Turning Development Upside Down
A book about reforming relief and development

Sunday, January 16, 2005

Chapter 240 Health in a historic crisis

HIV-AIDS, Malaria and other killer diseases

The world was becoming in healthier place as a result of some amazing advances in medicine and some well organized international interventions to intervene to end some terrible diseases like smallpox and polio.

But something appears now to be going wrong. Instead of further progress in eradicating disease and reducing mortality and morbidity, there is tremendous backsliding.

There are financial constraints in public health that are constraining everything in the health sector. The amount of money for public health in almost every country in the SOUTH is so limited that health services are bound to be inadequate. International official relief and development assistance (ORDA) is not enough either. ORDA does not start to address the health funding deficit.

But beyond the financing issues, there appear to be medical and scientific issues as well. The HIV-AIDS pandemic has changed the population dynamics of the whole of Africa, and in the hardest hit countries the expectation of life has dropped by more than 10 years in less than 5 years. Instead of moving up into the 60s, and a continuation of thirty years of steady progress, expectation of life has started to drop dramatically. With more than 3 million dying prematurely of AIDS related disease in a single year, the people of Africa are having to face an incredible crisis.

But it is not the only health crisis. Malaria continues to be a tremendous killer, and where it does not kill it still has a debilitating impact on an individual. Children are badly impacted by malaria. And the easy curatives for malaria are becoming less effective as more and more malaria becomes resistant to medication.

And after years of progress with tuberculosis, TB infection is again growing and becoming more and more widespread. And again, the TB strain that is spreading is one that is resistant to easy and low cost medication.

While there are many views about why disease is growing so fast now after years of progress, it is highly likely that poor medical services and lack of higuene are part of the problem. The writer is convinced that unsafe medical practices are feeding into the growing health crisis, especially unsafe injections and other procedures that result in blood contamination. The use of dirty needles is widespread, especially in the informal settings where people expect a health intervention to include getting an injection.

The Secretary General of the United Nations, Kofi Annan, to his credit, has raised the issue of the growing health crisis at the UN, and has been instrumental in having a Global Fund for HIV-AIDS, Tubruculosis and Malara (GFATM) launched. In its inaugural year the GFATM was able to mobilize around $3 billion, a substantial achievement, even though the requirements were for something more like $10 billion.

But the health sector is a problem area. It is something of a symbol of failed development. Progress was made, but the progress has not been sustained, and now there is a high probability that poverty is going to be more and more accompanied by health crisis as well.


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