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Ratio Blog: Doing the Numbers on AIDS Funding

Tuesday, 04 May 2010

In an ideal world, anyone sick should be able to get treatment and medication. In the real world, most states recognise that the government can and should play some role in the provision of a healthcare system. But how much of a role exactly, and how to finance it, how to work with the private sector, and how much of a responsibility (also for financing) to hand over to individuals is infinitely complex. It’s given not just Mr Barrack Obama a (presumably affordably medicated) headache over the past months.

Healthcare is also an issue that occupies the aid industry, and I spotted some troubling headlines: ‘Cutting AIDS funds risks death sentence’. The article cited a report titled ‘Rationing Funds, Risking Lives’ by the International Treatment Preparedness Coalition (ITPC) who claim that ‘patients are being turned away from treatment programmes and AIDS drug stocks are running out because of government budget cuts and flatlined funding from major donors.’ ITPC caution: "Governments, North and South, cannot afford to put the clock back and return us to the days when HIV was a death sentence. … If this trend continues, the result will be suffering and death for millions of people around the world currently living with HIV and the millions more who will be newly infected this year and the years to come."

Alarming. Nobody wants millions more condemned to death. However, what grabbed my attention in this article was not the apocalyptic AIDS death scenario, but that the explanation for this impending crisis wasn’t entirely clear to me: The article stated that the report was concerned about a decline in funding for AIDS drug provision for developing countries. What I could piece together from the article was that the Global Fund (GF), an international fund set up to raise money for AIDS, tuberculosis and malaria, was looking for USD20bn over the next three years, and that donors had warned that USD13bn would be difficult to provide. Also, that the GF had been conceived with funding of USD10bn a year, but currently had to work with USD3bn a year. If I do the maths based on those figures, under current funding levels, the GF would have USD9bn at its disposal for three years, so USD13bn would, in fact, not be a reduction, but an increase at a higher rate than average population growth – even if not hitting the GF’s preferred sum of USD20bn.

What the article didn’t tell me: Why were people then being turned away when they came for ARVs? Because there are more infected people? Is anything being done about preventing new infections? Isn’t part of the GF money spent on this? Or is it that more people know about being eligible for ARVs? There is a mention that the World Health Organisation recommends starting ARVs earlier – is that responsible for the presumed increase in demand?

Two points in particular struck me:

That it’s complicated, and not in a Facebook relationship status kinda way. Managing public healthcare is complex, supporting the healthcare sector through aid is complex. It is human to react with anger and sadness that people should die of illnesses that could be treated with a medication that can be bought for shillings. This is the argument that pulls on your heart and, more importantly, purse strings. But unless you deal with sufferers on an individual level, it’s never that easy. The ITPC report cites Kenya as one of the countries analysed. Kenya – like Uganda – ran into problems with the GF because the Kenyan authorities could not account for the funds given by the GF. So funding cuts here were probably due to the fact that the GF funds never reached those in need of ARVs in the first place. Uganda’s fantastic theft of GF money by the political elite and their backers is well documented. And that ties in with a more fundamental issue: would Kenya or Uganda really need aid funding, and the increase in GF funding that the ITPC lobbies for, if only they could get a grip on those money suckers like Goldenberg, maize, FPE and the like that divert public funds?

And there’s another interesting angle to this: Several development writers have pointed out that these special-purpose vehicles like the GF and also single-issue focused campaigns by NGOs can actually be detrimental to public health: AIDS lobbying often attracts more funding because of its emotional appeal, but in terms of overall needs, money for other illnesses may actually be more important. And these single-issue initiatives also do nothing to strengthen the overall public health system, but are often run in parallel structures that, if they offer better terms than the public health sector, draw qualified employees away from the government health system – an internal brain drain.

So: it’s complicated indeed. And that’s my second point: I distrust ‘development journalism’ because it isolates issues from their wider context: The article I read created an emotional appeal – but it’s not an NGO fundraising piece, but was written for a major news outlet that typically focuses on economic and business news.

Republished with kind permission from the Star.

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