Recent comments from the inside of the Global Fund, say Gorik Ooms (Medecins Sans Frontieres, Belgium) and colleagues, writing in PLoS Medicine, suggest an intention to focus more on the three diseases, and to leave the strengthening of health systems and the support to the health workforce to others.
This might create Medicines Without Doctors situations: situations in which the medicines to fight AIDS, Tuberculosis and Malaria are available, but not the doctors or the nurses to prescribe those medicines adequately.
It would be a strategic mistake, say the authors, for the Global Fund to create such a situation. The Global Fund is already supporting HIV treatment and prevention programmes, and is projected to provide treatment to 1.8 million people over five years.
Ooms and colleagues use the examples of two countries - Mozambique and Malawi - trying to fight against a full-blown AIDS epidemic with a fragile health system to underline the crucial role of Global Fund support to the health workforce.
Mozambique, for example, estimates that in order to roll out HIV drug therapy across the country, it would need eight health workers per 1000 patients receiving treatment: one to two doctors, two to seven nurses, one to three pharmacy staff and a wide range of counsellors and pharmacy staff.
In Malawi, there are 0.61 health workers per 1000 people, but the country is beginning to expand its health sector with donor support explicitly intended to scale up antiretroviral treatment without undermining the health sector.
Malawi is also the only country to win an important concession from the International Monetary Fund: an agreement that it will not be penalised for spending more on health sector wages than a cap agreed in 2003. Ceilings on government wage bills are features of IMF lending agreements with several African countries, and they restrict health care recruitment.
Malawi also benefited from health sector strengthening funds from the Global Funds fifth grant round.
Ooms G et al. Medicines without doctors: why the Global Fund must fund the salaries of health workers to expand AIDS treatment. PLoS Medicine 4 (4): e128, 2007.