Global HIV/AIDS and Health Fund: Foundation for action or fig leaf? | Aids

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This week, at a special UN meeting on HIV/AIDS, world leaders will announce a Global Health Fund – a war chest estimated by UN Secretary, Kofi Annan, to need US$7-10bn to tackle HIV/AIDS, TB and malaria in poor countries.
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    Global HIV/AIDS and Health Fund Foundation for action or fig leaf? June 2001      Copyright Oxfam GB 2001 © This briefing was prepared by the Policy Department of Oxfam (Great Britain) for Oxfam International as part of the 'Cut the Cost of Medicines' campaign. All campaign reports are available on the Oxfam GB website (www.oxfam.org.uk). These include more detailed analyses of the issues concerning access to medicines, particularly in relation to patent rules and corporate social responsibility, as well as Oxfam's coverage of the legal action brought by pharmaceutical companies against South Africa. For further information on this paper, contact Dr Mohga Kamal Smith, Health Policy Adviser, Policy Department, Oxfam GB, 274 Banbury Road, Oxford, OX2 7DZ, Tel: +44 (0)1865 312256, Email: msmith@oxfam.org.uk In Brussels Oxfam International can be contacted at: david.earnshaw@oxfaminternational.org     Global HIV/AIDS and Health Fund Foundation for action or fig leaf? This week, at a special UN meeting on HIV/AIDS, world leaders will announce a Global Health Fund – a “war chest” estimated by UN Secretary, Kofi Annan, to need US$7-10bn to tackle HIV/AIDS, TB and malaria in poor countries. If properly funded and managed, the Global Fund could act as a vitally needed catalyst to spearhead renewed efforts to tackle the devastating global health crisis and to spur governments – at national and international level – to do much more to prioritise and deliver on the internationally agreed health targets. Without proper funding and international commitment, the Fund could serve merely as another exercise in window-dressing while the health crisis deepens. The creation of the Fund is a belated, small step by the international community finally to address the scourge of HIV/AIDS that has infected over 36 million people world-wide. The woeful complacency of the international community in the face of HIV/AIDS has also highlighted inaction on other killer diseases in developing countries that with money and medicines could be prevented or treated. It has also put the spotlight on new patent rules that will lead to a hike in the price of medicines as big drug companies drive competition from the global medicines market. Combined with other problems such as the strangulating debt that leads to a net outflow of resources from poor to rich countries, the Fund will operate in an environment fraught with risks to public health. For it to achieve its aims, political will must be channelled to overcome these problems. The Global Health Crisis – lethal, yet surmountable The developing world faces a health crisis. Each day 40,000 people, the vast majority in poor countries, die from diseases the West has come to regard, largely, as manageable: chest infections, diarrhoea and measles – diseases which are both preventable and treatable. TB, once all but eradicated in the rich world, thrives in developing countries and, as resistance grows, is making a comeback elsewhere. 300 million people suffer the debilitating and painful effects of malaria. In addition to these infectious diseases, developing countries have to cope with rising rates of diseases more often associated with the rich world – diabetes, cardiovascular diseases and cancer. The harrowing media coverage of the impact of HIV/AIDS in sub-Saharan Africa has caused outrage at the geographical lottery that condemns the poor to die because treatment is simply too expensive. Poverty is the crux of the matter. According to the World Bank, the annual per capita spending on health in low-income countries is US$21, compared with US$4109 in the US. Under-funded health services, lack of investment in infrastructure, overworked and underpaid staff, the introduction of fees requiring the poor to pay to see a doctor, and high priced medicines all contribute to the fact that one in five people across the globe do not have access to modern health services. Women are the worst affected both in terms of their own health – most of the 600,000 women who die annually of pregnancy related causes live in poor countries – and also because they are largely responsible for family health care, including water and sanitation, providing food, and caring for the sick. Global HIV/AIDS and Health Fund Foundation for action or fig leaf? 1     At the current rate of progress the internationally agreed health targets for the year 2015 will not be met. Without improvements in health, other development targets will also be missed because health and poverty are inextricably linked. HIV/AIDS has had a devastating impact on families as people aged between 15 and 39 – the most economically productive years – are most affected. Women are particularly vulnerable due to inequalities in gender relations and access to services. HIV/AIDS also affects whole economies. In Malawi, 14 per cent of people in that age group live with the virus. The impact of other diseases on economic prospects is also negative: sub-Saharan Africa’s annual GDP would rise by US$100bn were malaria to be eradicated. The Global Fund – Welcome and Necessary Kofi Annan’s rallying cry for the international community to put hands in pockets and minds to solutions is welcome. It has not emerged from a vacuum. The proposal is in part an attempt to address growing unease about complacency around the global health gap. In this, it complements other recent, though belated, government moves, including a commitment to tackle HIV/AIDS and related infections at the G8 Okinawa summit in July 2000, and a European Community Programme of Action to confront HIV/AIDS, malaria and TB. It comes at a time of unprecedented criticism of the pharmaceutical industry: first, for failing to price medicines to make them affordable to the poor, and second, by colluding with governments to introduce stringent intellectual property protection that stands to increase prices further. The creation of the Fund presents various opportunities. First, the chance to focus attention on the health crisis and to kick start a co-ordinated international response involving both developed and developed countries in increased efforts to meet the human right to health. Second, the possibility of providing new money for health – both for infrastructure and the delivery of goods. Although US$10bn is not a large sum in global terms, it could make a real difference. Well-run, poverty-focused prevention and treatment programmes make a startling difference. A combination of mass public education, treatment and low-cost medicines has allowed Brazil to halve the number of HIV/AIDS deaths since 1997. Uganda has also made great strides in preventing the spread of the disease through bold public education. Third, it could provide an incentive to developing-country governments, daunted by budgetary constraints, to prioritise poverty-focused health programmes. The possibility of obtaining tangible benefits in the form of commodities such as bed-nets for malaria prevention, and medicines to treat a range of diseases, may make a critical difference to the political will required to tackle health problems. The Key Elements to Success   Though a welcome response to these challenges, the Fund will not be immune from debates about a sustainable long-term solution to the health crisis. It should not be seen as an alternative to existing HIV/AIDS and health programmes and increased aid contributions, but a means of identifying the way to achieve the best possible, co-ordinated response to the health challenge and as a means of establishing good practice. In Oxfam’s view the key elements of success are the following. A Comprehensive Fund Even if the annual financing target of US$10bn for the Fund were to be achieved, this would be equivalent to the UN’s estimate of what is needed to tackle HIV/AIDS alone. Given the devastating impact of other diseases as well, it is Oxfam’s view that Fund allocations should be determined by Global HIV/AIDS and Health Fund Foundation for action or fig leaf?   2
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