Have we got our priorities right?

IMG_0985
This Coca-Cola was some of the last to be produced and sold in glass bottles in Malta. These are 300ml bottles. African bottles typically hold 350ml.

One morning in 1988 I arrived early for a meeting in Chinsali, a small town in NE Zambia. I went into the dilapidated council chamber. There was no one else there and on the table was a copy of the Mining Mirror. It stood out because I’d never seen a copy before (Chinsali is miles away from Zambia’s copper belt, where the Mining Mirror is published) and it was printed to a very high quality which contrasted starkly with the dilapidated surroundings.

On page three, bottom right was a picture of a desperate African mother cradling her dead child. Along with the photo was a caption that went something like this:

1 in 5 of our children don’t make it to their 5th birthday
When we’ve sorted out this human catastrophe
we’ll start looking into the AIDS issue

At that time this view was not unusual. AIDS was seen by many people in low income countries as a preoccupation of the rich world. It’s something we, in the rich world, could actually catch and die of – a direct threat to us. A child dying in Africa from diarrhoea evokes our sympathy but not our fear. Not so in Africa. Today, in Africa alone, 4 children die every minute from simple causes like dehydration from diarrhoea. That’s 5,500 a day, 2 million a year. And those statistics have not really changed significantly since that morning in Chinsali more than twenty years ago.

According to a recent BBC article, Uganda’s misplaced health millions, the imbalance continues today, at least in Uganda. I quote:

In 2008 alone, funding from Pepfar reached $283.6 million – an amount which easily exceeds the entire annual budget for Uganda’s ministry of health.

“It makes you wonder whether this assignment of funds is justified when the most frequent cause of death in Uganda is, in fact, malaria,” says Mr Angemi.

The Ugandan health ministry acknowledges the imbalance.

“Since ARV medicine is very expensive and HIV testing equally so, expenditure on HIV completely overshadows what is otherwise available in the health system,” says the state’s head pharmacist, Martin Oteba.

After many trips throughout Africa, Harvard’s Daniel Halperin, who has been researching the disease for 15 years, has made the same observations.

“Many people in the West believe that all Africans are impoverished and infected with HIV. Yet the reality is that many countries have stable HIV statistics of under 3%,” he says.

But in spite of this, the vast majority of support, particularly from the US, is given specifically to the war on Aids.

“This is because it is a disease that we ourselves have dreaded and have therefore placed it at the top of the global agenda.”

Sometimes African health ministries become over-burdened with the huge deliveries of ARV medicine which they do not have the time, finances or manpower to distribute.

“The healthcare systems cannot keep up,” says Esben Sonderstrup, chief health consultant for Danida, the Danish international development agency.

“Then, there is the serious risk of medicine expiring and becoming unusable.”

For Mr Halperin, it is completely mindless to target aid with such a narrow focus on a single disease.

“Why then should foreign donors continue to multiply Aids spending but use small change on projects which, for example, provide safe drinking water?” he asks.

Last year, according to Mr Halperin, the US spent $3bn on Aids programmes in Africa but invested a mere $30m on safe drinking water.

Mr Halperin cites other examples.

One fifth of the world’s diarrhoea-related deaths occur in just three countries: the Democratic Republic of Congo, Ethiopia and Nigeria, all of which have relatively low HIV statistics.

Yet diarrhoea, which is relatively straightforward to combat, is largely ignored by donors in favour of Aids programmes.

Comments

  1. Magdalena Serpa says:

    Dear Simon,

    I think that we need to fight against all the infectious diseases. There is an interesting and paper in the Economist:

    Disease and intelligence
    Mens sana in corpore sano
    Parasites and pathogens may explain why people in some parts of the world are cleverer than those in others

    http://www.economist.com/node/16479286?story_id=16479286

  2. Magdalena Serpa says:

    the paper is interesting and controversial.

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