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Africa: Health Updates
AfricaFocus Bulletin
Oct 15, 2007 (071015)
(Reposted from sources cited below)
Editor's Note
"Donors are expected to give the Global Fund [to Fight AIDS, TB,
and Malaria] at least $9.7 billion over the next three years, 57%
more than they gave over the past three years. The pledges made at
last week's Global Fund Replenishment Meeting in Berlin, chaired by
Kofi Annan, constituted the largest single financing exercise for
health that has ever taken place." - Global Fund Observer,
September 30, 2007
This good news comes from the authoritative Global Fund Observer
(http://www.aidspan.org/gfo), a newsletter that reaches 10,000
subscribers around the world and that recently shifted its
principal operations from New York to Nairobi. As newsletter editor
Bernard Rivers notes in the excerpts below, this means that
countries can now submit more ambitious proposals in the Fund's
next round, with confidence that all technically approved proposals
will be funded. For the first time, there can be a reasonable
expectation that "demand" for funding will be met.
However, "demand" in the form of well-crafted proposals ready for
funding still falls far short of the "need" of efforts to confront
these three diseases and the more general health crisis confronting
Africa and the world. This AfricaFocus Bulletin, in addition to
excerpts from the latest Global Fund Observer, has a roundup of
short excerpts and links to other recent reports related to
Africa's health.
For previous AfricaFocus Bulletins on health and related links, see
http://www.africafocus.org/healthexp.php
"No Easy Victories: African Liberation and American Activists over
a Half Century, 1950-2000" is now shipping, and still available for
ordering on-line at a 20% discount until the end of October. The
book will also be on sale at the African Studies Association 50th
anniversary meeting in New York City, October 18-21.
The editors, along with Africa World Press, the Association of
Concerned Africa Scholars, and AfricaFocus Bulletin invite New
York activists, attendees at the African Studies Association, and
others who are interested to join them for a celebration of the
book's release on October 20, 2007.
For more information: http://www.noeasyvictories.org
++++++++++++++++++++++end editor's note+++++++++++++++++++++++
Donor Governments Pledge Record Amounts to the Fund
Global Fund Observer (GFO)
Issue 77 - 30 September 2007. [excerpts]
http://www.aidspan.org/gfo
Donors are expected to give the Global Fund at least $9.7 billion
over the next three years, 57% more than they gave over the past
three years.
Twenty-six donor governments and one foundation, gathering at a
Replenishment Meeting in Berlin, Germany that ended on Friday
[Sept. 28], promised that during the years 2008-10 they would give
at least $6.3 billion to the Fund. With the Fund projecting that
other donors will give at least $3.4 billion, this leads to a total
of $9.7 billion.
The G8 has declared that in the year 2010, the Fund will need to
spend $6 billion, or possibly as much as $8 billion. (This compares
with its likely expenditure this year of $3.2 billion.) The Fund
says that its total needs over the three years 2008-10 will be
$12-18 billion. Over the past few months, donor government studied
the Fund's needs and effectiveness and deliberated over how much
each would commit to for the three years 2008-10. They then came to
Berlin last week to announce their decisions.
The Replenishment Meeting was chaired by Kofi Annan, former UN
Secretary General, and opened by German Chancellor Angela Merkel.
The pledges constitute the largest single financing exercise for
health that has ever taken place. The amounts pledged were as shown
in the table below [see http://www.aidspan.org/gfo for table]. Some
highlights of the pledges were as follows:
- The three countries that pledged (or are projected to pledge) the
most for 2008-10 were USA ($2,172 m.), France ($1,274 m.) and the
UK ($729 m.).
- The three countries that pledged the largest percentage of their
Gross National Income (GNI) were Norway (0.087%), Ireland (0.076%)
and Sweden (0.075%).
- The country that pledged the largest amount per capita was the
Netherlands. (Of course, as one participant humorously pointed out,
the Bill and Melinda Gates Foundation pledged considerably more per
capita.)
- The three developed countries that pledged the smallest
percentage of their GNI were Japan, Finland and Switzerland (0.004%
each).
