In mid-December, the World Health Organisation (WHO) released its annual World Health Report, the first under the leadership of Director-General Jong-wook Lee. Building on its earlier announcement of a plan to bring AIDS treatment to 3 million people by the end of 2005 (http://www.africafocus.org/docs03/who0312.php), the WHO called for a return to the goal of "Health for All" adopted twenty-five years ago. The report calls for strengthening health systems across the board to address the widening gap between rich and poor countries, and it stresses that AIDS treatment will not be sustainable unless it is linked to the strengthening of primary health systems. The report thus presents a sharp contrast to the U.S. model of commercialized health care and the bilateral approach stressed by President Bush's new AIDS initiative. U.S. officials have used the weaknesses of national health care systems in African and other developing countries as an argument for a slower pace in funding for AIDS programs. The WHO reverses that argument, stressing the need for immediate steps to build additional health care capacity. This posting from the AfricaFocus Bulletin contains excerpts from the WHO's World Health Report, as well as links to additional recent reports from late 2003.
Equity in Health
HIV/AIDS awareness campaigners from developing nations are mobilising themselves to form a strong bloc to confront the World Trade Organisation (WTO), which they claim has made it difficult for people living with the disease to access treatment. They claim that the trade body articulates interests of western nations, which have suppressed developing states, giving way to unfair trade. This, the campaigners say, has made it impossible for poor nations to obtain cheap drugs, especially antiretrovirals (ARVs).
“At least tens of thousands of children die every year” because the World Health Organisation and the Global Fund for AIDS, Tuberculosis, and Malaria (GFATM) continue to fund (or support the funding) the purchase of old drugs by African countries rather than the newer, more effective and dramatically more expensive artemisinin-class combination therapies (ACT), according to an editorial “viewpoint” published in the January 17th issue of The Lancet. The editorial, written by academic malaria specialists and some researchers in the developing world accuses both organisations of “medical malpractice” and blames them for caving into pressure from donor governments such as the USA, whose aid officials say that ACT is too expensive.
Senior WHO and World Bank officials have warned donor countries and developing countries that many poor nations are behind in meeting the millennium development goals (MDGs) by the target date of 2015, and stressed that more resources and good policies and programmes are needed. The health-related goals include: halving maternal and child mortality rates by 2015; halving the proportion of people who suffer hunger; combating HIV/AIDS and other infectious diseases; and enhancing access to safe drinking water and essential drugs. A recent study by the World Bank concluded that so far no sub-Saharan African country is on target to reach the MDGs.
The South African AIDS advocacy group Treatment Action Campaign, which has been nominated for the 2004 Nobel Peace Prize, announced plans in January for a new campaign in its battle for universal AIDS treatment that would target inequities between the country's public and private health care systems, Reuters reports. South Africa's health care system has retained its apartheid-era structure of "elite" private hospitals, which primarily care for wealthy whites, and public hospitals, which are overburdened in their attempts to care for the majority of blacks, Mark Heywood of TAC said. In its campaign, TAC plans to target private hospitals, which it says are "too expensive," and push for a "people's health service for a people's antiretroviral program," Heywood said.
War is devastating health standards around the world as resources are deflected from fighting disease, health activists said ahead of the World Social Forum. The People's Health Movement, an international pressure group, said that more than 30,000 children over the world died of preventable diseases every day. Nine billion dollars is needed to provide water and sanitation for poor nations, while the global military expenditure was 900 billion dollars a year, said K. Unnikrishnan, spokesman for the movement.
Zambian President Levy Mwanawasa announced his government will provide free anti-retroviral drugs to about 100,000 patients by next year through the public health system. In a state-of-the-nation address to parliament, Mwanawasa said 10,000 HIV-infected people have so far been put on anti-retroviral therapy provided by the government.
Africans must become more active in campaigning for HIV/AIDS treatment initiatives in their communities. This was the key message emerging at a special discussion forum with Zackie Achmat, co-chair of the Treatment Action campaign, in Harare, Zimbabwe on Thursday, December 4, 2003. SAfAIDS (Southern Africa HIV/AIDS Information Dissemination Service) and HIVOS hosted the forum. The meeting was intended to be an opportunity for Zimbabweans to learn more about South Africa’s experiences in the treatment campaign and explore practicable solutions for the Zimbabwean situation.
The authorities in Swaziland are doing little to stem a flood of bogus "miracle AIDS cures" in a country with one of the world's highest HIV infection rates. "In a blink of an eye, it seems, Swazis have gone from deep denial of the existence of AIDS to panic as they realise all the people they are burying are not dying of witchcraft. The plethora of AIDS 'cures' is a product of that," AIDS activist Thembi Dlamini told PlusNews.
This paper discusses a set of complex, inter-connecting issues related to the moral imperative to increase access to HIV care and treatment in southern Africa, with a particular focus on antiretroviral therapy (ART). It is argued in the paper that an equity-oriented approach is necessary not only from a moral and humanitarian perspective but also for public health reasons. Unless attention is paid to the redistribution of available resources and to the relative and absolute levels of disempowerment amongst individuals, communities and countries, we run the risk of failing to achieve the Millennium Development Goals and the targets that have been set for increasing access to ART.