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Africa: Obstacles to AIDS Global Fund
AFRICA ACTION
Africa Policy E-Journal
January 7, 2003 (030107)
Africa: Obstacles to AIDS Global Fund
(Reposted from sources cited below)
This posting contains several recent documents and links to online
resources concerning the Global Fund to Fight HIV/AIDS, TB, and
Malaria. The obstacles to the Fund include not only problems of
implementation and refusal of the U.S. and other rich countries to
provide adequate funding, but also policies in other sectors which
undermine the Fund's potential. Particularly striking is the
commentary below by Gorik Ooms on IMF/World Bank-imposed limits on
health budgets.
See also the posting from last month on the Bush administration's
most recent actions to block new trade policies on generic
medicines (
http://www.africafocus.org/docs02/acc0212.php>). Recent
editorials in The New York Times (January 6, 2003) and the Guardian
(December 30, 2002) strongly condemned the Bush policy. As the
Times noted, "the lone holdout, the United States, blocked the
deal. Washington's position is wrong and so obviously influenced by
the drug companies that America is alienating nations whose support
it needs on other trade issues."
Editor's note: With the new year we are making some adjustments in
format and also adopting a new name for our electronic distribution
list: Africa Policy E-Journal. In addition to being shorter, the
new name better reflects our concept of this service as a
publication providing our readers with a careful selection of
current policy resources. As in the past, we will continue to rely
heavily on those of you who send us relevant documents. For our
selection guidelines and other background information, see
http://www.africaaction.org/e-journal.htm - William Minter, Senior Research Fellow
+++++++++++++++++end summary/introduction+++++++++++++++++++++++
NEW ONLINE RESOURCES
(1) From Africa Action
Two new 2-page fliers for use in campaign organizing (in PDF
format). Suitable for printing out and copying on front-and-back of
one 8 1/2" sheet.
The Global Fund to Fight HIV/AIDS
http://www.africaaction.org/action/globalfund2003.pdf
AIDS in Africa
http://www.africaaction.org/action/aids2003.pdf
(2) Global Fund Observer
Two new on-line resources on the Global Fund, a discussion forum
and a newletter, were launched in December by the Global Fund
Observer (GFO), a service of Aidspan (http://www.aidspan.org).
GFO has an Editorial Advisory Board initially comprising ICASO,
GNP+ and REDLA+ (the three organizations designated as
Communications Focal Points within the Global Fund's NGO board
delegations); plus Health & Development Networks (founder of the
Break-The-Silence listserv, which originally covered the Global
Fund); and the International HIV/AIDS Alliance. GFO is currently
provided in English only. It is hoped later to provide it in
additional languages.
To join the GFO DISCUSSION FORUM, send an email to
join-gfo-forum@aidspan.org Subject line and text can be left blank.
(You will receive consolidated postings up to once per day, and
will automatically receive the Newsletter.)
If you don't want to receive the GFO DISCUSSION FORUM, but do want
to receive the GFO NEWSLETTER (about twice a month), send an email
to receive-gfo-newsletter@aidspan.org Subject line and text can
be left blank.
For more information, go to http://www.aidspan.org/gfo
How IMF Policies Block the Global Fund.
Gorik Ooms, Mozambique, Dec. 16, 2002
Email: gorik@hotmail.com
[Copyright AF-AIDS 2002 http://archives.healthdev.net/af-aids
Email: af-aids@healthdev.net]
"It is very genocidal for one part of the world to have the cure
for the AIDS disease while millions of people in another part are
dying from the same. The developed world is challenged to make
antiretroviral drugs available", declared Uganda's President
Museveni (New Vision, 11 Dec 02).
But only weeks before this declaration, Uganda's Ministry of
Finance made it virtually impossible for the Ministry of Health to
accept a grant from the Global Fund to fight AIDS, TB and Malaria,
a grant that could help to make antiretroviral drugs available.
"Any new donor monies absorbed into a government sector must be
accompanied by a similar reduction within the sector in order to
keep the expenditure limit", said Francis Tumuheirwe, director of
budget in Uganda's ministry of finance (The Lancet, 7 Dec 02). In
other words, if Uganda gets the $52 million it asked from the
Global Fund, it will simply reduce its own contribution to the
health budget, which will remain the same, with or without Global
Fund monies. Obviously, the Global Fund will never accept this,
since it can only give money for additional activities, not to
replace Uganda's contribution to a fixed health budget. The
solution proposed by Uganda's Ministry of Finance - to cut into
other parts of the health budget to "make way" for the
interventions approved by the Global Fund - is clearly not
acceptable.
