Michael J. Carter
SEATTLE, Washington, Aug 20 2008 (IPS) – At the end of last month, U.S. President George W. Bush signed a global health package that effectively tripled U.S. spending over the next five years to fight HIV/AIDS, malaria and tuberculosis in poor countries, to 48 billion dollars.
The package, known as the President s Emergency Plan for AIDS Relief (PEPFAR), was originally signed in 2003 and helped to buy large amounts of antiretroviral drugs to support medical care for more than 1.4 million people.
Increasingly, experts say, this kind of disease-focused model is defining the global health agenda.
Bush s reauthorisation of the plan this year aims to provide essential treatment to three million people by 2015. The United States isn t alone in focusing on AIDS. The Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria currently funds treatment for an estimated 1.4 million people, and the U.N. General Assembly and the Group of Eight industrialised nations support universal access to AIDS treatment.
The priority of fighting AIDS and other diseases is also one of the U.N. s Millennium Development Goals.
However, despite the massive amounts of money driving current efforts, the global health agenda is still in its infancy. Finding the best way to fight poverty and diseases abroad is still a matter of debate.
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Ruth White, an associate professor of sociology and anthropology at Seattle University who runs an aid organisation, says that a narrow focus on disease has drawbacks.
It s dangerous because it sucks up resources that could be spread around to have more general health impact instead of focusing efforts on people with one disease and ignoring people with others, she said.
Basic nutrition can help provide immunity support that can prevent or ameliorate malaria, AIDS and tuberculosis. When people have poor nutrition and are generally unhealthy they are more susceptible to these illnesses, White said.
White is hardly the only voice in Seattle speaking on global health. The city is host to undoubtedly the largest private powerbroker in prioritising global health issues in the country, the Bill and Melinda Gates Foundation. The behemoth, which employs more than 620 people, has about 65 billion dollars in assets and has supplied 16.5 billion dollars in grants since its inception in 2000.
Bill Gates has stated that HIV/AIDS is the top priority of his foundation, which has provided large grants towards fighting the disease in Sub-Sahara Africa.
However, according to the Los Angeles Times, the strict disease focus carried out by the Gates foundation has created some problematic results.
The Times found that the high level of grants provided by the Gates Foundation to fight high-profile disease, notably HIV/AIDS, has led to recipients increasing their demands for specially trained clinicians, resulting in a diverting of staff from basic medical care. Such shortages have led to increased neglect of common medical conditions.
According to the article, such focus has shortchanged basic needs like nutrition and transportation. In many instances, patients actually vomit up their free AIDS medication due to malnutrition, and others lack money to travel to clinics providing such life-saving services.
An IPS request for an interview with the Gates Foundation was denied.
Part of the dilemma may be a lack of understanding of local community needs, according to Loyce Mbewa-Ong udi, president of the Rabuor Village Project (RBV), a Seattle-based aid organisation that works on a super-local level in the rural Kenyan village of its name.
You can t go in with a pre-designed programme, and that needs to improve big time, she said. Communities know what they want and what they need. They understand their priorities.
Mbewa-Ong udi believes that a pitfall for some organisations comes from being out of touch with a majority of African communities, which are rural. As many aid organisations operate in large urban centres, they fail to see challenges faced in the countryside, and tend to undervalue local knowledge.
The RBV s approach has been to work in partnership with community members focusing on disseminating health and development knowledge by forming a village committee, and by training 50 men and women in basic health-care knowledge.
We identify what is going on and address what they d like to improve, Mbewa-Ong udi said.
RBV has also worked on solving more than just the AIDS crisis. The organisation is concentrating on developing local industries, including brick making, sunflower oil production and dairy goats, in addition to a micro-lending programme. RBV has also drilled a well and is looking to develop a large-scale water distribution system for households and agriculture.
White agrees with the approach and thinks it needs to be more prevalent.
There is not enough humility in the willingness to be equal partners in our efforts on the ground, she said. We may have technical knowledge, but they (locals) have the cultural and practical knowledge we need to be most effective and efficient.
However, the emphasis on diseases like AIDS remains a difficult challenge to overcome.
AIDS and TB are diseases that scare the hell out of people in developed nations because they are global and spreading, said Charles Piller, an investigative reporter with the Los Angeles Times who has extensively covered the Gates Foundation.
And with good reason. According to the World Health Organization an estimated 33.2 million people worldwide were infected with HIV/AIDS as of 2007, 22.5 million of whom live in Sub-Saharan Africa. A total of 2.1 million died from the disease last year. But other pressing concerns exist.
Clean water would be a much better way to improve public health in places like Africa in the long run, but it s very costly infrastructure, Piller said.
Currently, one-fifth of the world s population does not have access to clean drinking water and two-fifths don t have access to basic sanitation, resulting in illness and the deaths of more than five million people each year, according to Water First International, a Seattle-based aid organisation that focuses on hygiene and water supplies in the developing world.
This issue of focusing on malaria, AIDS and tuberculosis is important, but the donor community must consider how funding is allocated, said Kirk Anderson of Water First International.
All you have to do is look at the funding towards those things and funding on water, he said. Are we going to allocate 100 times the amount of money towards malaria than water?
The message is out there and there s a caring community that wants to take action. But we as individuals need to be better educated on how to be good philanthropists and collect good information, he said.
