Swaziland

Climate Lessons from a Hotter Arab World

Photo credit: Curt Carnemark/World Bank

This week in Doha, the marble corridors of the Qatar National Convention Center resonate with voices from around the world. Over half way through the UN Climate Change Conference, as ministers arrive and the political stakes pick up, a sense of greater urgency in the formal negotiations is almost palpable. But in the corridors, negotiations are already leading to deals and dreams and action on the ground.

UN Secretary-General Ban Ki-moon opened the discussions by saying we need optimism, because without optimism there are no results. He reminded us all that Superstorm Sandy was a tragic awakening. He reiterated the call for a second commitment period of the Kyoto Protocol, a global agreement and 100 billion in climate finance by 2020.

Meanwhile our focus was firmly on the region ...

Transitions in financing HIV/AIDS programs

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.

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

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.

En Afrique australe, la tuberculose migre avec les mineurs

Il y a quelque temps, je suis parti en mission visiter un nouvel hôpital au Lesotho. Je savais que cet établissement était destiné à accueillir des patients atteints de tuberculose multi-résistante et je sais aussi le lourd tribut que la co-infection VIH-tuberculose fait payer au pays. Je m’attendais donc à ce que les caractéristiques démographiques des patients correspondent à celle du VIH : essentiellement des patients jeunes, et de plus en plus de femmes.

Mais je n’étais pas préparé à voir deux familles entières, jeunes et vieux, hommes, femmes et enfants, confinées ensemble pour un certain temps, sous la surveillance de professionnels de santé veillant à ce que tous prennent bien leurs doses quotidiennes de médicaments.

El desafío de la TB de África meridional emigra con los minero

Hace un tiempo, formé parte de una misión que debía visitar un nuevo hospital en Lesotho. Me advirtieron de antemano que el propósito de estas instalaciones era atender a las personas que sufren de tuberculosis (TB) multirresistente a los medicamentos, y conociendo la inmensa carga de coinfecciones de VIH y TB en el país, esperaba que el perfil demográfico de los pacientes fuera similar al del VIH: en su mayoría jóvenes y cada vez más mujeres.

Para lo que no estaba preparado era para encontrarme con dos familias enteras —jóvenes y viejos, hombres, mujeres y niños— confinados juntos en el futuro inmediato para ser observados por trabajadores de la salud mientras toman sus medicamentos diariamente.

南非的结核病问题随矿工迁移

不久前，我随代表团参观了莱索托的一家新建医院。有人事先提醒说，该医院专门治疗多重抗药性结核病患者，同时我也知道莱索托因艾滋病和结核病合并感染而面临沉重负担，因此我预想结核病患者的构成应该与艾滋病感染者的构成相吻合，即基本为年轻人，而且女性感染者不断增加。

令我毫无准备的是我目睹了两个家庭——无论是老少、男女，还是儿童——整个被集中在一处，由医务人员对其每人服药过程进行监督。今后一段时间内，他们都会呆在这里。

Southern Africa's TB challenge migrates with miners

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A while ago, I was part of a mission to visit a new hospital in Lesotho. Warned in advance that this facility was intended to treat people with multi-drug resistant tuberculosis (TB)– and knowing the huge burden of HIV-TB co-infection in the country—I was expecting the patients’ demographic to match the profile of HIV: largely young and increasingly female.

What I wasn’t prepared for was the sight of two entire families—young and old, men, women and children—all confined together for the foreseeable future, to be monitored by health workers as they take their daily drugs.

AIDS: translating scientific discoveries into sustainable, affordable programs

We’re entering a phase where AIDS is moving from emergency crisis financing to sustainable development financing—which is a major challenge, but one that we’re continuing to tackle, with the goal of stronger national ownership and responsibility.

One of the Bank’s international mandates is to support countries to develop better national health plans and budgets. Today, the Bank released an important study, The Fiscal Dimension of HIV/AIDS in Botswana, South Africa, Swaziland, and Uganda, which is a part of this mandate. The study helps countries do the long-range planning that we so desperately need in HIV programs.

The Bank has a long-established partnership with ministries of finance and planning, and we understand country systems. We stand ready to help countries integrate HIV into their programs and plan for it in a sustainable way.

We’ve seen extraordinary progress in AIDS. Today, we have more antiretroviral drugs to treat HIV than every other virus in history combined. We’ve reduced treatment costs from tens of thousands of dollars to as little as $100. And we’ve expanded our understanding of effective HIV prevention, including the role of male circumcision and the important role that treatment can play in prevention under the right circumstances.

Many of us involved in HIV remember the days when 70% of beds in health facilities in Africa were occupied by people with AIDS. Our successes in treatment and prevention have removed this specter and have allowed health systems to focus on other important health priorities.

Media Events for Development Campaigns

Using large international events to get attention for a development objective is a pretty good idea. Events like the Soccer World Cup are so called media events - events that capture the attention of a large audience, that break our routines, and unify a large scattered audience. Whatever team you were cheering for, you weren't the only one cheering for it, and didn't you feel like your team's friends were also your friends? This kind of mood - attention and a feeling of community - provides a great environment for campaigns that want to raise awareness about certain issues or that want to change norms and behaviors.

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