Pay more attention to silent killers

Health activists Médecins Sans Frontières (MSF) claimed last week that the global recession threatens Aids funding, putting millions of lives in Africa at risk.

Donors certainly have to think more carefully about getting the biggest bang for their buck but this is long overdue.

For too long, global health funding has gone to diseases like Aids with the most vocal lobby groups and not to the diseases with the greatest need.

HIV/Aids is the world’s most high profile disease. “World Aids Day” garners an astonishing 32.3m hits on Google.

According to a 2007 poll conducted by the Kaiser Family Foundation, people questioned in eight out of 10 sub-Saharan African countries consider Aids to be their country’s number one health priority.

The same poll shows people in Asia also believe HIV should be a major priority for their governments, with those in India and Bangladesh putting it at the top.

In fact, HIV/Aids causes only 5.7 per cent of deaths in developing countries.

Eight countries do have a severe Aids crisis, all in sub-Saharan Africa (Botswana, Lesotho, Mozambique, Namibia, South Africa, Swaziland, Zambia, Zimbabwe), hence the misperception among their neighbours.

The prevalence in South Africa is a massive 18.1 per cent but in India prevalence is a tiny 0.3 per cent and in Bangladesh it is too small to calculate.

In Kenya it is around eight per cent but new infections are falling.

That HIV/Aids is at the front of ordinary peoples’ consciousness is a result of decades of campaigning by international activists, perhaps the best organised and most powerful health lobby the world has ever seen.

A staggering 24,000 delegates, many of them professional campaigners, attended 2008’s biannual International Aids conference in Mexico City — and that’s just the ones who could afford the airfare and the $1,200 entry fee.

Since the early 1990s, thousands of Aids NGOs have sprung, producing a constant stream of publicity and advocacy.

Major development pressure groups such as Oxfam and Save the Children have put Aids at the heart of their lobbying.

As a result of this lobbying, the cash has poured in.

Aids spending rose from 3.4 per cent of all health aid to developing countries in 1990 to 23.3 per cent in 2007, from $0.2bn to $5.1bn.

President Obama has pledged to increase spending on Aids to 70 per cent of all US global health spending in 2010: US$8.6 billion, totalling US$63 billion over six years. And there is a dedicated UN agency, UNAIDS.

But much of this money has been poorly spent.

The Aids industry boasts about the millions of people on anti-retroviral treatment but almost no progress has been made in actually reducing the numbers infected globally— the only true measure of success.

Meanwhile, diseases that kill many more remain in relative obscurity.

The biggest killer in lower-income countries is chest infections such as pneumonia, accounting for 11.2 per cent of all deaths, mainly amongst children under five.

There is no UN agency for chest infections, almost no dedicated funding and only a sprinkling of NGOs.

Bizarrely, the first World Pneumonia Day was on November 2 this year, although this disease has always been a scourge of humanity.

The third biggest killer in developing countries, after heart disease, is diarrhoea.

This kills 1.5 million children every year, more than Aids, malaria and tuberculosis combined.

Yet there is no World Diarrhoea Day and the disease attracts a fraction of the funding of HIV/Aids.

There is only one staff member at the World Health Organisation working exclusively on childhood diarrhoeal diseases.

Easy management

Fortunately, things are beginning to change.

The UN has started pleading for funds to improve health systems, so that “silent killers” such as pneumonia and diarrhoea can be better tackled.

Some government aid agencies, such as Britain’s Department for International Development (DfID), plan to spend money on improving healthcare systems, rather than on specific diseases such as Aids.

Better healthcare systems also make it easier to manage HIV patients, who tend to have other health problems.

“Some policymakers say Aids is expensive, we should focus on cheap and easy things,” Tido von Schoen-Angerer from MSF said last week, adding: “It’s not that HIV is over-funded. Global health is under-funded.” Cutting through the lobbying of the Aids industry and focusing on the real problems would be a good way to start.

Stevens is a Senior Fellow at International Policy Network, a development think-tank based in London.