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Africa: Paying for Health
Feb 3, 2012 (120203)
(Reposted from sources cited below)
"Simply put, if we allow the fund to fail, many people will
die, and we will forfeit the chance at the "AIDS-free
generation" that U.S. Secretary of State Hillary Clinton
called for in November. This is no time to step back." -
The Global Fund to Fight AIDS, Tuberculosis, and Malaria has
suspended new grants, and, overall, the growth rate of
development assistance in health has slowed due to the
global recession, according to a December report from the
Institute for Health Metrics and Evaluation. Even though
domestic health funding in developing countries contains to
grow, and is in total far greater than the total of
development assistance in health, the gap between the needs
and the funding provided remains high. This is true both for
key diseases such as AIDS, malaria, and tuberculosis, and
for the overall financing of health systems.
Filling this gap in Africa, it is clear, requires sustained
and increased funding both from global institutions and from
This AfricaFocus Bulletin contains Paul Farmer's op-ed on
the Global Fund, from the International Herald Tribune; a
speech by UNAIDS Executive Director Michel Sidibé calling
for greater responsibility by African governments for AIDS
funding and action, and a report from the UN's IRIN news
service on successful increases in domestic funding for AIDS
from the national AIDS levy in Zimbabwe.
For a comprehensive quantitative report on financing of
health in developing countries, including data both on
development assistance for health and domestic health
financing, see the report released in December by the
Institute for Health Metrics and Evaluation
(http://www.healthmetricsandevaluation.org). To download the
full report, as well as tables and charts, visit
For additional background on developments at the Global
Fund, see recent issues of the independent Global Fund
http://www.aidspan.org/index.php?page=gfobackissues), particularly the issue of January 24.
For previous AfricaFocus Bulletins on health issues, visit
++++++++++++++++++++++end editor's note+++++++++++++++++
Why the Global Fund Matters
By Paul Farmer
Paul Farmer is chairman of the department of global health
and social medicine at Harvard Medical School and a
cofounder of Partners in Health, which has received support
from the Global Fund in Haiti, Lesotho and Russia.
February 1, 2012
Ten years ago, the heads of the G-8 countries met in Genoa,
Italy, to back the establishment of the Global Fund to Fight
AIDS, Tuberculosis and Malaria â a new funding mechanism
that dramatically increased resources available to fight
preventable, treatable diseases stalking the poor and
depleting developing economies around the globe.
In 2001, very few people â almost none, really â living with
H.I.V. in Africa had access to antiretroviral medicines.
Today, more than 3.3 million people â more than half of
those on treatment worldwide â are on treatment supported by
the Global Fund: A true victory for the global community.
The fund and the U.S. international AIDS program, Pepfar
(the President's Emergency Plan for AIDS Relief program),
are the most ambitious global health endeavors in
Now, 10 years since its founding, the Global Fund is facing
a serious financial shortfall, and the fund's board voted
recently not to accept new grant requests until at least
2014. Bill Gates' announcement of a $750 million
contribution to the fund in Davos last week was welcome news
â the Bill & Melinda Gates Foundation has been among the
greatest supporters of the Global Fund since its inception â
but will not change the board's decision. They knew of
Gates' donation before they canceled the current round of
This funding deficit hit right when the end of AIDS became
plausible: Last year, scientific breakthroughs provided
conclusive evidence that putting more people on treatment
earlier can significantly reduce incidence of H.I.V.
Treatment is prevention.
Beyond AIDS, the Global Fund is currently the largest donor
in the world for tuberculosis and malaria programs.
Operating in 150 countries, it has treated more than 8
million cases of tuberculosis and distributed 230 million
insecticide-treated nets. Deaths from malaria are down
nearly 40 percent in most of Africa. The question is not
whether the Global Fund works, but how to ensure it keeps
working for years to come.
In my mind, there are four reasons this is imperative:
First, the world needs to expand, not contract, access to
health care because of the sheer burden of disease. It is
unconscionable that, in 2012, we are still living in a world
where millions of poor people die of preventable and
Second, the Fund doesn't simply give handouts; it takes the
longer road of investing in and working with health
ministries. In doing so, it seeks to build (or rebuild)
local health systems, develop platforms for transparency and
accountability, boost local procurement and improve supply
chains, and help train civil servants and health
This approach has had profound spillover effects on other
health and development priorities. In central Haiti, for
example, establishing effective treatment programs for AIDS,
tuberculosis, and malaria has raised the standard of care
for chronic conditions like major mental illness, heart
failure and several forms of cancer.
Third, the Global Fund proves how much multilateral
organizations can accomplish. While the usual players â the
G-8, say â bear the greatest financial burden, I would urge
some of the recipient countries to consider themselves
partners of and contributors to the fund. In today's global
economy, countries like India, Russia and China play
meaningful roles as donors and as recipients of grants.