- The three countries whose pledges grew the most since from their
pledges for the previous three years were Russia (increased 8.7
times), Saudi Arabia (3.6 times) and Spain (3.4 times).
+ + + + + + + + + + + + + + + + + +
Record Amount in New Grants Recommended for Approval in Round 7
Round 7 applicants to the Global Fund submitted fewer, but bigger
and better, proposals than applicants in all previous rounds.
The Global Fund's Technical Review Panel (TRP) has reviewed the 150
eligible Round 7 proposals that were submitted to the Fund, and has
recommended that the board approve 73 of them. The grants
recommended for approval will cost a total of $1,112 million over
two years. This is a record amount: in the six previous rounds, the
two-year value of approved grants ranged from $571 million to $968
million.
The percentage of proposals recommended for approval was also a
record - 49%, up from an average of 38% over the previous rounds.
The average two-year cost of the proposals recommended for approval
in Round 7 was $15 million - again a record, up from an average of
$10.3 million over the previous rounds.
On the other hand, the number of eligible proposals submitted in
Round 7, at 150, was the lowest ever.
The TRP's recommendations regarding Round 7 will be reviewed and
voted on by the Board of the Global Fund at its next meeting on
November 12-13. (In previous rounds, the board has always followed
the TRP's advice regarding which proposals to approve.) GFO does
not have information regarding which particular proposals have been
recommended for approval; the Fund will release that information
once the board has made its decisions in November.
+ + + + + + + + + + + + + + + + + + +
Analysis: New Donor Pledges Free Round 8 Applicants to Submit Bold
Proposals
The pledges made to the Fund for 2008-10 at last week's
Replenishment Meeting in Berlin, as reported above, were
impressively large. Global Fund staff said that over the last few
weeks, their private estimates of how much would be pledged
steadily climbed from $7 billion to $8 billion to $9 billion. The
final number was nearly $10 billion.
The total of $9.7 billion that the Fund published was made up of
two parts; $6.3 billion from countries that made commitments, and
$3.4 billion estimated by the Fund as likely to come from countries
that did not make commitments in Berlin. (Countries like the USA
and Japan have legislative procedures that make it impossible for
them to make financial commitments for future years.)
Both numbers are somewhat conservative. ... But even with no new
pledges at all for 2008-10, the $9.7 billion that the Fund
currently and conservatively expects to receive will be enough
money to enable the Fund to continue operations at least at its
current level for at least another three years.
This is very significant. In past years, many applicants to the
Fund worried that if they collectively submitted ambitious
proposals, the Fund might not have enough money to pay for them.
(Although in fact, no proposal that the TRP has recommended for
approval has ever gone unfunded.) But now, potential applicants for
Round 8 grants can confidently assume that even if Round 8 costs,
say, $1.5 billion (50% more than the largest-ever previous Round),
the Fund should be able to afford it. ...
If we regard the term "the need" as meaning how much money should
be spent on tackling the three pandemics if all people are to
receive the services they deserve, and the term "the demand" as
meaning the cost of actual projects that implementing countries
choose to put together to meet that need, it's fair to say that
although the Fund has certainly not raised enough money to meet the
"need", it has raised enough money to meet the "demand", unless
countries scale up the quality and size of their proposals. This
means that a major emphasis by the Fund and its allies over the
next few years must be raising "the demand" so that it starts to
approach "the need".
No country need now worry that if they work hard on writing a
high-quality Round 8 proposal that the TRP likes, the proposal will
go unfunded. But the time to start that work is now, not on March
1, when the formal call for proposals is issued. And indeed, many
countries are already hard at work designing their Round 8
proposals.
Ending Malaria Deaths in Africa: One of the world's worst killers
can be stopped soon if we make the investment
By Jeffrey D. Sachs
http://scientificamerican.com
For article go to: http://tinyurl.com/3ybcsq
September 18, 2007
For Africa, the epicenter of the world's malaria scourge, an
historic breakthrough in health and economic development is now
within reach. A combination of new technologies, new methods of
disease control and rising public awareness is poised to bring
malaria deaths down by 90 percent or more - if we will follow
through.
...