This means that President Museveni can call for as much
international financial support for antiretroviral therapy as he
wants: as long as his own Ministry of Finance is firmly committed
to a public health budget that doesn't exceed $9 per person per
year, "no matter how much donors are willing to provide", the
inaccessibility of antiretroviral therapy - described as a
'genocide' by the President himself - will continue. It makes you
wonder who the real decision-maker in Uganda is; the President or
the Minister of Finance? Or is it someone working for the IMF?
Like Uganda, Mozambique has a public health budget of $9 per person
per year. Like Uganda, Mozambique wants to provide antiretroviral
therapy to the people who need it. Like Uganda, Mozambique is
counting very much on the Global Fund to keep its people alive.
Mozambique and Uganda have poor public health budgets because they
are poor countries. But also because they have accepted - or, at
least in the case of Mozambique, was obliged - to adopt the IMF and
World Bank economic and development doctrine, in the form of a
Structural Adjustment Program (or SAP.) This doctrine is quite
simple: it is based on the assumption that real development and
economic growth can only occur when governments limit public
spending to a percentage of their gross domestic product. In very
poor countries, this has resulted in ridiculously low public health
and education budgets (less than 50% of children of school age
attend school in Mozambique, less than 50% of the population has
access to poor public health services.)
But this would be just a temporary problem, assured the IMF and the
World Bank. Soon there will be economic growth, they promised,
economic growth will increase state budgets for public social
services, and many people will become rich enough to buy private
social services. Very conveniently, this doctrine provided an
excellent excuse for reducing international aid. It was not only
permitted to give less, rich countries were actually doing poor
countries a favour by giving less (and thus stimulating their
economic growth.) In the '90s, international aid levels dropped
dramatically.
Fifteen years later, the 'temporary problem' has been solved for
less than 3% of Mozambicans. They can afford private schools and
private clinics. 47% have access to poor public services, badly
equipped and run by underpaid civil servants. The other 50% don't
send their children to school and don't go to health centers. IMF
and World Bank no longer promote SAPs, they invented a new game and
called it 'poverty reduction.' In theory, Poverty Reduction
Strategic Papers (or PRSPs) are meant to ensure that the benefits
of debt cancellation are invested directly in poverty reduction. In
reality, they just protect the core of the old SAPs, ensuring that
public spending remains capped. While HIV infects more and more
Africans, the IMF and the World Bank ensure that African countries
are not able to provide enough education to their children to
protect them against HIV, let alone provide lifesaving treatment.
When African leaders, gathered in Abuja in April 2001, promised to
substantially increase their public health budgets, I wondered if
they realized they were defying IMF and World Bank policies. I felt
relieved when I read the 'Declaration of Commitment on HIV/AIDS'
that came out of the UNGASS meeting in June 2001. The international
community was actually supporting increased public spending to
fight AIDS and other infectious diseases! The fulfilment of this
commitment would require improved health and education services!
Then came the report of the WHO Commission on Macroeconomics and
Health; an implicit but clear condemnation of IMF and World Bank
policies, arguing that increased spending on health would not harm
but rather stimulate economic growth. When the Global Fund
announced its first approved proposals in April 2002, I was
saddened that the Mozambican proposal was not included, but
satisfied to see that similarly poor countries would receive
substantial amounts, amounts that would obviously make their health
budgets break through the ceilings foreseen in their respective
PRSPs.
I should have been completely convinced when the World Bank
Multi-sectoral AIDS Plan (MAP) team visited Mozambique for the
third or the fourth time in October 2002, announcing that the MAP
would be funded with a grant, not a loan, and that the World Bank
had secured $1 billion for several MAPs. Surely, if this $1 billion
went to the countries that need it most, it would lift their
budgets well over the PRSP ceilings. Surely, if the World Bank
supports such a strategy, the IMF would not challenge it. The door
was open for a rights-based approach to health care and education.
Suspicious as I am, I questioned the World Bank MAP team about
this. Did their macroeconomists agree with this? Because if not,
that $1 billion was useless, it would only replace national
contributions or contributions from other donors, but not increase
the budgets. The answers were vague and evasive. One said that PRSP
budgets were targets, not ceilings. The other admitted that there
might be a problem.
