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AIDS Debate Poses Tough Funding Questions to Top Thinkers

Donna Barne's picture

AIDS Debate

The question was on the pros and cons of HIV/AIDS funding and the tools were sharp insights and passionate views as some of the most influential figures in the fight against AIDS and poverty participated in a lively debate before a packed World Bank auditorium July 23.

The webcast event, co-hosted by the Bank, U.S. Agency for International Development/ U.S. President's Emergency Plan for AIDS Relief, and the medical journal The Lancet, asked a panel of experts to weigh global funding for HIV/AIDS in a fiscally strained, post financial crisis environment. The debate was part of the first International AIDS Conference to be held in Washington in 22 years.

Transitions in financing HIV/AIDS programs

Patrick Osewe's picture

(Portrait of mother and child. Botswana. Photo: Curt Carnemark / World Bank)

While participating in a study of HIV spending efficiency in South Africa, I met a young HIV-positive mother who had just received the joyful news that her new-born daughter was healthy and HIV-free. Wiping away tears of relief, she described the gratitude she felt for the antenatal clinic staff, who had helped start her on antiretroviral treatment (ART) and thanks to whom she now had the hope of a bright future for her daughter. This encounter was just one among many similar incidents during the study – and, as our preliminary data show, is representative of the positive impact of the Government’s strong commitment to bringing down rates of HIV.

 

South Africa has mounted one of the strongest responses to HIV in the world. Its most dramatic success has been the scale-up of ART since 2003, growing from almost nothing to the country’s largest health program that treated about 1.5 million people in 2011 (out of a total HIV-infected population of 5.6 million).

 

The impacts of this treatment drive are already showing, with overall mortality, maternal and infant deaths all on a downward trend following their HIV-related peaks in the early-to mid-2000s. However, the cost of sustaining this success is huge: South Africa has committed to putting an estimated target of almost 10% of the entire population on a life-long course of expensive drug treatment. And, even with government negotiators bringing down ART drug prices by 65% since 2008, successful testing campaigns coupled with the worrying increase in resistance to first-line therapies look set to further raise the financial risk.

 

These challenges extend beyond South Africa. An analysis of the fiscal dimensions of HIV/AIDS released by the World Bank earlier this year in a number of countries concluded that without significant additional investments in prevention starting now, the cost of treatment will rapidly become unaffordable for even the most cash-rich countries on the African continent.

Health information systems in developing countries: Star Wars or reality?

Patricio V. Marquez's picture

(Doctor at the GP office working with prescriptions. Kirov, Russia. Credit: Dmitry Kirillov/World Bank)

In the late 1990s, an international consultant told me that a proposed electronic health information system in the Dominican Republic was “like Star Wars and will not work in this country.”

 

Our objective was to improve service delivery by virtually connecting health providers to share medical records with one another as patients moved from health centers to hospitals. We learned that this was much more than an overnight task, requiring a sustained medium-term effort by the government to get the system fully up and running.

 

In recent years, I’ve seen similar efforts realized in the Russian Federation, Georgia, Azerbaijan and Botswana. In two Russian regions, Chuvash Republic and Voronezh Oblast, for example, electronic records are helping coordinate the flow of clinical and financial information across the health systems as facilities, departments within hospitals, and health insurance agencies have been “virtually” connected through broadband networks. The electronic records are supporting clinical decision-making, facilitating performance measurement and pay-for-performance initiatives, and ultimately the continuity of care as patients move across the health system. Inter- and intra-regional medical consultations and distance learning activities are also being supported by telemedicine networks that connect specialized hospitals with general facilities.

Rio's Buzzing About Natural Capital Accounting

Rachel Kyte's picture

Only a very short time ago, we were drawing blank looks when we mentioned "natural capital accounting." This week at Rio, everyone is talking about it. Walls are plastered with flyers about it.  And our event on it yesterday drew such a crowd it was standing-room only.

With three presidents, two prime ministers, one deputy prime minister, a host of ministers, top corporate leaders and civil society groups in the room, we announced that the 50:50 campaign to get at least 50 countries and 50 companies to commit to acting on natural capital accounting was a success. The latest tally: 59 countries, 88 private companies, 1 region, and 16 civil society groups signing on to the Gaborone Declaration, recommitting to other natural capital initiatives, or agreeing to join forces with this movement.

Intersectoral work for health: Mirage or oasis?

Patricio V. Marquez's picture

It is common to hear officials from countries and international agencies talk about the multiple challenges that impede intersectoral work for health. The concern is valid: while ministries of health and related institutions are organized and funded to improve the “health” of the population, other ministries do not have such a mandate. In most cases, this has led to a certain paralysis characterized by lofty aspirations in the health sector about the potential benefits of intersectoral action, but with little collaboration and action involving other sectors.

Join Us for a Live Chat about Rio+20 on World Environment Day

Rachel Kyte's picture

Credit: Henrique Vicente, Creative Commons

On June 5, World Bank Vice President for Sustainable Development Rachel Kyte will host a live online chat about Rio +20 and sustainable development at live.worldbank.org. Submit questions now, and then join Rachel Kyte and economist Marianne Fay on June 5 at 14:00 GMT/10 a.m. EDT.
 

