Fresh money, old problems

The money has been secured to finance the Global Fund for AIDS, Tuberculosis and Malaria through to 2010, announced the donor conference’s chairman Kofi Annan. “With that money, millions of lives can be saved in the next few years,” the former UN secretary-general said. Since its establishment as a public-private partnership in 2002, the Global Fund has pledged a total of $ 8.6 billion in support of 450 health programmes in 136 countries. It is now the world’s biggest donor in the fight against AIDS, tuberculosis and malaria.

However, in the debates before, during and after the conference, criticism was raised on a number of issues. At the opening itself, conference host Angela Merkel poured vinegar into development-community wounds: “A great deal of effort is duplicated, resources are not always used efficiently,” Germany’s chancellor complained. The executive director of the Global Fund, Michel Kazatchkine, stressed the need for “bilateral and international organisations, the countries concerned and our private-sector and civil society partners [to] harmonise and coordinate their efforts”.

Critics also pointed out that the funds pledged will not be enough to meet the massive scale of demand. The Fund is by far the biggest financier of health programmes worldwide. Indeed, it currently provides some two-thirds of the funding for the global fight against tuberculosis and malaria, although it furnishes less than a quarter of the money available for AIDS control. The focus on these three infectious diseases often obscures the fact that health systems in developing countries need strengthening in general. AIDS, malaria and tuberculosis are the world’s worst epidemics at present – claiming six million lives a year – but poor countries are plagued by many more ailments, which go unaddressed. Lots of diseases are directly linked to poverty and pollution. What is more, Africa and other parts of the developing world suffer from a massive shortage of doctors and nurses – a shortage made worse by industrialised countries actively recruiting health professionals in developing countries.

What is crucial in the fight against the three epidemics is access to cheap and effective drugs. The debate on patent protection of AIDS medicines, however, shows that Western governments have no cohesive plan: they seem generously to foot the bill for drugs as donors yet, in doing so, they relieve the pharmaceutical industry of the need to lower prices for poorer countries.

In many cases, however, poor countries fail to make necessary efforts themselves. With the new Debt2Health initiative, donors now want to prompt governments in the developing world to commit more money. Germany’s Development Minister Heidemarie Wieczorek-Zeul, for instance, has signed an agreement to cancel € 50 million of Indonesian debt to Germany. In return, Indonesia will make half of the freed-up money available to the Global Fund for investment in Indonesian health programmes. Kenya, Pakistan and Peru are the next candidates. In this way, another € 200 million will be mobilised for the Fund in the next four years. Wieczorek-Zeul described the initiative as groundbreaking in financing the fight against the world’s most dangerous infectious diseases.
Roland Bunzenthal