BBC asks, "Is Africa spending too much $$$ on AIDS?"
 

Uganda's misplaced health millions



This health centre lacks even the most basic equipment


By Jeppe Villadsen
BBC Focus on Africa magazine, Nairobi



On a sun-drenched Sunday after a weekend in the country with his wife and two colleagues, Diego Angemi drives from the Sipi Falls in eastern Uganda towards the capital, Kampala.
He has travelled this stretch of road many times before but this time there is a dramatic turn of events. A hit-and-run accident has left a boy lying unconscious at the side of the road.
They rush the boy to a regional hospital in Mbale, a village about 200km north-east of Kampala, in the hope that they can save his life.
Their hopes are soon dashed. In the hospital's emergency room, apathetic staff must be persuaded even to investigate the boy.
"Unbelievably, the doctor seemed almost annoyed by the fact that we had brought the boy in," Mr Angemi recalls.
The reason for the staff's apparent numbness, however, soon becomes clear.

In contrast to the health centre, this research centre is worth millions

There is no equipment in the department, not even for basic resuscitation procedures. The emergency room has neither oxygen nor equipment for monitoring blood pressure. There is not even a simple penlight to investigate eye movement.
"While we sat waiting and hoping that the doctor would take responsibility we realised that the boy's hands were turning cold and that his pupils were dilating. He died right there in front of us," Mr Angemi says.
Huge imbalance
Although the emergency room of this local hospital is dysfunctional, right next door is a newly-erected building belonging to Taso, a Ugandan Aids support organisation, which houses medicine and hospital equipment worth millions of dollars.
Nearby is an arm of the Joint Clinical Research Centre (JCRC), the self-governing state institution which researches HIV and Aids. JCRC is the largest provider of anti-retroviral (ARV) medicine in sub-Saharan Africa.
Both these organisations are recipients of multi-million dollar support from the US. One of the main American funders is Pepfar - the President's Emergency Plan for Aids Relief.
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."
Multitude of diseases
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.

DEATHS IN UGANDA
Aids: 94,000
Malaria: 41,000
Diarrhoea: 30,000
Tuberculosis: 15,000
Measles: 7,000
Tetanus: 7,000
Source: World Health Organisation, figures from 2002
"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.
No-one turned away
At the main Taso centre in Masaka, southern Uganda, there is a new building with a bright, newly furnished office stocking an excess of campaign materials.
Martha Nakayma, a 26-year-old public-relations assistant, relays the demands of a district which has an estimated 80,000 HIV-positive inhabitants. Already more than 25,000 people have received help from the centre.
Aside from doctors, nurses and social workers, personnel at the Taso centre include nine information technology assistants and two marketing people.
Pepfar is Taso's main donor, providing approximately 60% of the funding.
"We are always able to offer the right medicine to our patients. It has never been necessary to turn anyone away," says Ms Nakayma.
She explains that one day each week is reserved for home calls to those who live far away.
A skills development programme for patients means the hum of sewing machines is often heard. In addition, there is a theatre group for productions on HIV-related topics.
"We also offer massage and special aromatherapy which can help to alleviate pain," she says.
Elsewhere, there are local general medical clinics like the Ssekiwumna Health Centre situated on a dirt track off a main road outside Kampala.
On an average day, up to 30 patients visit the clinic, typically with conditions like malaria, skin infections or diarrhoea.
Its annual budget is just $3,500.
No apologies
One of the biggest problems in institutions like this is the unreliable delivery of medicine and the lack of transport facilities, says Charles Mugyenyi, a health worker at the centre.
His dream is to purchase a motorcycle for the small clinic.


African leaders recently announced a joint bid to tackle malaria

All this stands in stark contrast to the large sums pumped into Aids' centres by international donors.
"Of course a lot of money goes to HIV/Aids because it is a terrible illness, but more should go to programmes like vaccination campaigns, tuberculosis and family planning," says Mr Mugyenyi.
So what do the representatives of Pepfar make of the criticism?
Premila Bartlett, Pepfar's coordinator in Uganda, says they have nothing to apologise for.
She argues that, unlike many other international organisations which had "lofty goals" to get people on treatment, Pepfar has actually committed resources to the disease and in doing so has made things happen.
Pepfar, she says, is certainly not trying to undermine the existing system but rather to repair something which "in many cases is in pieces".
One of the problems is government commitment.
"If that isn't there, the system isn't going to get fixed and the people won't get the services they need."


BBC World

Same old story. Aid given to Africa ends up either in politician's pockets or warlord's pockets to the detriment of those who it was supposed to help.

a clever ambulance driver would have given the kid aids before taking him to the better hospital.

AIDS, schmAIDS. SO eighties.

Things always take a bit longer to get to these places. Like New Zealand. Africa will probably get the New Romantics pretty soon.

He's dead. Tragic if bizarre skiing accident many years ago.

Accident schmaccident! Bono lives again! If you strike him down he'll only come back stronger.

Africa probably doesn't know who Bono is even. Does that mean they'll only get all that charity money in about 25 years?

Tell Cher.

No, on second thought...

Cher is 142 years of old!!! Did you know that!!

I wouldn't ask for her ID in bed.

Thanks for the advice...

Never look a gift whore in the mouth.

I'm wondering how many SuchFriends threads we've derailed.

Oh yes, I do that far too often.

One for you:
Never poke a gift in the horse throat.

42.5443 - this one isn't complete.

By the way, I'm glad to be working with you on these projects.

We'll take them down one by one. Tomorrow belongs to us.

10.09 - it has been written...thread doomsday is upon us.

This is actually an interesting thread. Sorry for derailing it!

I know.. the controversy with AIDS spending in Africa is at many levels..

today in Africa WHO statistics are often grossly inflated to receive or prioritize AIDS medication funding. this creates an inbalance as demonstrated by the article in Uganda. However this is only a manifestation of a bigger problem with AIDS taking to high a priority in Africa today.
On a fundamental level, AIDS medication in particular has received to high a focus and priority over more basic requirements such as water sanitation, food production and distribution of more conventional medicine and medical attention. For example, many many diseases kill and afflict many many africans, it is estimated that preventable diseases are the single largest contributor to underdevelopment and underproduction in Africa by crippling the labor force with delibitating diseases. If these diseases were treated properly, Africa could develop beyond its problems and be in a proper position to tackle AIDS/HIV.
Further, even for those who have AIDS, what is more important clean water or AIDS medication? From AIDS you die from OTHER diseases, so technically speaking, the most effective way to save peoples lives from AIDS is to deal with the other preventable diseases which ACTUALLY kill even those with AIDS. People with AIDS need clean water, food and medical care MORE SO than anyone, and MORE SO than they need specific AIDS medicine. What good is AIDS medicine if the water your drink is full of disease or parasites? What good is AIDS medicine if you have nothing to eat? What good is AIDS medicine if you die from malaria or yellow fever or meningitis or one of the other 300 odd preventable diseases which kill in Africa today? AIDS is blown well out of proportion considering the SPECIFIC AND IMMEDIATE NEEDS in Africa as we speak.

Not sure if you said this...I imagine the reason is that the people funding the research etc aren't doing it for Africans but rather to help prevent Aids becoming a problem in their/western countries.

true, but there is a HUGE amount of international pressure and funding in Africa on AIDS.. it is highly prioritized, often-times above more pressing or easily solved problems. It is a better investment to build water and medical infrastructure FIRST, then use such networks to distribute AIDS medicine to an over-all healthier population.. but the Bonos of the world pump pump pump the AIDS crisis it deafens the other issues.

Yeah true. I just think that maybe all the funding isn't necessarily entirely altruistic.

The more research done the sooner we'll find a cure. Fuck it if people in Africa are or not helped by it - I think that is the hidden attitude in much of this.

true, how terrifyingly true :(

personally, science theorizes that 10% of ALL humans are entirely immune to all viruses. I believe that the system has an agenda to let all the other folks die off and the survivors from the ten-percenters become the new race of heroes.. nazism revived! Why else do police dogs speak german?

It's only nazism revived if the ten-percenters are all Aryan. What if they were all black. Would that be marxism revived?

marcus garvey's wet dream!

I bet those 10% wil be Puerto Ricans.

BORIQUA!

I see, you like Glice, have misinterpreted Garvey and Rastafari concept of Black Supremacy. It is not to be mistaken as similar to white supremacy. Black Supremacy does not teach the blacks are superior to whites or all other people and races as white supremacy does. Garvey and the UNIA is not a KKK for blacks to hate whites..

It is the concept of black power and supremacy in black places such as Africa, the South, or the Caribean, where white supremacy, racism and colonialism have and continue to disenfranchise and even brutalize black peoples. When Rastaman say, "Black Supremacy" they do not imply automatic inferiority of others, as in White supremacy.

So Garvey's paradise is not a world of only black folks, but rather a world where black folks control what is theirs, Africa for the Africans as he said.

What was the philosophy of The Black Panthers?

Black power and community activism. Much like the UNIA the Panthers ran afterschool programs, neighborhood clean up/watch groups, soup kitchens, food banks, loan and financing for the poor, and especially the development of black-owned and operated businesses, exactly as Garvey's UNIA had achieved 40 years previous, and exactly like the UNIA was shut down PERSONALLY by Hoover and the FBI.. Both Garvey's UNIA and The Panthers were of the greatest social movements to arise in American history, had they not been infiltrated, set up and destroyed, they would be as important in American history as the Founding Fathers or the Sons of Liberty..

...and hiding tim leary!!
how were they set up?

CIA agents were selling heroin through neighborhood crews like Avalon and Pirus who would in 1971 become the bloods and Main Street who became the Crips. The CIA was using these neighborhoods to sell heroin from Vietnam since that late 1950s. In the late 1960s the Black Panthers were especially active in South Los Angeles, Watts and Compton, and so the gang and drug dealing activity went into significant decline. The CIA upped their game, sent more cadres in and initiated a surge in drug dealing by flooding the streets. They instigated gang violence through assassinations, rumors and set ups. They supplied the dope, the guns and the rumors, the Crips and Bloods started the rivalries. The Crips started as a result of the little brothers and homies of the former Panthers who had by 1971 either been arrested or assassinated. Marcus Garvey and the UNIA were set up by Hoover personally through three cadres we call Bag-o-Wire who sabotaged Garvey's business and stock efforts and eventually set him up for mail fraud and sent him to prison and deported him. Then more cadres infilitrated the UNIA neighborhoods and forced the decline of UNIA business and organization.. black power has always been a threat the the US. Why do you think Obama sold out Henry Louis Gates Jr and now even Jimmy Carter!