A child suﬀering from diarrhoea receives care at
a makeshift hospital at Kibati in
the Democratic Republic of Congo.
Photograph: Walter Astrada/AFP/Getty Images
Focus on Aids, they say, has led to neglect
of other fatal conditions killing young children
Top scientists are demanding a controversial
overhaul of health spending in Africa,
arguing that the billions of pounds targeted
at HIV during the past 20 years have led
to a neglect of other killer diseases
and basic health problems such as diarrhoea.
Developed countries poured $13.2bn (£8.2bn)
last year into efforts to combat HIV, chiefly
for Africa, up from $480m in 1996.
But only eight countries, all in southern Africa,
remain in the grip of a severe Aids crisis,
while World Health Organisation data show
that five of the biggest killers in Africa
are illnesses that affect children
under the age of five.
Childhood diarrhoea kills an estimated
1.5 million children under five
each year worldwide – at least half
of them in Africa – although it is easily
treatable with zinc tablets that cost little
more than $2 each. Diarrhoea received
less than 5% of worldwide research
and treatment funding last year.
Daniel Halperin, an HIV epidemiology researcher
at the Harvard Medical School of Public Health,
said: "There has generally been
a misalignment from the donors.
It is time for a rethink. Many people in the west
believe all Africans are impoverished
and infected with HIV. Yet the reality is
that most countries have
stable HIV prevalence of less than 3%.
What most people really need
are things such as clean water
and family planning. Even tuberculosis
and malaria get far
less money than HIV. In some cases
these sectors have inadvertently
been hurt by the focus on HIV."
One of Africa's leading health economists,
Alan Whiteside, who is director
of the Health Economics and HIV/Aids
Research Division at the University
of KwaZulu Natal, said the flood
of donations towards the battle
against Aids had also created
the conditions for widespread
misuse of the funds. Whiteside played
a prominent role in bringing
the southern African Aids epidemic
to the world's attention in the 1990s.
He has also advised the United
Nations and Aids2031 – an international
expert group set up to chart
the best route to tackle Aids
in advance of the 50th anniversary
of the first report of the illness.
"The lure of Aids money has led
in some African countries
to large-scale corruption," he said,
"and the establishment of non-government
organisations as an industry.
The achievement of the United Nations
Millennium Development Goals
by 2015 depends on us getting
our focus on Aids right.
"Where those goals are missed
by the widest margins, Aids
will have been responsible. The focus
on treatment has distracted
us from prevention. Solutions need
to be tailored to the situation in each country.
Money needs to be reallocated
based on what we know now,
not what we knew then."
Other health crises in Africa
include malaria, which kills
an estimated 400,000 people a year,
and complications resulting
from pregnancy and childbirth,
which claim 350,000 lives annually.
Hypertension, strokes and road accidents
are also of increasing concern,
with many hospitals across the continent
unable to cope adequately
with accident and emergency cases.
In Uganda, which has a 6.7% adult HIV
prevalence rate, critics of the current
priorities of health spending point
to examples such as the clinic run
by Dr Bitekyerezo Medaro, who is
struggling to provide treatment
for diabetics at a government unit
in Mbarara, southwest of Kampala.
Across the road is a state-of-the-art
HIV clinic funded by the United
States government. Dr Medaro said
western dietary trends have pushed
the rate of diabetes in adults
in Mbarara to 5%, but the resources
available to deal with the problem
are minimal. "My patients sleep
on the floor, or outside," he said.
"We have lost 16 people due
to lack of drugs. One woman told me
she would like to have HIV,
because at least those drugs are free,
whereas she has to pay for her insulin."
Uganda's annual health budget of around
$112m is dwarfed by donor spending
earmarked for HIV of $167m, largely
contributed by the US. Foreign money
for HIV also floods into Uganda and
other African countries from
multinational companies anxious
to fulfil pledges of "corporate responsibility".
Ugandan Aids activist Elvis Basudde said
the high level of spending was not
yielding proportionate results.
"About 350,000 people are in need
of anti-retroviral treatment,
but only 150,000 are receiving it.
This is as a result of corruption,
negligence and bureaucracy.
Uganda is one of the few African
countries with a factory producing
anti-retrovirals. Nevertheless, we are told
there is a shortage of drugs.
We are also told the global
financial crisis has led 95% of donors
to cut back. But it is difficult
to know who to believe."
There are increasing examples of Aids funds
being siphoned off by corrupt officials.
Last year the Global Fund asked
Zimbabwe to pay back $7.2m
in "misused" funds. European donors
earlier this year froze HIV/Aids
funding to Zambia.
In Uganda three former ministers
of health are currently facing corruption trials.
In Kenya a legal challenge
by drug suppliers of the government's
tender process has, in effect,
halted the supply of Aids drugs.
Aids became a development issue
in the 1990s and moved up
the agenda as a result of
the South African epidemic
and the denial stance
of former President Thabo Mbeki.
But critics of current donor
spending in Africa argue
that the scale of the southern
African problem and Uganda's early
Aids emergency has led
to misdirected health spending
in the rest of the continent.
Whiteside was, however,
keen to emphasise that Aids spending
is vital for those already on
or requiring treatment: "Hundreds
of thousands of people are now
on treatment and need
to remain on it for the rest of their lives."
Where funds go
HIV-related aid versus national health
budgets in three African countries:
health budget (2003): $113m
Donor spending on HIV (2005): $104m
HIV prevalence: 1.4%
health budget (2003): $112m
Donor spending on HIV (2005): $167m
HIV prevalence: 6.7%
health budget (2003): $37m
Donor spending on HIV (2005): $47m
HIV prevalence: 3.1%
Source: Centre for
Global Development 2007
Sent from Kigali, Rwanda