Rio +20 is coming up in a few weeks. Some 75,000 leaders, advocates, scientists and other experts are expected in person, and tens of thousands more will be watching online to see how the world can advance sustainable development.

Many of us have been advocating for greener, more inclusive growth since before the first Earth Summit at Rio 20 years ago. We’ve seen economic growth lift 660 million people out of poverty, but we’ve also seen growth patterns run roughshod over the environment, diminishing the capacity of the planet’s natural resources to meet the needs of future generations.

The growing global population needs world leaders to do more than just check in at the UN Conference on Sustainable Development, Rio+20 – it needs them to move the needle now toward truly sustainable development practices.

Demystifying Natural Capital Accounting: 10 African Countries Sign On

Rachel Kyte's picture

Credit: Juan-Vidal, Creative Commons

We’ve all seen what happens when natural capital is undervalued. Oceans that billions of people rely on for food and income get overfished and become dumping grounds for chemicals and waste. Mangroves that protect shorelines from storms are replaced with resorts.

Many countries are looking beyond GDP to help them address the challenges undervaluing natural capital has created. What they need is a measure of a country’s wealth that includes all of its capital — produced, social, human, and natural capital.

In Botswana at the Summit for Sustainability in Africa this afternoon, 10 African countries endorsed the need to move toward factoring natural capital into systems of national accounting. By Rio +20, the upcoming UN Conference on Sustainable Development, we hope to see 50 countries and 50 private corporations join this effort.

Circumcision and smoking bans: Can policies nudge people toward healthy behaviors?

Patricio V. Marquez's picture

Walking through river. Mali. Photo: © Curt Carnemark / World Bank

The scaling up of voluntary medical male circumcision, particularly in high HIV prevalence settings, is a highly cost-effective intervention to fight the epidemic—randomized controlled trials have found a 60% protective effect against HIV for men who became circumcised.

But, the supply of this medical service is just one part of the picture. Without active involvement from individuals and communities to deal with social and cultural factors that influence service acceptability, the demand for this common surgical procedure will be low.

Indeed, on a recent visit to Botswana, a country with high HIV prevalence and low levels of male circumcision, my World Bank colleagues and I had a good discussion with the National HIV/AIDS Commission about ways to address the low uptake of voluntary, safe male circumcision services in spite of a well-funded program by the government.  It was obvious to all that if the demand for, and uptake of, this service were not strengthened through creative mechanisms that foster acceptance, ownership, and active participation of individuals and community organizations, the program would not help control the spread of HIV through increased funding of facilities, equipment, and staff alone.

So, what do we need to do to ensure that need, demand, utilization, and supply of services are fully aligned to improve health conditions?

Tobacco Kills: So what to do in Africa?

Patricio V. Marquez's picture

The scientific evidence is overwhelming. As Robert Beaglehole and colleagues at the World Health Organization (WHO) pointed out years ago, tobacco is the only consumer product that eventually kills half of its regular users if they follow its manufacturers’ recommendations. 

Photo Credit: By AdamCohn, FlickrGiven this dire reality, it is clear that Africa is now at a crossroads. On one hand, the countries in this region have become an attractive and under-tapped market as tougher regulations, high taxes, and greater consumer awareness of the dangers of smoking in developed countries are “closing the door” to tobacco imports and leading to significant drops in consumption. And on the other hand, cigarettes are becoming increasingly affordable as incomes rise in several African countries due to the rapid economic growth of recent years. Indeed, African countries are experiencing the highest increase in the rate of tobacco use amongst developing countries--the number of smokers in sub-Saharan Africa is projected to increase 148 percent by 2030, to 208 million smokers or one-fifth of the total population. 

Malaria is a preventable and treatable disease, but for how long?

Maryse Pierre-Louis's picture

www.worldbank.org/malaria

This year, on World Malaria Day, April 25, the global health community has reason to celebrate. Indeed, thanks to substantial investments from partners and countries over the last decade, the scorecard on malaria reports good news:  a reduction of more than 50% in confirmed malaria cases or malaria admissions and deaths in recent years in at least 11 countries south of the Sahara, and in 32 endemic countries outside of Africa. Overall, the number of deaths due to malaria is estimated to have decreased from 985,000 in 2000 to 655,000 in 2010. 

The fact that an estimated 1.1 million African children were saved from the deadly grip of malaria over the last decade is an extraordinary achievement. By the end of 2010, a total of 289 million insecticide-treated nets were delivered to sub-Saharan Africa, enough to cover 76% of the 765 million persons at risk.

Over the past 5 years, four countries were certified as having eliminated malaria: Morocco, Turkmenistan, the UAE and Armenia.  In southern Africa, health ministers of eight countries -- Botswana, Namibia, South Africa, Swaziland, Angola, Mozambique, Zambia, Zimbabwe--have developed a regional strategy to progress towards E8 malaria elimination status.  


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