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AIDS—South Africa and beyond
Newsdesk Paying the price of HIV/AIDS—South Africa and beyond
532
Better cooperation within and between sectors—eg, health, water and sanitation, education—is vital, says Vicky Blagbrough of WaterAid: “There are fundamental divisions that widen the higher up the hierarchy you go. By the time you reach multilateral donor level, the divisions are chasms. This means policy decisions, implementation, funding, and research are not coordinated and thus often not costeffective”. Previously, different donors required countries to monitor need and assess use of funds in different ways. In response, UN agencies have formed the Global AIDS Monitoring and Evaluation Team to strengthen countries’ capacity for monitoring epidemics and the performance of their programmes. In addition, the World Bank is keen that countries adopt the Joint Policy Review process recently used in Kenya, a complex but transparent process that involves all stakeholders down to the smallest groups. Despite these moves, widespread disagreement remains over how to pay for the fight. Ooms criticises “IMF and World Bank macroeconomists who continue to impose public spending caps that exclude AIDS treatment programmes”. Devarajan counters that “excessive spending that exceeds revenue leads to high fiscal deficits which, in turn, cause macroeconomic crises that often hurt the poor”. In less than 3 years, virtually all of the poorest African countries that have developed a national plan have been awarded grants under the World Bank’s multi-country AIDS programme, which, like the GFATM, funds public, private, and civil-society initiatives. Tren concludes that “while support from the west is important, vital even, the buck stops with African governments”. At last, even South Africa has a chance to prove its critics wrong. Global Fund
The long-awaited signing of an of affected communities to use agreement to receive US$41 million additional resources”, says Paul Zeitz from the Global Fund for AIDS, TB, of the Global AIDS Alliance. These and Malaria (GFATM) represents “a resources are needed precisely to turning point for South Africa”, strengthen health-care infrastructure declared GFATM head Richard and improve distribution channels, he Feachem on August 7. The agreement, states. In another blow, the USA has which includes increased access to limited its GFATM contributions to antiretroviral and tuberculosis drugs, could not be more timely since, according to a recent World Bank report, failure to rapidly step up efforts to fight HIV/AIDS could result in the economic collapse of nations such as South Africa. Previous economic models have underestimated how HIV/AIDS decimates human capital and “weakens the ability of today’s generation to pass on its skills and knowledge to the next”, says co-author and World Bank economist Shantayanan Peter Piot and Richard Feachem Devarajan. “In countries facing one-third of overall contributions to an HIV/AIDS epidemic on the same the fund. Thus, if the EU and others scale as South Africa, for example, if don’t raise $2 billion, the US nothing is done quickly to fight their contribution falls. But some donors, epidemic, they could face economic such as the British government, collapse within several generations”. remain convinced of the need to Despite $15 billion pledged by the US channel substantial funds through government for the next 5 years, and other mechanisms, while waiting to increased funds promised by the EU judge the success of the fund. and bilateral donors, funding still falls Such delaying tactics could be well short of the $10 billion that deadly, as could a lack of secure UNAIDS estimates is needed this year funding. Gorik Ooms of Médecins to tackle the global epidemic. sans Frontières, Belgium, notes that, “There is no question that we need for example, “poor countries that more money for the fight”, says Keith Hansen of the World Bank’s AIDS want to start a national HIV treatment control programme in Africa. “It is programme need a funding source hollow solace to say that finally, 20 that is reliable and guarantees some years after the start of the HIV continuity; they cannot start treating epidemic, we have decided to run the people now and abandon treatment in race.” Critics point out that already, US 3 years if the donor has second monies have been substantially cut, thoughts about it”. Moreover, says and now amount to less than aid to Richard Tren of Africa Fighting Israel allowed in the same budget. Malaria, a South Africa-based President Bush’s explanation was that advocacy group, “I think there is a programmes cannot effectively absorb danger that each agency wants to do its more funding, while distribution own thing and grab its own glory—it mechanisms for medications are is certainly true of malaria control. lacking. This results in bitty projects that are “Sadly, the President’s statements not necessarily based on good science are misleading regarding the capacity or medicine”.
Kelly Morris
THE LANCET Infectious Diseases Vol 3 September 2003
http://infection.thelancet.com
For personal use. Only reproduce with permission from The Lancet.
