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."
Resource allocation and health financing
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.
The leaders of the world's major industrial nations have said they would provide about $6 billion in foreign aid -- some of which would be used to fight the spread of HIV/AIDS -- to African countries that meet specific reform criteria, the Los Angeles Times reports. The plan, called the New Partnership for Africa's Development, was proposed at the G8 summit meeting near Calgary, Canada, by leaders from South Africa, Nigeria, Algeria and Senegal and was accepted by the G8 members, including the leaders of Britain, Canada, France, Germany, Italy, Japan, Russia and the United States. The plan requires African countries that wish to receive aid to "demonstrate they are pursuing free market reforms and democracy." Starting in the next four years, the G8 will offer countries that meet such criteria "help in the battle against the AIDS epidemic," in addition to assistance to end civil wars and improve market access for African goods.
WHO, 2002. Anthony D. Harries, Technical Adviser, National Tuberculosis Control Programme, Ministry of Health, Lilongwe, Malawi; Nicola J. Hargreaves, Coordinator, PROTEST Project, National Tuberculosis Control Programme, Lilongwe, Malawi and Lecturer in Tropical Medicine, Liverpool School of Tropical Medicine, Liverpool, England; Rehab Chimzizi, Coordinator, PROTEST Project, National Tuberculosis Control Programme, Lilongwe, Malawi; and Felix M. Salaniponi, Programme Manager, National Tuberculosis Control Programme, Ministry of Health, Lilongwe, Malawi.
A decline in TB is unlikely to occur unless strategies to combat HIV and TB simultaneously are implemented. HIV/AIDS and TB are two of the world?s major pandemics, the brunt of which falls on sub-Saharan Africa. Efforts aimed at controlling HIV/AIDS have largely focused on prevention, little attention having been paid to care. Work on TB control has concentrated on case detection and treatment. HIV infection has complicated the control of tuberculosis. There is unlikely to be a decline in the number of cases of TB unless additional strategies are developed to control both this disease and HIV simultaneously. Such strategies would include active case-finding in situations where TB transmission is high, the provision of a package of care for HIV-related illness, and the application of highly active antiretroviral therapy. The latter is likely to have the greatest impact, but for this therapy to become more accessible in Africa the drugs would have to be made available through international support and a programme structure would have to be developed for its administration. TB programmes could contribute towards the development and implementation of a comprehensive HIV/AIDS management strategy complementing the preventive work already being undertaken by AIDS control programmes. Correspondence should be addressed to Anthony D. Harries, c/o British High Commission, PO Box 30042, Lilongwe 3, Malawi.
How has AIDS affected development in the world's poorest regions? How can we reduce the devastation caused by the epidemic? The Zimbabwe-based NGO, SAfAIDS, examined the impact of HIV in Southern Africa where the disease affects a quarter of the adult population. The AIDS epidemic is assuming crisis proportions in the region and is reversing advances made against poverty and under-development. As the cost of care for people with AIDS escalates, donors find it difficult to provide adequate funding for support and care efforts. Communities have a critical role to play in looking after the sick.
An HIV/AIDS vaccine offers the best hope of controlling the pandemic in Africa, leading scientists have said at the opening of a two-day meeting of the African AIDS Vaccine Programme (AAVP) in Cape Town, South Africa. HIV/AIDS was a "nightmare" for Africa but the development of a vaccine for the continent was a "dream worth dreaming", Jose Esparaza, coordinator of the World Health Organisation (WHO)/UNAIDS HIV Vaccine Initiative, told about 200 delegates attending the meeting. Two-thirds of all people living with HIV are in Africa, yet African vaccine research received only 1.6 percent of the US $2.5 billion spent on HIV research annually, he said.
The HIV/AIDS pandemic has spurred significant advances in reproductive health policies across Africa, however, governments do not allocate sufficient legal and financial resources to ensure that the policies are effective, according to a report launched by advocates from seven African countries: Ethiopia, Ghana, Kenya, Nigeria, Tanzania, South Africa, and Zimbabwe, and the U.S.-based Center for Reproductive Law and Policy (CRLP). The report is based on two years of collaborative research and analysis of laws and policies related to women's reproductive lives.
Somnath Chatterji, Bedirhan L Ustün, Ritu Sadana, Joshua A Salomon, Colin D Mathers, Christopher JL Murray, Global Programme on Evidence for Health, Policy Discussion Paper No. 45, World Health Organization, 2002. Health is an attribute of individuals, which is best operationalized as a multidimensional set of domains; To obtain meaningful information on health and health interventions, the boundaries of the notion of health must be determined by identifying a set of core domains of health. The threshold for loss of health in any given domain reflects norms or standards. Health state description and measurement must be distinguished from (1) subjective evaluations of health; (2) consequences of health states; and (3) environmental impacts on health and other proximate or distal determinants of health.
In keeping with the above conclusions, WHO thus recommends that for measurement purposes, health be understood as a multidimensional phenomenon that can be narrowed to a core set of health domains, each characterized by a single cardinal scale of capacity (measured or latent, and including currently available personal aids). The overall level of health associated with the set of abilities (or capacities) on the core health domains may be characterized by a cardinal scale of health state valuations. These valuations quantify level of health, not quality of life, well-being or utility.
Tim France, Gorik Ooms and Bernard Rivers (21 April 2002).
Nearly one year ago, the majority of the world's nations resolved at `UNGASS', a major UN conference on AIDS, to increase annual expenditure on the AIDS epidemic to $7-10 billion by 2005, with much of this money to be raised and disbursed by a new global fund. When the fund was eventually set up, its mandate was extended, and it was named the Global Fund to Fight AIDS, Tuberculosis and Malaria. AIDS, an unprecedented and accelerating emergency, is already having a devastating impact in Africa, with similar impacts unfolding on other continents. Every day, 8,000 die, and 13,000 more become infected. Experts agree that reasonable expenditures on prevention and treatment of AIDS, tuberculosis and malaria can be of dramatic benefit not only to human health, but also to economic development. Thus far, efforts have been made to raise the money needed by the Global Fund through ad hoc voluntary donations. These efforts have failed. Governments have pledged a mere $1.8 billion. Contributions from the private sector have been even more disappointing, with not a single meaningful pledge since the Bill & Melinda Gates Foundation offered $100 million ten months ago. It's time for a new approach.
Adam Oliver, LSE Health and Social Care, London School of Economics and Political Science ISBN [07530 1932 9] Discussion Paper 2, February 2002. Health care resources are scarce, and there are competing moral claims on how the available resources ought to be distributed. Many of the claims focus upon the distribution of health outcomes, and thus assume that different health outcomes arising from disparate health care programmes can in some sense be compared. If cardinal values for health states could be elicited, they would help us to distribute resources more accurately towards our chosen health care objectives (whatever they might be).