I guess we have the real answer now. No matter how much donors are
willing to provide, no matter how much the Global Fund is willing
to provide, Uganda will not increase its health budget and
therefore it will not provide antiretroviral therapy (unless
President Museveni has the courage to intervene directly.) The
arguments used by Uganda's Ministry of Finance are pure IMF
doctrine arguments: increasing the health budget with the Global
Fund grant would destabilize Uganda's economy, the way to increase
expenditure on health is through sustained economic growth, Uganda
must reduce its dependence on donors. This is probably why the
chairwoman of the parliamentary committee on social services
wondered whether the ministry of finance or the IMF was the
architect of the low ceiling.
Does it really matter? Does it really matter if the decision to
sacrifice thousands of people living with AIDS on the altar of a
development doctrine that has proven to be ineffective came from an
office in Washington or from an office in Kampala? Does it really
matter if the South African form of structural adjustment - GEAR -
was voluntarily adopted by President Mbeki, strongly encouraged by
the IMF and the World Bank or even imposed by them? It doesn't make
any difference to South Africans, many of whom died of cholera in
October 2000 because they suddenly had to pay for water and
couldn't; they don't get antiretroviral treatment when they need it
because of 'financial discipline' in a vain pursuit of economic
growth. Does it really matter if NEPAD - the New Partnership for
African Development that hardly mentions AIDS at all, let alone
AIDS treatment - is the fruit of African Renaissance or the result
of 20 years of indoctrination by Washington-based macroeconomists?
The result is the same: poor health care and poor education for
poor people.
I believe the Global Fund has met its worst enemy in Kampala.
Raising the funds needed to fight AIDS, TB and Malaria remains
important, but it is not enough. It must also promote a
rights-based approach to social services, one that legitimises
public budgets that are in accordance with real needs, not limited
to a percentage of gross domestic product. Otherwise the Global
Fund will end up channelling funds to relatively well-performing
countries only, while refusing agreements with the countries that
really need it, because their budgets are capped and Global Fund
money would only replace national contributions or contributions
from other donors and would not create additional services.
Both objectives, to raise more money and to create a climate that
allows spending it where it is needed most, go hand in hand. Both
require a new development vision. Both require a genuine
understanding that only a healthy and well-educated population can
create real and sustainable economic growth. Both require a genuine
understanding that access to treatment is a human right!
posting by Brook K. Baker, B.Baker@neu.edu, Health GAP, USA
2 Jan 2003
Reproduced from the Global Fund Observer Discussion Forum
(http://www.aidspan.org/gfo), a service of Aidspan.
[The following post is in response to a 16 December 2002 posting
(above) by Gorik Ooms on the AF-AIDS listserv. - GFO Discussion
Forum Moderator]
Gorik Ooms wrote about an important issue when he discussed the
indirect and behind-closed-door impact of IMF/WB structural
adjustment programs and poverty reduction strategy plan
requirements on health care budgets. Specifically, he recited
instances where finance ministers stated that Global Fund moneys
were going to replace, rather than supplement, other public health
expenditures, presumably because of neo-liberal caps on public
spending on health and/or because of conditions on use of foreign
funds for recurrent public health expenditures. Although Gorik
reported on Uganda, the same problem occurred in Tanzania.
It would be very helpful if the Global Fund would issue a formal
statement on "additionality" that expressly challenges these IMF/WB
ceilings. In order to develop medical capacity for VCT and
treatment, substantially more funds must be spent on medical
training, clinic construction, equipment purchases, expansion of
drug distribution systems, and human expertise. In addition,
medical salaries must be raised in the public sector to reduce the
brain drain of trained personnel (which should be the subject of
another Global Fund policy announcement along with a condemnation
of rich country recruiting of medical personnel). And finally, much
more money must be spent over a long period of time on drug
purchases.
Certainly, the Global Fund has a very sound policy on
additionality. And it should be commended for standing up to Uganda
at a time it was being criticized for not getting more Round 1
money out the door quicker. What it hasn't done, however, is issue
a condemnation of IMF/WB policies that place spending ceilings that
then work their way down to finance ministers and CCM's. On the one
hand, the World Bank is now giving grants for AIDS infrastructure
projects, but its SAP's (and the IMF's) still inhibit the "vision"
of neo-liberal bureaucrats in developing countries. It would be
great if the Fund actually "spoke out" against some of the
impediment to treatment that are structural as well as fiscal. It
should adopt such a statement at its next meeting the end of this
month.
