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Submitted by Anonymous on
I wish the World Bank (and indeed the rest of the world too) would go back to public health fundamentals and instead of presenting a compelling case for one issue - invest time presenting evenhanded analysis of financing challenges and opportunities for multiple issues in a way that helps support more efficent investments and allocations overall. While there are clearly efforts to do this, we are still starting from a skewed position - not just at the Bank, but globally (including at the Global Fund for AIDS TB and Malaria where financing is 52%, 32%, and 16% respectively). The loudest single voiced advocacy dictates investment patterns and it tends towards the atonal braying kind, rather than a harmony between voices that ought to be raised together when there is common cause. The classic example of this is the asymmetric response to HIV and TB by the Bank and other development partners both in staff, analytic work, and financing. Apart from the many other health challenges worthy of support and engagement - Africa indeed has an HIV/AIDS epidemic, but also a TB epidemic, and a TB/HIV epidemic - the latter two are woefully neglected. Every year 1.1 million people living with HIV get sick with TB and 1 in 4 AIDS deaths are due to TB (430,000 people living with HIV die from TB each year). Africa now has the highest number of TB deaths (HIV+ and HIV-) of any other region. Is is also not on track to reach the TB MDG-related target of 50% mortality reduction by 2015 unlike other regions that are on track. This is due to HIV/AIDS on one hand, and a breathtaking (excuse the pun) negligence by the international community to address TB and to co-epidemic of TB/HIV. For example, for every $100 going to Africa from the Global Fund, $6 is for TB. It would be interesting to compare Bank investments in HIV/AIDS and TB over the last 5 years... To illustrate the skew - here are some figures on total global donor financing per year: HIV/AIDS - $6.9 Billion Total deaths - 1.7 million (430,000 of which are TB deaths among HIV+) Malaria - $2 Billion Total deaths - 655,000 TB - $480 million Total deaths - 1.4 million (430,000 of which are TB deaths among HIV+ ...yes, these are the same that are counted in HIV/AIDS) The bottom line is that when a person with HIV dies of TB it is a public health failure. When major investments in HIV are made in countries struggling with a co-epidemic of HIV and TB - and there is limited or no effort to address the co-epidemic, it is irresponsible and dangerous (...and inefficient). It is exciting that PEPFAR's blueprint for an AIDS-free generation puts addressing the TB/HIV co-epidemic as its first priority under it's 'roadmap for smart investments' - it's exciting because no major player in global health has prioritized this before. The Bank is well placed to provide leadership and momentum here - but there is little evidence that this is happening (yet)... signed - impatient, but optimistic