Efforts at malaria control in the 1950s and 1960s successfully used
the insecticide DDT and the medicine chloroquine to eliminate the
disease in many temperate and sub-tropical regions. But malaria
persisted in the tropics and especially in Africa, where the
intensity of transmission is the world's highest for ecological
reasons. Africa pays a fearful price for its ongoing malaria
burden, not only in more than one million deaths each year but also
in significantly reduced economic growth.
Until very recently, things were getting worse, not better. The
malaria parasite became widely resistant to chloroquine. Confusion
over DDT's prudent anti-malaria application (sprayed as a thin film
on the inside walls of houses) and its function as an insecticide
in open fields (which is environmentally unsafe and promotes
resistance) also curtailed use of the chemical.
... a confluence of advances gives a chance for a breakthrough in
the near term. The first is the invention of long-lasting
insecticide-treated bed nets, which protect sleeping individuals
against indoor nighttime biting. These nets last for five years,
unlike earlier nets that needed re-treatment every few months.
The second advance, which can save countless lives, is a new
generation of highly effective medicines based on artemisinin, an
herbal extract discovered by Chinese scientists. (Artemisinin
should be used only in combination with more traditional drugs,
however, to prevent the onset of resistance in parasites.)
The third advance is a new approach to disease control. In the
past, the U.S. government and other donor agencies favored the sale
of bed nets at a discount. The result was a very slow uptake of the
nets because most African rural households were too poor to buy
them. ...
The new strategy is based on mass free-distribution of nets, with
one net for every sleeping site. Everybody is protected from
illness and no group is left as a reservoir for transmission. The
artemisinin-based medicines should also be available for free
within the villages. This approach is highly affordable for donor
countries, because the cost of each net is only $5, and each
treatment dose of medicine about $1. Free distribution of nets is
already being applied successfully in several impoverished
countries.
Malaria control is the bargain of the planet. A study that my
colleagues and I undertook recently showed that comprehensive
coverage of nets and medicines, and indoor insecticide where
advisable, can be accomplished for $3 billion per year in the next
few years, which equals just $3 from each person in the high-income
world. Or to put it another way, the equivalent of two days of
Pentagon spending could save more than a million lives per year.
Reclaiming the Resources for Health
EQUINET Steering Committee
http://www.equinetafrica.org/newsletter
October 2007 - Newsletter 79 [excerpt from editorial]
Within Africa, millions of people experience deprivation of the
most basic rights to water, shelter and food, millions of children
have lost parents due to early adult death, a majority do not have
secure incomes and many live in situations of conflict and social
disruption. Also within the continent, health workers, teachers and
others provide valuable services, state officials and university
staff take on intense workloads with limited resources, and civil
society and community organisations implement innovative local ways
of improving life.
An enormous gap continues to exist between global attention and
local reality.
On October 23 2007, EQUINET is launching a new publication- an
analysis of equity in health in east and southern Africa. The book,
"Reclaiming the resources for health: A Regional analysis of equity
in health in east and southern Africa" explores the challenges and
options for overcoming persistent inequalities in health in east
and southern Africa (ESA). It is written by the EQUINET steering
committee and jointly published by EQUINET with three African
publishers, Weaver Press Zimbabwe, Fountain Publishers Uganda and
Jacana publishers, South Africa.
...
The evidence in the analysis points to three ways in which
"reclaiming" the resources for health can improve health equity:
- for poor people to claim a fairer share of national resources to
improve their health;
- for a more just return for ESA countries from the global economy
to increase the resources for health; and
- for a larger share of global and national resources to be
invested in redistributive health systems to overcome the
impoverishing effects of ill health.
The region has the economic and social potential to address its
major health needs. Yet improved growth has often occurred with
falling human development indicators and increased poverty. In many
ESA countries, widening national inequalities in wealth block poor
households from the benefits of growth, while substantial resources
flow outwards from Africa, leaving most of its people in poverty,
and depleting the resources for health. ...
While many of these actions [to address this] lie outside the
health sector, the analysis argues that health systems can make a
difference, by providing leadership, shaping wider social norms and
values, demonstrating health impacts and promoting work across
sectors. ...
