantmakers.org..