NextBillion - An Initiative of the William Davidson Institute at the University of Michigan

Wednesday, January 28, 2015

In June, 2014, the Global Fund to Fight AIDS, Tuberculosis, and Malaria completed its support for operations in China.1 The 10-year partnership between China and the Fund measurably improved China’s management of the three diseases, but it also created benefits that extend far beyond the metrics usually used to assess public health programmes. These benefits include deeper engagement with civil society organisations, stronger public health systems, and the implementation of innovative approaches for disease management. As China celebrates these achievements, it must also devise a roadmap for continuing its record of success, now that the Fund has left.

China’s relationship with the Global Fund began shortly before the 2003 severe acute respiratory syndrome epidemic, an event that proved the importance of containing public health threats that could undermine the country’s economic growth. Successful pilot programmes have shown the effectiveness of various interventions against tuberculosis, malaria, and HIV/AIDS, and demonstrated the potential for scaling up those programmes in a way that would create a greater impression. In fact, it was the very potential large-scale interventions and strategic public health programming that made China and the Fund such natural partners. The results have been impressive.

Access to quality diagnosis and treatment of multidrug-resistant tuberculosis (MDR-TB) expanded from just two pilot projects in 2006 in two provinces to 92 sites in 30 provinces in 2013. China has also expanded access to innovative rapid diagnosis for MDR-TB in more than 900 counties across the country. And, by the end of June, 2014, more than 9000 patients had started treatment for MDR-TB (unpublished data).

Extraordinary progress was made towards the elimination of malaria. In 2002, the objective was to control malaria’s spread; by 2020, the goal will be to eliminate local transmission of the disease entirely.2 Between 2002 and 2012, the number of Chinese provinces reporting domestic cases of malaria has plummeted from 24 to five, and the number of reported malaria cases decreased from 100?106 cases and 48 deaths in 2005 to 4498 cases and 33 deaths in 2011.3

Finally, China’s rate of HIV infection has been stabilised at 0·06%; between 2005 and 2012, the number of patients receiving antiretroviral therapy increased from 19?282 in 2005 to 176?655. HIV prevention outreach services achieved 81% coverage in commercial sex workers and 77% in men who have sex with men (MSM) by 2011. Harm reduction interventions in people who inject drugs have brought about substantial reductions in HIV incidence (from 0·54% to 0·31%) and prevalence (from 9·3% to 6·4%) over 2009–11 (unpublished).

Important though they are, numbers alone do not tell the whole story. Engagement with the Global Fund has changed China’s fundamental approach to these three diseases, resulting in many gains that are hard to quantify but nevertheless invaluable. The first is a change in mindset. The way China’s leaders think about development has progressed, making the public health system more transparent, open, and accountable. This quantum advance in governance derived partly from procedural and reporting requirements that came with China’s alliance to the Global Fund. The Chinese Government cofinanced the Global Fund programme, a move that transformed China from an aid recipient into a full and active partner. Such a collaborative arrangement meant that all costs and other procedural details were clearly and publicly allocated, and that all programmes were audited, infusing the system with international standards of transparency.