Wednesday, January 2, 2008

Funding the fight against AIDS in Africa: You should have (Red) this

Here is an interesting argument from the former USAID HIV prevention advisor for southern Africa advocating a broader approach for healthcare in Africa by not merely throwing money at aids, but the need to strengthen basic health systems in Africa.

Many millions of African children and adults die of malnutrition, pneumonia, motor vehicle accidents and other largely preventable, if not headline-grabbing, conditions. One-fifth of all global deaths from diarrhea occur in just three African countries — Congo, Ethiopia and Nigeria — that have relatively low H.I.V. prevalence. Yet this condition, which is not particularly difficult to cure or prevent, gets scant attention from the donors that invest nearly $1 billion annually on AIDS programs in those countries.

I was struck by this discrepancy between Western donors’ priorities and the real needs of Africans last month, during my most recent trip to Africa. In Senegal, H.I.V. rates remain under 1 percent in adults, partly due to that country’s early adoption of enlightened policies toward prostitution and other risky practices, in addition to universal male circumcision, which limits the heterosexual spread of H.I.V. Rates of tuberculosis, now another favored disease of international donors, are also relatively low in Senegal, and I learned that even malaria, the donors’ third major concern, is not quite as rampant as was assumed, with new testing finding that many fevers aren’t actually caused by the disease.

Meanwhile, the stench of sewage permeates the crowded outskirts of Dakar, Senegal’s capital. There, as in many other parts of West Africa and the developing world, inadequate access to safe water results in devastating diarrheal diseases. Shortages of food and basic health services like vaccinations, prenatal care and family planning contribute to large family size and high child and maternal mortality. Major donors like the President’s Emergency Plan for AIDS Relief, known as Pepfar, and the Global Fund to Fight AIDS, Tuberculosis and Malaria have not directly addressed such basic health issues. The Global Fund’s director, Michel Kazatchkine, has acknowledged, “We are not a global fund that funds local health.”

The problem is not only from the government. In an article for Foreign Affairs last year, Laurie Garrett argued that while more money is being poured into public health from private donors, much of it is directed “narrow, disease-specific problems” and not tackling public health in general. From her article:

Moreover, in all too many cases, [health] aid is tied to short-term numerical targets such as increasing the number of people receiving specific drugs, decreasing the number of pregnant women diagnosed with HIV (the virus that causes AIDS), or increasing the quantity of bed nets handed out to children to block disease-carrying mosquitoes. Few donors seem to understand that it will take at least a full generation (if not two or three) to substantially improve public health -- and that efforts should focus less on particular diseases than on broad measures that affect populations' general well-being.

The Los Angeles Times, in a recent investigation, found that one unintended consequence of laser focus on a specific disease is that local health workers who specialize in AIDS are paid much more than their counterparts.

Here’s the takeaway lesson from the LA Times.

Because of the generosity of the foundation and other donors, millions of children have been protected against scourges such as malaria and measles -- and AIDS deaths in much of Africa are finally leveling off. Dr. Mphu K. Ramatlapeng, Lesotho's health minister, echoed health authorities worldwide when she said this would have been impossible "if it were not for the money from Bill Gates."

But because of the overwhelming nature of AIDS, wartime disruptions and poor governance in some nations -- and because of the priorities of global health groups, including GAVI and the Global Fund -- key measures of societal health have stalled at appalling levels or worsened.

Dr. Peter Poore, a pediatrician who has worked in Africa for three decades, is a former Global Fund board member and consultant to GAVI (formerly the Global Alliance for Vaccines and Immunization). He says they and other donors provide crucial help but overstate the impact of their programs. "They can also do dangerous things," he said. "They can be very disruptive to health systems -- the very things they claim they are trying to improve."

Three arguments making basically the same point. Only here at Africa Flak.

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