PHM-Exch> Anti-disease funds could be harming health systems

[Claudio Schuftan]

From: Vern Weitzel <vern.weitzel at gmail.com>
crossposted from: "[health-vn discussion group]" health-vn at anu.edu.au


http://www.guardian.co.uk/world/2009/jun/19/funds-investigation-aids-tb-malaria

Anti-disease funds could be harming health systems

Lives saved in fight against Aids, TB and malaria but donors may lure
hospital
workers away

Sarah Boseley, health editor
The Guardian,    Friday 19 June 2009


The vast sums of money ploughed into efforts to fight diseases such as Aids,
TB
and malaria in the last 10 years have saved many lives but have also
sometimes
undermined health systems in poor countries, according to a survey by the
World
Health Organisation and others published today.

Funding for what the researchers call development assistance for health has
quadrupled from $5.6bn (£3.4bn) in 1990 to $21.8bn in 2007. A worldwide
outcry
around the turn of the millennium over the plight of people in Africa dying
of
Aids, a disease kept in check with drugs in rich countries, triggered a rush
to
fund big disease-fighting programmes on the part of western governments, aid
organisations and philanthropic donors such as the Bill and Melinda Gates
Foundation.

But until now, there has been little attempt to find out how well the money
has
been spent and what impact the focus on high-profile diseases has had on the
everyday business of hospitals, clinics and overworked healthcare staff in
the
poorer countries.

An extensive investigation published in the Lancet by a collaborative group
headed by the WHO but involving a large number of experts from governments,
universities, aid organisations and campaigners reveals a mixed picture.

On the minus side, the report finds that healthcare workers have been lured
away
from government hospitals by the higher salaries paid by international
organisations involved in Aids and other disease programmes. In some
countries,
the rush to win grants from the Geneva-based Global Fund to fight Aids, TB
and
Malaria may have led to proposals being put forward that are inappropriate.

The disease-specific programmes, says the report, "address issues of global
importance, but whether they serve the specific needs of the countries in
the
best way possible is not known".

The programmes have achieved much and must continue, it adds, but they need
to
include targets for strengthening the general health systems of the
countries
where they are working.

On the plus side, millions of people are alive because of the roll-out of
HIV
drugs to more than 3 million people in developing countries. The number of
children protected against malaria by insecticide-impregnated bed nets rose
almost eightfold from 3% in 2001 to 23% in 2006. Disease elimination
programmes,
such as for polio and river blindness, are making good progress. Global
immunisation has also made big strides, the report says.

Some programmes have had a wider impact than their immediate focus.
Following
the big injection of funds for HIV/Aids to Botswana from mainly US donors
and
its own government, infant mortality dropped and life expectancy increased
for
the first time in decades.

In Kenya, the distribution of bed nets led to more pregnant women attending
antenatal clinics.

To improve the health of as many as possible in the developing world,
disease
programmes need to include health system strengthening, the group says.

But Dr Jim Kim, of the Harvard school of public health – who set the target
for
the drugs roll-out when he was head of the WHO's department of HIV/Aids –
said
the extra money now being spent on health would not have been forthcoming
without the sort of global outcry that was triggered over Aids in Africa.

"We have to understand the current situation in its historical, social,
political context. It came about because of very specific interventions by
very
specific people," he said.

"It would be a mistake to say to the donors, 'you made a mistake and we are
now
going to correct your mistake'. If you did that, the money would just dry
up."
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