Addressing these problems demands a strengthened public sector in
health. Current average spending on health systems in the region is
below the basic costs for a functional health system, or even for
the most basic interventions for major public health burdens.
Therefore one priority is for governments to meet the as yet
largely unmet commitment made in Abuja to 15% of government
spending on health, excluding external financing. We argue,
however, for "Abuja PLUS" - for international delivery on debt
cancellation and for a significantly greater share of this
government spending to be allocated to district health systems.
...
The book will be available after its launch on 23rd October from
EQUINET (admin@equinetafrica.org)or from the publishers in the
region (Weaver Press, Fountain Publishers and Jacana). ... For further information
on the issues raised in this brief please also visit the EQUINET
website at www.equinetafrica.org.
Health Workforce Advocacy Initiative
http://www.healthworkforce.info
September 25 letter from Eric Friedman of Physicians for Human
Rights (efriedman@phrusa.org)
The Global Health Workforce Alliance is an international
partnership hosted by the World Health Organization and is
dedicated to identifying and implementing solutions to the global
health workforce crisis. The Health Workforce Advocacy
Initiative (HWAI) will engage in evidence-based advocacy to
advance local, regional, and global efforts to enable all people,
at the soonest feasible time, to have equitable and sustained
access to a skilled, motivated, and well-equipped, informed, and
managed health workforce who have decent wages and good working
conditions, and are capable of delivering on such health goals
and obligations as Universal Access and the health-related
Millennium Development Goals.
HWAI is launching a Campaign for Sustainable Health Workforce
Financing. As we all know, greatly increased funding will be
needed to create a workforce that is capable of delivering on
Universal Access and the MDGs. Given the centrality of increased
resources to strengthening the health workforce and the health
systems in which they operate, and the advocacy necessary to
unlock those resources, we felt that this should be the central
focus of our work.
The campaign will have two layers, global and national.
Globally, we will engage in advocacy with key international
targets such as the Global Fund, support advocacy to remove
macroeconomic constraints, and develop material, including
evaluations of and recommendations for major development partner
investments in the health workforce. At the national level, we
will join forces with partners in pilot countries to use the
international reach of HWAI to strengthen local campaigning
around sustainable financing for HRH. Initially we will be
working with partners in Uganda. We plan on developing an
advocacy toolkit for health workers (with some focus on
sustainable financing for the health workforce) and a set of key
principles that can be used to evaluate or contribute to the
development of a health workforce plan.
The success of this campaign depends very much on a network of
advocates. It requires the development of a movement that is
committed to achieving health goals such as Universal Access and
the MDGs, is convinced that empowering, enabling, and expanding
the health workforce is vital to achieving, sustaining, and
building on these goals, and that advocates for the measures
necessary to develop that workforce. We need to support one
another, including by sharing evidence, ideas, and other
information, collectively strategizing, engaging in open
discussions, supporting advocacy, and maximizing on our
connections and capacities.
We therefore encourage you to join the [HCW] listserv, the
virtual home of the HWAI network. ...it is open to anyone who
identifies with the vision and goals of this network, including
advocates within governments.
Anyone who would like to join should email their name, e-mail
address, affiliation, and country to Sharonann Lynch of MSF at
sharonann.lynch@gmail.com, who administers the [HCW] listserv.
Please cc me (efriedman@phrusa.org).
Additional new links
AllAfrica Opens News Center and Health Office in Monrovia
http://allafrica.com/stories/200710050940.html
Global Coalition on Women and AIDS
Educate Girls; Fight HIV/AIDS
http://womenandaids.unaids.org
Aids & Rights Alliance for Southern Africa
http://www.arasa.info
Latest Reports of AIDS Drug Prices from MSF, WHO
http://www.who.int/hiv/amds/price/en
Note that MSF reports reductions in prices from second-line
antiretrovirals, but alarmingly high prices for newer less toxic
versions of first-line drugs.
Substance Abuse and HIV/AIDS in sub-Saharan Africa
Special free issue of African Journal of Drug and Alcohol Studies
http://www.sahealthinfo.org/admodule/journal52006.htm
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