532
Better cooperation within and between sectors—eg, health, water and sanitation, education—is vital, says Vicky Blagbrough of WaterAid: “There are fundamental divisions that widen the higher up the hierarchy you go. By the time you reach multilateral donor level, the divisions are chasms. This means policy decisions, implementation, funding, and research are not coordinated and thus often not costeffective”. Previously, different donors required countries to monitor need and assess use of funds in different ways. In response, UN agencies have formed the Global AIDS Monitoring and Evaluation Team to strengthen countries’ capacity for monitoring epidemics and the performance of their programmes. In addition, the World Bank is keen that countries adopt the Joint Policy Review process recently used in Kenya, a complex but transparent process that involves all stakeholders down to the smallest groups. Despite these moves, widespread disagreement remains over how to pay for the fight. Ooms criticises “IMF and World Bank macroeconomists who continue to impose public spending caps that exclude AIDS treatment programmes”. Devarajan counters that “excessive spending that exceeds revenue leads to high fiscal deficits which, in turn, cause macroeconomic crises that often hurt the poor”. In less than 3 years, virtually all of the poorest African countries that have developed a national plan have been awarded grants under the World Bank’s multi-country AIDS programme, which, like the GFATM, funds public, private, and civil-society initiatives. Tren concludes that “while support from the west is important, vital even, the buck stops with African governments”. At last, even South Africa has a chance to prove its critics wrong. Global Fund
The long-awaited signing of an of affected communities to use agreement to receive US$41 million additional resources”, says Paul Zeitz from the Global Fund for AIDS, TB, of the Global AIDS Alliance. These and Malaria (GFATM) represents “a resources are needed precisely to turning point for South Africa”, strengthen health-care infrastructure declared GFATM head Richard and improve distribution channels, he Feachem on August 7. The agreement, states. In another blow, the USA has which includes increased access to limited its GFATM contributions to antiretroviral and tuberculosis drugs, could not be more timely since, according to a recent World Bank report, failure to rapidly step up efforts to fight HIV/AIDS could result in the economic collapse of nations such as South Africa. Previous economic models have underestimated how HIV/AIDS decimates human capital and “weakens the ability of today’s generation to pass on its skills and knowledge to the next”, says co-author and World Bank economist Shantayanan Peter Piot and Richard Feachem Devarajan. “In countries facing one-third of overall contributions to an HIV/AIDS epidemic on the same the fund. Thus, if the EU and others scale as South Africa, for example, if don’t raise $2 billion, the US nothing is done quickly to fight their contribution falls. But some donors, epidemic, they could face economic such as the British government, collapse within several generations”. remain convinced of the need to Despite $15 billion pledged by the US channel substantial funds through government for the next 5 years, and other mechanisms, while waiting to increased funds promised by the EU judge the success of the fund. and bilateral donors, funding still falls Such delaying tactics could be well short of the $10 billion that deadly, as could a lack of secure UNAIDS estimates is needed this year funding. Gorik Ooms of Médecins to tackle the global epidemic. sans Frontières, Belgium, notes that, “There is no question that we need for example, “poor countries that more money for the fight”, says Keith Hansen of the World Bank’s AIDS want to start a national HIV treatment control programme in Africa. “It is programme need a funding source hollow solace to say that finally, 20 that is reliable and guarantees some years after the start of the HIV continuity; they cannot start treating epidemic, we have decided to run the people now and abandon treatment in race.” Critics point out that already, US 3 years if the donor has second monies have been substantially cut, thoughts about it”. Moreover, says and now amount to less than aid to Richard Tren of Africa Fighting Israel allowed in the same budget. Malaria, a South Africa-based President Bush’s explanation was that advocacy group, “I think there is a programmes cannot effectively absorb danger that each agency wants to do its more funding, while distribution own thing and grab its own glory—it mechanisms for medications are is certainly true of malaria control. lacking. This results in bitty projects that are “Sadly, the President’s statements not necessarily based on good science are misleading regarding the capacity or medicine”.
Kelly Morris
THE LANCET Infectious Diseases Vol 3 September 2003
http://infection.thelancet.com
For personal use. Only reproduce with permission from The Lancet.