Under the East Africa Public Health Laboratory Networking Project, diagnostic capacity has been strengthened through the construction of state of the art laboratories. © Miriam Schneidman / World Bank Group 2018
My interest in public health began in childhood and was marked by my experiences growing up in a low-income country with limited public health infrastructure. I felt firsthand the impact of an inadequate public health system when a beloved cousin succumbed to AIDS. My mother suffered a prolonged, resistant infection with complications after invasive surgery, and my family constantly battled malaria due to drug resistance or counterfeit drugs.
Accumulated scientific evidence shows that proper nutrition and stimulation in utero and during early childhood benefit physical and mental well-being later in life and contribute to the development of children’s cognitive and socioemotional skills. Yet, a critical but often overlooked fact in policy design and program development across the world is the association between maternal depression and childhood stunting -- the impaired growth and development measured by low height-for-age.
On September 20th, 2017, a young hunter, in his 30s, arrived at a health center in Kween District, located in Eastern Uganda, on the border with Kenya. He had symptoms of fever, bleeding, diarrhea, and vomiting. Within 5 days he was dead. Two weeks later, his sister also showed up at the same health facility: she had similar symptoms. Within a week, she too was dead. Posthumous samples confirmed that she had Marburg Virus Disease (MVD), one of the most virulent pathogens known to infect humans. On 19th October, the Ugandan government notified WHO and publicly announced an outbreak of MVD. Not long after this announcement, MVD claimed another victim – this time, the hunter’s brother.
This week at the Third International Financing for Development Conference in Addis Ababa, we’ve seen the birth of a new era in global health financing.
The World Bank Group, together with our partners in the United Nations, Canada, Norway, and the United States, just launched the Global Financing Facility in support of Every Woman Every Child. It’s hard to believe it’s been less than 10 months since the GFF was first announced at the 2014 UN General Assembly by World Bank Group President Jim Yong Kim, UN Secretary-General Ban Ki-moon, Prime Minister Stephen Harper of Canada and Prime Minister Erna Solberg of Norway. We’re grateful to the hundreds of representatives from developing countries, UN agencies, bilateral and multilateral development partners, civil society and the private sector who have contributed their time, ideas, and expertise to inform and shape the design of the GFF to get it ready to become operational.
This week in Addis Ababa, Ethiopia, during the Third International Financing for Development Conference, the United Nations, along with the World Bank Group, and the governments of Canada, Norway and the United States, joined country and global health leaders to launch the Global Financing Facility (GFF) in support of Every Woman Every Child. Partners announced that $12 billion in domestic and international, private and public funding had already been aligned to country-led five-year investment plans for women’s, children’s and adolescents’ health in the four GFF front-runner countries: Democratic Republic of the Congo, Ethiopia, Kenya and Tanzania.
Today is World Habitat Day. Created almost 30 years ago, the day promotes adequate shelter for all. Why should this be mentioned in a blog on investing in health? Because adequate shelter, including access to safe water and sanitation, is essential for health. Several million people, many of them chidren, die from diarrheal diseases every year. Many of these deaths can be attributed to unsafe water, poor sanitation and poor hygiene.
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.
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).
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.
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.