Is there any way to get this issue on the Global Fund agenda?
Should people on this listserve draft a letter to the Global Fund?
First Year Update -
the Global Fund to Fight Aids, TB and Malaria (GFATM),
1st January 2003
Southern NGO Board Team:
Milly Katana, Board Member and Rev. Fidon Mwombeki, Alternate Board
Member
excerpted from posting Jan 4, 2003 on
breaking-the-silence-subsribe@yahoogroups.com
See
http://groups.yahoo.com/group/breaking-the-silence for full
posting
As we come to the end of the first year of operation of the GFATM,
we wouldlike to give you a brief update on the current status of
affairs.
Today, the GFATM has been able to attract $2.1B for a period of 5
years. This is a major breakthrough in resource mobilization for a
global cause of this nature. The resources so far realized are
indeed below the estimated annual $10B that was anticipated when
the Secretary General of the United Nations, Mr Kofi Annan called
for the International Community to establish a Global Fund to
respond to AIDS in April 2001.
In the past year, the GFATM has approved 54 proposals from the
first round of proposals for a period of 2 years. The total
investment in these projects is approximately $620M. A second
invitation of proposals was issued in July 2002 and a total number
of 150 proposals worth approximately $1.1B have been received. The
Board will meet at end of January 2003 to make decisions on these
proposals. We have received information that NGOs proposals had
major difficulties in getting endorsement especially for proposals
that were targeting access to HIV/AIDS treatment.
The GFATM Secretariat and the Chairperson have been able to enter
into four grant agreements. By end of January 2003, which will be
the first Anniversary of the Fund, a total of 20 grant agreements
will be made from the first round of proposals. It has taken long,
from April 2002 when the board approved the proposals from eth
first round, due to logistical arrangements that had to be
negotiated by the Secretariat and the recipient projects. It has
been a tiring process characterized by a lot of innovation and
often disagreements between in-country parties. Such disagreements,
in a few cases have led to slowed-down processes until the
partnerships have been streamlined and strengthened. With the
enormous wealth of experience that has been accumulated from
managing the first round of proposals in the first year, it is
anticipated that the second round agreements and those remaining
from the first round will be reached relatively faster. Indeed each
proposal is handled on a case-by-case basis, but experience is
available to draw lessons from.
There are still approved NGO proposals from the first round for
which grant agreements cannot be made yet due to lack of
endorsement by country coordinating mechanisms (CCMs), as required
by the GFATM. The NGO board members, like all the other board
members, are greatly concerned about this delay, which is
frustrating the efforts of the civil society community to
effectively participate in grassroots response to HIV/AIDS, TB and
Malaria. ...
During the first year, the Latin American Network of People Living
with HIV/AIDS (REDLA+) kindly offered to serve as the Communication
Focal Point for the Southern NGO Board team. REDLA has done a
commendable job of backstopping the board member and the alternate
on all matters related to interfacing with the GFATM secretariat
and the communities. Particular recognition is made of LACCASO -
the Latin American Network who have facilitated the interaction
between eth board team and the Spanish-speaking Communities.
We request you to consider the following actions during 2003:
i. Continue putting up the case and remind the world of the
business sense of investing in alleviating the impact of HIV/AIDS,
TB and malaria. Particular efforts should be made to reach
governments in the South and the private sector as effective
stakeholders' to invest in the GFATM.
ii. Remind parties who have pledged resources to the GFATM to make
good their pledges on time so as to channel resources to the second
round of proposals which will be approved in January 2003.
iii. Effective participation at the country level processes to
reflect the private-public partnership philosophy of the GFATM at
the global level
iv. Supporting the effective use of the resources channeled by the
GF to scale up intervention at country level.
We thank all colleagues who have supported us during the first year
and wish you all a fruitful 2003.
+++++++++++++++++++++Document Profile+++++++++++++++++++++
Date distributed (ymd): 030106
Region: Continent-Wide
Issue Areas: +health+ +economy/development+
The Africa Policy E-Journal is a free information service
provided by Africa Action, including both original
commentary and reposted documents. Africa Action provides this
information and analysis in order to promote U.S. and
international policies toward Africa that advance economic,
political and social justice and the full spectrum of
human rights.
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