Without taking social and political realities into account, the Gates Foundation patronage of even the most powerful medications cannot meet the goal of reducing global inequities. Recently Warren Buffett has received near-universal praise for his $31 billion donation to the Bill and Melinda Gates Foundation. The foundation has likewise enjoyed wide acclaim for its global health and educational programs, with Buffett's gift the highest tribute of all. So what could possibly be wrong with Gates-Buffett philanthropy, aimed at improving global well-being? Five such issues are highlighted, warranting pause to the all-around backslapping.
Resource allocation and health financing
The Global Fund Secretariat’s suspension of funding to Uganda: How could this have been avoided?
Kapiriri L, Martin DK: WHO Bulletin 84, August 2006
In August 2005, the Global Fund to fight AIDS, Tuberculosis and Malaria Secretariat suspended its five grants to Uganda following an audit report that exposed gross mismanagement in the Project Management Unit. How could this have been avoided? How can other countries avoid a similar pitfall? We argue that if a legitimate and fair decision-making process were used, the suspension of funding to Uganda could have been avoided, and that this lesson should be applied to other countries. The “accountability for reasonableness” framework of relevance, publicity, revisions and enforcement would help in implementing legitimate and fair decision-making processes, which would improve effectiveness, accountability and transparency in the implementation of Global Fund programmes, preventing future suspension of funding to any Global Fund projects.
Uganda: Foreign envoys demand action against Global Fund culprits
Plusnews, 23 August 2006
European envoys in the Ugandan capital, Kampala, have asked the government to take "expeditious" action against individuals, including senior politicians, accused of mismanaging HIV/AIDS grants. The diplomats were further concerned at the slow implementation of the judicial commission of inquiry report.
A costing analysis of community-based programs for children affected by HIV/AIDS: Results from Zambia and Rwanda
Dougherty L, Forsythe S, Winfrey W: Eldis, 5 July 2006
This paper analyses the programmatic costs of CARE Rwanda's and Bwafwano Zambia's two community-based programmes for children affected by HIV/AIDS in Rwanda and Zambia in order to provide information on the current costs of the two programmes. The paper also discusses additional costs related to scaling up the existing programmes and outlines issues relating to long term sustainability of programmes for children affected by HIV/AIDS.
Lack of resources affects all children, not only those with heart disease
Reynolds L, Sanders D: The Sunday Independent, 18 June 2006
We share the distress of our colleagues at the large numbers of children in South Africa who suffer and die from surgically correctable heart disease because there are insufficient human and other resources to provide them with the operations they need. But the plight of children with heart disease only gives us a small glimpse into children's health in South Africa generally and into the crisis affecting the public health sector. Our government and health service administrators must provide more explicit policies and frameworks that guide the allocation of health resources according to agreed priorities.
Further details: /newsletter/id/31622
Social protection: The role of cash transfers
McKinley T (ed.): Poverty in focus, June 2006
Poverty reduction is the result of several interacting factors, including importantly: redistribution of incomes, assets, and opportunities; pro poor economic growth; and social provision and protection. This issue of IPC's journal Poverty in Focus highlights the importance of social protection in the struggle against global poverty. For South Africa, the implications of income grants are analysed, including both poverty reduction outcomes and the macro-economic feasibility; while cash transfers in Zambia and social protection for pro-poor growth are just some of other areas covered relevant to Southern Africa.
A free for all? Removing health user fees in Africa
Gilson L, McIntyre D: id21 Health Systems, 31 May 2006
Charging patients for basic health care hits the poorest members of society the hardest. Many fall into debt or simply do not seek care from public health services. The Commission for Africa has called for basic health care to be free for everyone. How would this impact on already under resourced health services?
A price to pay? Increasing insecticide-treated net coverage in Malawi
Stevens W, Wiseman V, Ortiz J: id21Health, 31 May 2006
Nets treated with insecticide have proved to be an effective method of reducing malaria. Before increasing the scale of this intervention, however, policymakers need to be fully informed of the costs involved and the effect that the scaling-up will have. Cost-effectiveness has been measured in trials, but what does the intervention cost in practice?
Anti-malarial treatment in Tanzania: Differences in willingness to pay
Wiseman V, Onwujekwe O, Matovu F: ID21 Health, 31 May 2006
The appearance and rapid spread of resistance to anti-malarial drugs has created a crisis for effective treatment in Africa. Consensus is growing that the only realistic treatment option will be a move away from treatment with one drug (monotherapy) to the more expensive combination therapies, particularly artemisinin-based combinations. However, a potential obstacle to the introduction of this new type of treatment is that it costs up to ten times more than monotherapy. There is concern that if poor patients’ families have to bear the cost of the drug combinations, they might delay treatment or avoid it altogether.
From funding to action: Strengthening healthcare systems in Sub-Saharan Africa
World Economic Forum: AllAfrica.com, 1 June 2006
In the first ever project of its kind, the World Economic Forum’s Global Health Initiative has brought together a range of stakeholders to identify how business could partner with the public sector to improve healthcare systems in Sub-Saharan Africa. The resulting White Paper for consultation collects the views of diverse stakeholders on the barriers to effective healthcare systems in the region, and identifies opportunities for business to use its knowledge and skills to help tackle the problems through new public private partnerships. If turned into action some of the strategic interventions identified in this paper could contribute to improving access to health for millions of Africans.