Is AIDS diverting attention from other problems?
This is an increasing refrain that I’ve heard lately. AIDS is sucking the expertise and funding out of other sectors, particularly in health but quite possibly also in other parts of the development agenda. This is the subject of a recent post by Jeremy Shiffman at the Center for Global Development. There are other health problems that kill as many if not more people in developing countries. Problems such as infant diarrhea get ignored or short shrift. He notes that:
Deaths due to HIV/AIDS, after all, comprised around 5 percent of total mortality in low and middle-income countries as of 2001 according to a recent study in the Lancet.
Meanwhile, AIDS is getting more and more of the health and overall foreign assistance budget. Shiffman notes that:
For instance, over the years 1998 to 2003, as funding for HIV/AIDS grew from 9 percent to 43 percent of overall U.S. foreign assistance for health and population.
In another piece, he gives an example of what this means in countries like Rwanda:
For instance, with an HIV prevalence of 3.1 %, Rwanda has been allocated US$ 187 million since 2003 exclusively for HIV/AIDS from three international programmes (the Global Fund, PEPFAR and the World Bank’s Multi-Country AIDS Programme), compared to only US$ 37 million annually in government expenediture on health.
Marilyn Waite over at the Princeton AIDS blog has raised this point as well and suggests an even darker potential consequence, a country that seeks to boost its AIDS prevalence to get extra cash.
I want to bring up a new EXTREMELY DISTURBING issue regarding HIV/AIDS: it has become the new “sexy” topic in the development community. This translates to the following troublesome reasoning (no exaggeration): if we can increase the HIV/AIDS prevalence rate in Madagascar, we can get billons and billons of US dollars from all sorts of people and organizations, and we can better develop our country (or this country when the statement comes from the expats).
AIDS is drawing the health care talent and funds to the neglect of the broader health mission. Because there has been so little investment in health infrastructure, the long-term challenge of building governance capacity so that countries can take charge of their own health problems is going sadly neglected. Donors need to recognize this sooner rather than later.
Filed under: Politics and Policy
[…] Recently, I posted on rising concerns that AIDS is drawing attention from other health care issues. Fortunately, there appears to be some recognition that addressing HIV/AIDS alone may not only be problematic for this reason, it may be counterproductive since many of the other health problems can make HIV treatment programs less effective. Moreover, if broader issues of poverty and inequality remain unaddressed, people with vulnerable immune systems may lack the resources for good nutrition, clean water, and other basic necessities that are necessary for minimally good health. Fortunately, this message isn’t lost on policymakers. Mark Dybul, the Bush Administration’s Global AIDS Coordinator, in a recent teleconference before World AIDS days took pains to describe how the Bush Administration is seeking to “connect the dots” between AIDS and other development problems. […]
[…] Laurie Garrett in the cover story of the forthcoming Foreign Affairs talks about the issue of broader financing for health care systems. Africa’s needs are much larger than AIDS, and, as we blogged about, excessive focus on one disease may lead to under-financing of the rest of the health sector as the best talent all get drawn to work on ARV provision. Diseases and health conditions that enjoy a temporary spotlight in rich countries garner the most attention and money.This means that advocacy,the whims of foundations,and the particular concerns of wealthy individuals and governments drive practically the entire global public health effort.Today the top three killers in most poor countries are maternal death around childbirth and pediatric respiratory and intestinal infections leading to death from pulmonary failure or uncontrolled diarrhea. […]
[…] There is an emerging debate in healthy advocacy about the wisdom of focusing funding so much on fighting a few diseases. Is AIDS money truly additional money that would not have gone for other purposes or is AIDS taking money out of child survival, maternal health and other worthy areas of expenditure? (Jeremy Shiffman of the Center for Global Development and Laurie Garrett have both made this argument in recent months as we blogged about here, here). […]