Dr. Roland Msiska, Project Director for UNOPS executed UNDP Regional Project on HIV and Development in sub-Saharan Africa-Pretoria, South Africa.
This paper attempts to contribute to potential ways of ensuring that the momentum that has been generated by UNGASS and the creation of the GFATM for an effective well coordinated response to HIV, especially in Africa, is increased and sustained for at least 20 years. In order to achieve this, I am suggesting that we respond to the following questions: (a). What is the current situation of HIV/AIDS and what are the implications for achieving the global millennium goals? (b). What are the key areas of focus for sustaining the momentum of UNGASS implementation at global, regional and national levels? (c). How can we ensure that the GFATM facilitates the implementation of UNGASS at global, regional and national levels? (d). How can we ensure that wealthy nations facilitate countries in the sub-Saharan Africa to meet UNGASS commitments?
Resource allocation and health financing
UN Habitat estimates that by 2025 over a third of all people in developing countries will be living in informal urban settlements. How can municipalities and governments do more to provide the most marginalised of the urban poor with adequate sanitation services? Can linkages and dialogue between policymakers and residents be fostered? A paper from the University of Southampton’s Institute of Irrigation and Development Studies (IIDS) reports the results of a study looking at policies, current service levels, attitudes, practices and expectations of residents and officials in 12 slums and shanty-towns in South Africa, Zambia and Zimbabwe. Resultant guidelines suggest that unless agencies learn to be more responsive to the needs, demands and interests of poor communities, urban environments are likely to become ever more unsanitary.
The working group report that by rapidly scaling up existing, successful prevention programmes, it will be possible to contain and ultimately reverse the HIV/AIDS epidemic. The paper reviews successful prevention strategies but points out that such programmes reach less than one in five of those who are vulnerable. A number of scientific studies that measure the effectiveness of programmes in preventing infection via all forms of transmission are reviewed. The report discusses the major obstacles to the upscaling of effective prevention methods, which it identifies as:
limited resources
lack of local capacity
stigma
lack of political commitment
the need for greater access to treatment
the need for new treatments and technologies
Recommendations are made to tackle these obstacles through building capacity, increasing resources and accelerating research into new prevention technologies.
Robert Guest, The Economist
Last year, a group called the Commission on Macroeconomics and Health (CMH), which is backed by the World Health Organisation, called for rich nations to donate an extra $27 billion a year towards grappling with poor countries' health problems. It is an excellent idea, but there seems to be little chance that such a vast sum will actually be raised. All hope is not lost, however. A recent experiment in Tanzania has shown that a small health budget can go a long way, provided that the money is spent with care. The results are so striking that they are worth examining in detail.
The first section explores the role of economics in addressing the HIV/AIDS epidemic. Essays address use of resources, globalisation and HIV and economic evaluations of social interventions. Papers in section two consider the impacts of the disease, especially economic impacts, and consider methods of measuring those impacts. The final part of the document considers how economics can be used to respond to the pandemic, through assessment of resource allocations, economic evaluation and cost effectiveness as well as analysis of trials looking at prevention and treatment options.
New approaches to healthcare funding often rely on outdated attitudes to gender. How can donors ensure that gender analysis is effective? Should they move beyond a narrow focus on women as a separate group? Researchers from the UK University of Manchester argue for a new approach to gender in healthcare funding. In many countries, donors are changing the way they finance health programmes. They are moving away from funding individual health projects and now encourage aid for government-managed health sector programmes. This new form of funding requires innovative forms of gender analysis and gender-sensitive interventions in the health sector.
What are the implications for reproductive health of health reforms in low and middle-income countries? The last decade has seen a change in approach from supply-side health sector reforms to an emphasis on demand-driven and anti-poverty interventions. But has this increased access to reproductive healthcare and have services improved as a result? A report from the UK Institute of Development Studies argues that the impacts of health reform depend heavily on the local context in different countries. This includes economic, political, demographic and epidemiological factors. Different strategies are therefore needed to ensure further improvements in reproductive healthcare.
Dr Godfrey Swai, Tanzania Public Health Association.
HIV/AIDS, Tuberculosis and Malaria are diseases of poverty or deprivation. Effective rolling back of the three diseases must also roll back poverty. The intimate link between equity in health and poverty reduction cannot be ignored by the international community and poses the challenge for effectiveness of the Global Fund. The share of the global burden of the three diseases for Sub Sahara Africa is unacceptably high, and increasing, deepening poverty and threatening human survival. This region deserves special consideration under the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM).
Some activists have already called for the resignation of Richard Feachem, even though he has not yet signed a contract to become the first director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Boston Globe reports. Feachem, the founding director of the Institute for Global Health at the University of California-San Francisco, was named as the fund's first director in April by the fund's board but has come "under fire" from some activists because of comments regarding the amount of money in the fund. According to comments that first appeared in the Memphis Commercial Appeal, Feachem said that the fund had "plenty" of money to get started. Northeastern University law professor Brook Baker and Gorik Ooms, head of Medicins Sans Frontieres in Tanzania, last week in an e-mail demanded that Feachem step down from his prospective position unless he "distanced himself" from his comments. Baker said that Feachem, as the head of the "grotesquely underfunded" fund, should be "a drum major who is marching at the head of the pack and demanding the money" and should not be "making 'nice nice' with politicians in the hope that they will become more forthcoming in the future." Feachem, who could "as early as today" sign a $200,000 annual tax-free contract to become the fund's first director, responded to both Baker and Ooms by e-mail, saying that he "understood ... the activists' frustration" and acknowledging that the fund "needed much more money."
The number of contraceptive users in developing countries is expected to surge by more than a third within the next 13 years, reaching 764 million by 2015. Without more funding for contraceptives, many couples will be unable to plan how many children to have and when, or to protect themselves against HIV/AIDS or other sexually transmitted infections, according to a new report from the John Hopkins Bloomberg School of Public Health.