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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.

Laboratory accreditation: Critical to quality care

Miriam Schneidman's picture

The quest for an accurate, timely and affordable medical diagnosis remains elusive in many developing countries.  In East Africa, laboratories are often poorly staffed; ill-equipped; and lack quality systems. Obsolete equipment clogs up limited space. Clinicians often resort to presumptive diagnoses rather than requesting lab confirmations. Individuals suffering from infectious diseases, such as tuberculosis, run the risk of going undetected and transmitting the disease to others, or being misdiagnosed, which in turn leads to compromised care and higher health care costs. 

 

Many laboratories are not adequately prepared to respond during public health emergencies, yet their services are critical to detecting new pathogens and containing disease outbreaks. 

 

World Laboratory Accreditation Day, observed recently, offers a good opportunity to draw attention to the critical role of laboratories in health, and the importance of accreditation in promoting quality.  Accurate and reliable laboratory services are critical for conducting clinical diagnosis, guiding treatment, and responding to disease outbreaks.  There’s a growing recognition of the importance of laboratory services, and several important initiatives have been launched, including the WHO-AFRO Stepwise Laboratory Improvement Process towards Accreditation (SLIPTA).

Isolated West Nile Region Home to First Sub-Saharan World Bank Project to Issue Carbon Credits

Isabel Hagbrink's picture

Electricity transmissions lines in Uganda. Credit: Arne Hoel/World Bank

Wedged between the Congo, the south of Sudan, and the West Nile River, the 1.5 million people in Uganda’s West Nile region live in relative isolation from the rest of the country.

Nowhere in Uganda is oil and gasoline more expensive than in the West Nile. The national power grid does not reach into the northwest of Uganda, and power from generators is available only for a lucky few and only for a few hours a day.

Some entrepreneurs have started mills and small workshops, outfitting them with old diesel generators that are inefficient and very expensive to operate. Some institutions, such as hospitals, and some of the richer households have their own diesel generators that help them escape the scarce and unreliable public power service. The growth in individual generators is indicative of a general upswing in economic activity in the region, but life without reliable electric power has remained a challenge.

That is now beginning to change, and carbon credits are playing an important role.

It’s a Capital (plus Advisory) Problem not a Pipeline Problem

Aleem Walji's picture

Photo Credit: methodlogical.wordpress.comI recently returned from travel to India and East Africa where I attended a round table on social enterprise with the Government of India and met impact investors focused on Kenya, Tanzania, Rwanda, and Uganda. After listening carefully to entrepreneurs, investors, and government officials, I’m compelled to say something entirely inconsistent with conventional wisdom in the world of impact investing: there is not enough capital to support the pipeline of enterprises focused on solving our most vexing social problems. By social problems, I mean the provision of basic goods and services to the bottom of the economic pyramid where governments and markets often fail.

Take access to energy for example or access to sanitation in much of Africa and South Asia. More than 1.3 billion people on the globe still lack access to electricity and over 2.5 billion lack basic sanitation. Every 20 seconds a child dies because of poor sanitation.

These are public goods and unambiguously the responsibility of public actors. But in reality, governments often don’t have the resources, the will, or the capacity to provide these basic services to many of their citizens. And purely commercial enterprises lack incentives to provide services where financial upside is limited and the ability of poor people to pay is constrained. But this is precisely where inclusive (or socially driven) businesses and social entrepreneurs, for profit and not-for-profit, are innovating and developing new business models to solve our most pressing social challenges.

ICTs to transform health in Africa: Can we scale up governance and accountability?

Meera Shekar's picture

Uganda man sends health SMS.

Start-up eHealth innovations are popping up all over Africa, providing a glimpse of how ICTs can transform the delivery and governance of health services in the region. Many of these pilots show promise, but their rapid growth also poses challenges: At an eHealth conference held in Nairobi in May and co-organized by the World Bank, health professionals and development partners discussed how to identify the best of these evolving tools and bring them to scale.

Your views on the impacts of an upcoming project on infrastructure in Uganda

Stuart Solomon's picture

The World Bank is preparing a new project in partnership with the Government of Uganda to support infrastructure development in 14 of the country’s Municipal Councils. The Uganda Support for Municipal Infrastructure Development (USMID) project will be one of the first in the world to pilot a new way of distributing World Bank funds to governments. The new pay-out process will link the disbursement of funds directly to project results. For instance, unless the Municipal Council completes the infrastructure they plan to build, no more money will be given to the government. That’s just an example. This process, called Program for Results, is important because it places a more direct emphasis on development results.

Addressing the Digital Divide

Tanya Gupta's picture

Perhaps the biggest challenge to harnessing technology for economic development is addressing the digital divide.  How can we do so?  This is a big question and to answer it comprehensively by looking at all the work on this area is beyond the scope of this blog. However let’s look at a few obvious ways of overcoming the digital divide:

(1) Development projects that focus on, and are relevant to the poor.  The Monitoring of Integrated Farm Household Analysis Project (IFHAP) was conducted every five years from 1996 to 2007 in the thirty-three (33) major rice- producing provinces in the Philippines.  The study noted the potential of mobile phones as key tool for information dissemination in agriculture as they are widely owned. In 2007, 90% of the farm households surveyed owned at least one mobile phone.  I agree with the authors of this study that while policy, infrastructure, and digital divide do indeed aid in assessing readiness; a social dimension is also present, which we ignore at our own peril.


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