The health of nations

The financial crisis should not stall initiatives like the Global Fund,which battles AIDS,TB and malaria

Written by New York Times | Published:February 3, 2012 3:26 am

The financial crisis should not stall initiatives like the Global Fund,which battles AIDS,TB and malaria
Paul Farmer

Ten years ago,the heads of the G-8 countries met in Genoa,Italy,to back the establishment of the Global Fund to Fight AIDS,Tuberculosis and Malaria — a new funding mechanism that dramatically increased resources available to fight preventable,treatable diseases stalking the poor and depleting developing economies around the globe.

In 2001,very few people — almost none,really — living with HIV in Africa had access to antiretroviral medicines. Today,more than 3.3 million people — more than half of those on treatment worldwide — are on treatment supported by the Global Fund: a true victory for the global community. The fund and the US international AIDS programme,Pepfar (the President’s Emergency Plan for AIDS Relief programme),are the most ambitious global health endeavours in generations.

Now,10 years since its founding,the Global Fund is facing a serious financial shortfall,and the fund’s board voted recently not to accept new grant requests until at least 2014. This funding deficit hit right when the end of AIDS became plausible: Last year,scientific breakthroughs provided conclusive evidence that putting more people on treatment earlier can significantly reduce incidence of HIV. Treatment is prevention.

Beyond AIDS,the Global Fund is currently the largest donor in the world for tuberculosis and malaria programmes. Operating in 150 countries,it has treated more than 8 million cases of tuberculosis and distributed 230 million insecticide-treated nets. Deaths from malaria are down nearly 40 per cent in most of Africa. The question is not whether the Global Fund works,but how to ensure it keeps working for years to come.

In my mind,there are four reasons this is imperative: First,the world needs to expand,not contract,access to health care because of the sheer burden of disease. It is unconscionable that,in 2012,we are still living in a world where millions of poor people die of preventable and treatable diseases.

Second,the Fund doesn’t simply give handouts; it takes the longer road of investing in and working with health ministries. In doing so,it seeks to build local health systems,develop platforms for transparency and accountability,boost local procurement and improve supply chains,and train civil servants and health professionals.

This approach has had profound spillover effects on other health and development priorities. In central Haiti,for example,establishing effective treatment programmes for AIDS,tuberculosis,and malaria has raised the standard of care for chronic conditions like major mental illness,heart failure and several forms of cancer.

Third,the Global Fund proves how much multilateral organisations can accomplish. While the usual players — the G-8,say — bear the greatest financial burden,I would urge some of the recipient countries to consider themselves partners of and contributors to the fund. In today’s global economy,countries like India,Russia and China play meaningful roles as donors and as recipients of grants. The Global Fund is a truly multilateral organisation,and stronger for it.

Fourth,a recession is a lousy excuse to starve one of the best (and only) instruments we have for helping people who live on a few dollars a day. Most marginalised populations around the globe have always faced economic contraction; “financial crisis” has been ongoing for them since the day they were born. It would be a great mistake to allow one of the world’s most effective global health institutions to fail because we need to get our own fiscal house in order. We need to summon the funding and political will,now,to protect the hard-fought progress of the past decade. Simply put,if we allow the fund to fail,many people will die,and we will forfeit the chance at the “AIDS-free generation” that US Secretary of State Hillary Clinton called for in November. This is no time to step back.

The writer is chairman of the department of global health and social medicine at Harvard Medical School and a co-founder of Partners in Health,which has received support from the Global Fund in Haiti,Lesotho and Russia

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