By: The Global Fund to Fight AIDS, Tuberculosis and Malaria

Earlier in 2021 the Global Fund to Fight AIDS, Tuberculosis and Malaria published a report showing how COVID-19 had massively disrupted health systems and health service delivery for HIV, TB and malaria in low- and middle-income countries in Africa and Asia in 2020. The report highlighted the urgent need to scale up the adaptive measures that health facilities adopted to continue the fight against HIV, TB, and malaria to ramp up delivery of critical supplies for the COVID-19 response, and prevent health care systems and community responses from collapse.

The data collected shows that for April to September 2020, compared to the same six-month period in 2019:

• HIV testing fell by 41%.
• TB referrals declined by 59%.
• Malaria diagnoses fell by 31%.
• Antenatal care visits fell by 43%.

The spot-checks also highlighted a critical lack of tests, treatments and PPE needed to fight COVID-19, particularly in Africa: only 45% of health facilities had enough essential PPE items for its health workers, including masks, disinfectant, gloves and hand sanitizer; and across the 24 countries in Africa that were surveyed, only 11% of health facilities could conduct COVID-19 antigen rapid diagnostic tests, and only 8% could conduct polymerase chain reaction tests.

The Global Fund and partners immediately rose to the challenge through its COVID-19 Response Mechanism which quickly responded to countries’ needs to address both COVID-19 and HIV, TB and malaria service adaptations.

Health financing and, especially, domestic health financing, also has a critical role to play if hard-won gains are not to be completely lost. Yet the pandemic has led to a twin fiscal shock. Revenues have fallen and spending needs have risen. Spending has been maintained by increasing debt, and reallocating funds to health from other sectors including education and infrastructure.

Most countries will face tight fiscal circumstances over the coming three years. Just over a third of African countries will not regain pre-pandemic levels of spending by 2024 unless they can increase revenues and cut unproductive or low priority spending to make space for more health spending.

Yet all is not lost. Ministries of Finance can support Ministries of Health to effectively prioritise and spend their budgets. Ministries of Health can improve the efficiency of health spending by targeting resources carefully and ensuring funds reach front-line providers. Both Ministries of Finance and Health will need to forge closer working relationships if they are to address this combined health and fiscal crisis, and support the Global Fund and its partners to help them in mitigating the impact of COVID-19 in their countries and adapt HIV, TB and malaria services to address the pandemic’s impact on service delivery.