One of the most controversial subjects in global health is the topic of user fees for health services and commodities. Ever since Nancy Birdsall, David de Ferranti and John Akin declined to rule out user fees as a useful source of health financing way back in 1987, the World Bank has been pilloried for "advocating user fees" in the health sector, which the Bank has never done.
CGD Policy Blogs
On Thursday, Jeremy Shiffman joined Maurice Middleberg (Global Health Council), Anne Tinker (Saving Newborn Lives), and Rachel Nugent (Center for Global Development) at a standing-room only event at the Center to discuss a framework explaining why some health initiatives attract global political priority and others are unable to do so.
CGD held a fascinating lunchtime discussion earlier this week with "scientist morphed into journalist" Helen Epstein, about her new book, The Invisible Cure: Africa, the West, and the Fight Against AIDS.
Technical consensus plays a critical role in the achievement of global health objectives; for example, it is often hailed as the key driver of the TB community's success with DOTS by facilitiating financial and political support. The much more fragmented malaria world, by contrast, competes internally for money and attention across an array of treatment and prevention strategies rather than presenting a unified front, while epidemiologists can't even agree on the burden of disease.
HPV vaccines are the first of several new preventive technologies aimed at adolescent girls - an entirely new market that poses a series of unique policy and finance challenges to developing country governments and donors. As a result, decisions about HPV introduction have been so closely linked to the eventual availability of AIDS vaccines and microbicides that the conversation has largely shifted away from talk of cost-effectiveness and public health benefits (e.g.
Mozambique's Minister of Health Dr. Paulo Ivo Garrido is worried about the shortage of doctors in his country. He recently declared that "The main problem in the Ministry of Health is the shortage of [medical] staff. We need specialized doctors, not just general practitioners." He has a plan to encourage the migration of 8,000 doctors from other African countries into Mozambique over the next decade.
* This post is co-authored by Caesar Cheelo, Lecturer in the Economics Department at the University of Zambia and Principal Investigator for the HIV/AIDS Monitor Project.
Last week Laura Bush and daughter Jenna Bush stopped in Lusaka as part of their whirlwind four nation tour through Africa to highlight PEPFAR's programs and its achievements in Senegal, Mozambique, Zambia and Mali. The visit of a First Lady of the US to a country in the developing world, cleverly coined as FLOTUS in a related SAIS blog, does two things: 1) it throws the country in to a frantic and often wasteful scramble - whitewashing walls, scrubbing floors and children, rehearsing shows and painting banners - to present the shiniest version of a program on the day of the visit; and 2) it allows the US to loudly herald its success and it should, especially when you consider what its HIV/AIDS program has done in Zambia, a country heavily ravaged by the HIV/AIDS epidemic:About 16 percent of adults are HIV-positive in Zambia, a politically stable, copper-rich but largely impoverished southern African country of 11.5 million. Zambia has been a major recipient of American HIV/AIDS funding. The country received US$149 million (â‚¬109 million) in funding through the U.S. President's Emergency Fund for AIDS Relief (PEPFAR) in fiscal 2006 and will receive almost US$200 million (â‚¬149 million) in fiscal 2007. Funding is expected to rise in 2008. While it has struggled to reduce new HIV infections, Zambia's government has put more than 90,000 people on anti-retroviral drugs over the last few years with help from the United States and other partners. The government officially made anti-retroviral drugs free in 2005, though many rural Zambians still find it hard to get care.
PEPFAR and other donors are pouring resources in to Zambia with the clear purpose of supporting the national fight against HIV and this is undoubtedly a good thing. But if those dollars have to keep flowing we need to show what is and what is not being achieved with the money, how and why. CGD's HIV/AIDS Monitor is working with research partners in Africa to examine issues that are central to the global aid effectiveness agenda and some themes that are more specific to HIV/AIDS responses supported by donors and their programs in Africa. Given that data collection for Theme 1 on "Tracking the Funding" is near completion, we invited our country-based research partners to informally share what they have been learning about PEPFAR funding and programs in Zambia in the last 6 months. Their observations point to the success (summarized below) that PEPFAR has had in mobilizing external and domestic resources for HIV/AIDS, in rapidly scaling up treatment and in catalyzing the government to improve public health systems in particular. Early findings about the many challenges (and possible solutions) presented by PEPFAR funds in Zambia are also summarized below.
The Global Fund to Fight AIDS, Tuberculosis and Malaria has quickly become one of the world's largest funders of health programs. Just five years after its founding, it has approved proposals worth $6.8 billion for 448 programs in 136 countries, and disbursed over $3 billion.
The World Bank's long-awaited (at least by some) report on Public Policy and the Challenge of Chronic Non-communicable Diseases (chronic NCDs), was released last week at a well-attended book launch in Washington. By now, the most important fact about chronic NCDs - their ubiquity - will not surprise people. The report says bluntly: