General foreign aid and health aid are up but donors still not meeting targets

This blog was originally published by Global Health TV on Oct. 29, 2014.

After two years of declines, overseas development assistance (ODA) rebounded in 2013, but most donors have not met their commitments and are not sending a high enough proportion of their aid to the poorest countries, according to the ONE Campaign’s 2014 DATA Report.

Global health funding hit an all-time high of $31.3 billion in 2013, and funding for maternal, newborn and child health increased by nearly 18% between 2010 and 2011, reported the Institute for Health Metrics and Evaluation at the University of Washington in its annual report on global health financing.

And while aid donors are finally showing signs of improvement in meeting transparency commitments on that ODA, the majority – including the United States – is a long way from its commitment to adopt standards set by the Aid Transparency Index 2014.

These were some of the headlines coming out of two reports released this month, but very much overshadowed by the justified focus on Ebola, as well as an earlier report on global health financing released in April.

In Costa Rica, strengthening health systems has a human side

A lab technician at the blood bank of Hospital de los Niños in San Jose.

NOTE: This originally appeared on the Impatient Optimists blog on February 28, 2013.
 
SAN JOSÉ, Costa Rica — Until I came here, I thought of “health system strengthening” strictly in clinical, technical terms – as a set of procedures for improving HIV testing, disposal of bio-waste, and health data management.

It is indeed all of those things, as I learned during a visit to a program working to improve care for people living with HIV led by IntraHealth International , a non-profit organization that empowers health workers to serve better communities in need,  but it also has a more human side.

Over two days, I spoke with a dozen health workers and managers about IntraHealth’s Central America Capacity Project. Several of them referred to these technical improvements as the calidad (or quality) side of health system strengthening, but they seemed to place equal emphasis on calidez (warmth). Many of the calidez changes can be made without incurring much, if any, financial cost. Virtually all of the health workers I talked to gave me examples of calidad and calidez:

• A lab technician at Hospital Dr. Max Peralta in Cartago, about 20 kilometers from downtown San José, emphasized improved procedures in handling of bio-wastes (calidad).
• The head of the blood bank at the Hospital de los Niños (Children’s Hospital) said that one of Capacity’s most important changes was simply securing a room where blood bank staff could talk to blood donors in private (calidez).
• Dr. Luis Ledesma, former director of Hospital de las Mujeres (Women’s Hospital), says Capacity has improved both types of health care, and he gave an example of each. Calidad: Improving and increasing HIV testing. Calidez: Calling a person by their name.

AIDS prevention must be more of a priority

Everyone working in HIV/AIDS -- as I have been for 17 years since I founded Society for Family Health, the leading HIV prevention organization in Zambia in 1992 -- has heard the aphorism "We can't treat our way out of this epidemic" and everyone knows that for every person that goes on treatment, there are several more new infections.

Both Randall Tobias and Mark Dybul, the first two PEPFAR coordinators, always said that HIV prevention was a priority. But in reality, prevention was never a priority with PEPFAR and could never be a priority since the law that created PEPFAR hamstrung prevention efforts by limiting them to 20% of the budget. And the bitter political battles swirling around HIV prevention during the eight Bush years prevented an evidence-based formula for measuring the number of HIV infections from being implemented. Instead, PEPFAR was reduced to measuring prevention with process indicators such as messages transmitted and campaigns conducted.

I thought of all of this today when reading the press accounts of the visit of Secretary of State Hilary Clinton to HIV/AIDS programs supported by the U.S. government in South Africa. Treatment dominated Secretary Clinton's visit and understandably so, given the fact that South Africa has more HIV-positive people than any other country in the world. But where is prevention in all of this? After all, even South Africa, with its vastly greater resources as compared to any other sub-Saharan African country, cannot treat its way out of its epidemic.

That is why I was so pleased to see, hidden at the end of today's Washington Post account of Secretary Clinton's visit to South Africa, the following paragraph:

"U.S. Rep. Nita M. Lowey (D-NY), the head of the House Appropriations subcommittee that funds foreign aid programs, said at the ceremony that she hopes to see more assistance going toward prevention, rather than just treatment."

Bless the heart of Rep. Lowey for reminding us of this simple fact: We will never get ahead of the AIDS pandemic until we focus more on prevention, which continues to be grossly neglected. It is so much easier -- although much, much less cost-effective -- to treat people after they have been infected than to prevent the infection in the first place.

And it is awfully messy -- not to mention politically perilous -- to protect injecting drug users, sex workers and the men who patronize them, and even more controversial when we direct efforts at adolescents who most adults would prefer to pretend will be celibate until marriage.

Thanks to Rep. Lowey for reminding us of the importance of prevention, and let's hope Eric Goosby, the incoming PEPFAR coordinator, hears her plea, and directs more PEPFAR resources into prevention, finally. The future of the pandemic depends on it.