Gabriel Jaramillo, a Brazilian banker who last week was
named the fund's general manager, will surely strengthen
these links and reinvigorate its leadership. The Global Fund
is a truly multilateral organization, and stronger for it.
Fourth, a recession is a lousy excuse to starve one of the
best (and only) instruments we have for helping people who
live on a few dollars a day. Most marginalized populations
around the globe have always faced economic contraction;
"financial crisis" has been ongoing for them since the day
they were born. It would be a great mistake to allow one of
the world's most effective global health institutions to
fail because we need to get our own fiscal house in order.
Along with Pepfar, the Global Fund has, without question,
helped turn the corner on AIDS. It has also helped realize
substantial gains against TB and malaria that must be
maintained. We need to summon the funding and political
will, now, to protect the hard-fought progress of the past
Simply put, if we allow the fund to fail, many people will
die, and we will forfeit the chance at the "AIDS-free
generation" that U.S. Secretary of State Hillary Clinton
called for in November. This is no time to step back.
AIDS Dependency Crisis: Sourcing African Solutions
Michel Sidibé, Executive Director of UNAIDS
28 January 2012
Place: Addis Ababa, Ethiopia
Occasion: 26th Summit of the NEPAD Heads of State and
Government Orientation Committee
Ten years ago, AIDS was transformed from an epidemic of fear
and denial to a political issue that African leaders brought
to the UN General Assembly. Leadership on AIDS in Africa has
been sustained and strengthened thanks to many of you:
Presidents Kagame, Goodluck Jonathan, Toure, Wade, and Zuma;
Prime Minister Meles; and others in this room. Last year,
President Bongo even brought AIDS back to the UN Security
This is the only continent where national leaders have made
progress on AIDS a defining legacy of your commitment to
your own people.
Ten years ago, Senegal and Uganda were the only two success
stories we had in Africa. Now 22 African countries have
lowered the rate of new HIV infections by 25% or more.
Today, more than 5 million people living with HIV in Africa
are alive because they have access to treatment. The end of
this tragic epidemic is finally within our reach.
Ten years ago, AIDS was the crisis in Africa that moved
international donors to make the paradigm shift from
millions to billions. It led to the creation of the Global
Fund and the biggest scale-up of any health or development
programme in the history of Africa. Today, over $US 8
billion is spent every year on the AIDS response in Africa.
These are massive resources but they are still not enough to
sustain the fragile gains we have made.
Why? The dilemma of dependency. Africa is too dependent on
external resources, especially for the AIDS response.
In over half of African nations, more than 50% of the
resources for treatment come from external sources. Over 4
million Africans depend on external donors for the
medication they take every day to stay alive.
What if these funds run out? Where will millions of Africans
turn to for hope and for life? This is a source of great
risk and potential instability. The status quo cannot be
The global financial crisis has shown in cruel terms that
external aid is the first thing some donors will cut when
they need to protect themselves. Countries cannot plan and
prioritize their AIDS response without pattern, without
predictability, without sustainability.
Especially now, when donors are scaling back, we are
clinging to a massively inefficient and unsustainable
paradigm. It is time for a new development paradigm that is
developed and owned by the leaders of Africa.
For the first time in history, global investments for HIV
are declining. The Global Fund faces an unprecedented
crisis, and has announced no new funding until at least
We must continue to fight for the Global Fund. It is an
irreplaceable partner, and is essential to meeting the
targets and commitments of the Political Declaration and the
MDGs. But the health of millions of African cannot depend on
decisions made in Geneva.
The treatment gap is growing wider and costs are rising
quickly. Five million Africans are still waiting for ARVs.
Every day, more people must move to costlier second-line
treatments because they are developing resistance.
Meanwhile, we now know that putting people on treatment
early can reduce the risk of transmission to a partner by
96%. This is a major opportunity to reduce new infections,
and we cannot afford to miss it.
This highlights Africa's other dangerous dependency:
medicines. The vast majority of HIV treatment drugs consumed
in Africa are imported from generic manufacturers. Over 80%
come from one country: India. This arrangement is
unpredictable and unsustainable. Changes in markets and
trade rules could move drugs out of the reach of people who
depend on them.
Africa should produce its own high-quality, low-cost HIV
medicines that can get from the lab to the marketplace
quickly and are protected from counterfeiters. Only African
leadership can make this happen.
In crisis lies opportunity for Africa.
I am confident Africa will be the source of new solutions to
the outdated development cooperation paradigm. In doing so,
the AIDS response will help Africa will reduce its overall
external dependency on aid.
