Reality check: why a global bail-out for health is needed

September 2, 2010

Reality check: why a global bail-out for health is needed

Ten years ago, countries launched the Millennium Development Goals and pledged to halve child and maternal mortality and halt the spread of killer diseases like HIV/AIDS, malaria and tuberculosis by 2015. With five years left on the clock, world leaders are convening in New York this month to review the progress achieved.

They are in for a reality check. Even in places not affected by war or violence, death and disease continue to take an appallingly high toll. The situation can only be viewed as an acute emergency, rendering a massive and urgent response necessary. Solely relying on volatile donor support is risky and insufficient. We need to find new, additional, ways to raise predictable and sustainable sources of revenue to help plug the gap.

The frequent call upon a medical humanitarian organisation like Médecins Sans Frontières and the scope of our interventions are clear indicators of the crisis; last year alone, we gave antiretrovirals to 160,000 HIV-positive people, treated over a million people for malaria and vaccinated close to eight million for meningitis.

Our teams see first-hand how much more needs to be done. Despite the pledge to halve hunger, the food crisis continues to afflict countries like Niger, with rates of malnutrition exceeding the 15% emergency threshold in some areas. The fate of women and children in countries like Sierra Leone, where every eighth woman dies in childbirth, shows how far we are from realising the objective of maternal and child mortality. And infectious diseases still claim a devastating toll in places like Lesotho or Swaziland where more than a fifth of the adult population is infected with HIV.

Yet simple tools that can save lives do exist. Newer drugs and rapid diagnostic tests have made effective treatment of malaria feasible. Take HIV - higher treatment coverage in countries like South Africa and Malawi not only saves lives, but also prevents the emergence of opportunistic infections such as tuberculosis, and can even help control the epidemic at population level. These are the tangible, community-wide benefits of putting more people on treatment earlier. MSF programmes treating malnourished children with ready-to-use therapeutic foods see extremely good results, and giving supplementary foods to children before the hunger season, as we are doing right now in Niger, can even reduce the number of children getting acutely malnourished. Innovative approaches are important too: MSF has seen how community malaria workers in Mali or patient groups for AIDS in Mozambique can complement more traditional approaches, and how abolishing user fees in order to provide essential care free of charge, has contributed to a rapid reduction of mortality in MSF projects in countries like DR Congo or Burundi.

As a doctor who has treated patients for tuberculosis in Ethiopia, neglected diseases in the Congo and worked on maternal and child health in Azerbaijan, I have seen how international aid can make a huge difference to people’s lives. For many diseases, we know what we need to do to save lives.

But unless patients benefit from these effective interventions and other advances, the health-related MDGs will not be met. Indeed the World Health Organization estimates these Goals are likely to fail – meeting them would require spending around $37 billion a year more on health than today. This does not include the costs of researching and developing new drugs, diagnostics and vaccines that our teams in the field desperately call for to detect, treat or prevent disease.

Yet at a time when more political commitment and money is needed, we’re seeing less of it: in several countries the donor contribution to health is shrinking rather than growing. MSF has witnessed patients being turned away from clinics as donors retreat from earlier pledges and flatline their commitments to fight HIV/AIDS. The result is that AIDS treatment is being rationed to the sickest only, and different health priorities are pitted against each other with patients forced to compete for their share of an ever shrinking pie. If funds are reduced for an epidemic which still kills two million people per year, one can only fear what may happen with other less acutely visible health problems.

After the billion dollar bail-out so decisively mobilised to save the financial sector, donors claim there is no money left to bail out public health and save the lives of millions.

Some of the largest multilateral agencies that finance health programmes in the developing world, such as the Global Fund to Fight AIDS, TB and Malaria or the Global Alliance for Vaccines and Immunization, are today facing unprecedented cash crises that threaten their ability to save lives. Both organizations are holding ‘replenishment conferences’ early next month in an attempt to raise money – but both are unlikely to get anywhere close to what they need.

But international funding remains essential and past donor commitments must be met. Mobilising additional money for priority health funding can take many forms, and one such example already exists – the international health agency UNITAID finances health programmes thanks to a tiny tax on airfares. Whether it is a small levy on all financial transactions, or just on currency transactions, innovative financing mechanisms have the potential to raise considerable sums, leveraged in a painless way.

Schemes like these are already being discussed by global leaders. The International Monetary Fund recently deemed them feasible, and there is strong backing by the EU for similar levies following the calls by Merkel and Sarkozy. But it is critical that part of any such new resources be allocated to global health. Just recently, sixty countries participating in the group that created UNITAID proposed a global solidarity levy on currency exchanges, where all funds raised would go to fill the health and development gap.

World leaders have the choice to prove their engagement for public health and find a way to finance the promises made to millions of people ten years ago. At the heart of this lies a political decision. As a medical humanitarian organisation, MSF knows all too well that the consequence of political inaction is unnecessary death.

Dr. Unni Karunakara, International President, Médecins Sans Frontières

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