Experts want African aid funds channelled away from HIV

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:

• Ethiopia

National government

health budget (2003): $113m

Donor spending on HIV (2005): $104m

HIV prevalence: 1.4%

• Uganda

National government

health budget (2003): $112m

Donor spending on HIV (2005): $167m

HIV prevalence: 6.7%

• Rwanda

National government

health budget (2003): $37m

Donor spending on HIV (2005): $47m

HIV prevalence: 3.1%

Source: Centre for

Global Development 2007

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Sent from Kigali, Rwanda

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