First, we must get quality-assured drugs sooner to the
people who need them. Africa needs its own African Medicines
Regulatory Agency. The AIDS responseâwith its successful
history of patent and licensing advocacyâcan be a catalyst.
Second, we need to establish centres of excellence for the
local production of medicines in Africa.
Most importantly, we must decrease dependency by growing
African investments. We are ready to work with you to
mobilize innovative sources of domestic funding that can be
owned and sustained by Africa.
There are many examples of this: Make more use of "soft
loans" from African sources, like the African Development
Bank. Tap into remittance flows from the African diaspora.
Create public-private partnerships to bring African business
into the funding picture. Create new, innovative taxes and
levies, like a few cents from a mobile telephone call or a
currency transaction. We can learn a lot from Zimbabwe and
Kenya, who are already putting these mechanisms in place.
The poor and marginalized often face catastrophic health
expenses. Countries should introduce more innovative social
insurance schemes as a way to channel health and social
spending more efficiently and fairly.
External aid is not going to disappear, and it should not.
Instead, governments should negotiate more predictable,
sustainable investments from international partners.
Your Excellencies, It is time for Africa to demonstrate that
you are leading your response to AIDS to ultimately
transform your response to development. It is tragic that 24
million people in Africa have lost their lives to this
epidemic. But it is unacceptable that when we have the
science, the medication and the resources available in
Africa. It is unacceptable that we have people on this
continent still getting infected with HIV and dying from
It is time to demonstrate that countries can come together
with a single purpose: Defining a new paradigm based on
social realities and economic progress. A paradigm that
centres on shared values, shared responsibility, and mutual
accountability. A paradigm that will deliver a new, socially
sustainable agenda that is written and owned by Africa.
Zimbabwe: Improved AIDS levy collections fill part of
Harare, 3 February 2012 (PlusNews) - With global funding for
HIV/AIDS on the decline, Zimbabwe's innovative AIDS levy - a
3 percent tax on income - has become a promising source of
funding for the country, with a dramatic increase in revenue
collected in the past two years.
The levy was introduced in 1999 to compensate for declining
donor support, but low salaries and the poor performance of
industry meant not enough money had been collected - until
recently. In its 2010 report on Zimbabwe's progress in
implementing the Declaration of Commitment on HIV/AIDS,
adopted by the General Assembly in 2001, the government
admitted the levy was "essentially non-existent in 2007-2008
due to economic challenges the country was facing".
According to the organization's recently published audited
financial statements for the year ending 31 December 2010, a
total of US$20.5 million was collected in 2010 against $5.7
million the previous year.
Murombedzi Kuchera, chairman of the National AIDS Council
Board, attributed the increase to improved revenue flows
owing to improved political and economic stability in the
country, which has created more jobs in the formal sector
and improved tax remittances. Zimbabwe's economy has
witnessed steady growth following the formation of the
coalition government of Prime Minister Morgan Tsvangirai and
President Robert Mugabe in 2009.
"The 259 percent increase in the collections was mainly
through the increased capacity utilization by industry and
commerce," Kuchera said in his statement.
Although the revenue figures for 2011 have not yet been
audited, the National AIDS Council estimates it collected
about $25 million. However, the exact figure will be
confirmed after the audit by the Comptroller and AuditorGeneral,
which audits all the finances of parastatals, at
the end of 2012.
"The AIDS Levy is certainly proving to be a good source of
funding for the country's HIV and AIDS response," National
AIDS Council information and communication officer Orirando
Manwere told IRIN/PlusNews.
"Our projections are that for 2012, with the growing
economic stability in the country, we will collect more than
$30 million through the funds and even more in 2013.
However, this is all largely dependent on economic growth,"
Although 347,000 people are on antiretroviral (ARV)
treatment in the country, another 600,000 need the
medication. The treatment gap widened after Zimbabwe adopted
the new World Health Organization guidelines that recommend
starting treatment earlier.
The AIDS levy contributed almost a quarter of the money to
purchase ARVs, while 76 percent of the treatment programme
was financed by international donors such as the Global Fund
to fight AIDS, Tuberculosis and Malaria and the UK
Department for International Development.
But the country - one of the hardest hit by HIV/AIDS - still
needs a lot more funding to cover the "worrying" treatment
gap, cautioned HIV/AIDS activist Stanley Takaona.
"Many people are dying because they cannot access treatment.
Zimbabweans are playing their part to take care of their own
by contributing to the AIDS Levy but this is not enough.
Government must allocate funds from the fiscus to fund the
HIV/AIDS response; it's their responsibility," he said.
Kumbirai Mafunda, spokesperson for the Zimbabwe Lawyers for
Human Rights, warned against complacency. "Yes, the increase
in the AIDS Levy is remarkable but we all know it's not
enough... now government has to increase budget allocations
to the health sector."
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