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AIDS, Malaria, TB: World must Step up with Needed Funds

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Each year, AIDS, TB and malaria kill six million people and disable hundreds of millions more, mostly in developing countries. The economic and social destruction caused by these three diseases is devastating.

Malaria is a completely preventable killer. Insecticide–treated bed nets, costing as little $10, can reduce incidence levels by 50 per cent. Yet, one million people, the vast majority children under five, die from malaria annually – the equivalent of 50,000 classrooms full of preschool kids wiped out each year.

Tuberculosis kills 1.7 million people each year. It is a disease of poverty, preying on those with weakened bodies and compromised immune systems. As such, TB is a leading killer of people with HIV. Now, HIV/AIDS in sub–Saharan Africa is on the verge of spreading to highly populated countries such as China and India. These two countries alone account for one–half of the world’s cases of tuberculosis. The introduction of HIV into India and China would be like putting a match to a powder keg.

Apart from the human toll, these three diseases have an immense economic toll. HIV/AIDS is expected to slash overall economic activity in Africa by one–quarter. TB often strikes young adults, putting entire families into financial crisis when a breadwinner is afflicted. It is estimated that malaria alone costs Africa $12 billion US annually in lost productivity. The best stimulus package for fragile economies is a healthy workforce.

In one of the brightest multilateral moves ever, the Global Fund to fight AIDS, Tuberculosis and Malaria was created in 2002 to respond to these formidable challenges. It is, by all estimations, one of the leanest and meanest organizations ever to come into existence. It was set up to get around some of the worst aspects of international development: cumbersome and wasteful strategic alliances; corruption in some countries; and self–interested aid disbursement by rich countries seeking to increase access to markets or bolster strategic alliances.

One guiding principle of the fund is local ownership. Country–level partnerships between government agencies, civil society, private–sector institutions, donor agencies, NGOs and affected communities are created to ensure that a broad range of stakeholders have input into the development of grant proposals. The proposals are evaluated by an independent technical review panel comprised of disease and development experts.

Since the fund has no field staff, it relies on the partnerships to oversee the implementation of approved proposals and on independent local auditors to verify the accuracy of recipients’ progress reports. Only grants with satisfactory performance as measured against agreed targets continue to receive renewed funding. This is known as "performance–based funding," another guiding principle of the fund.

The results of this novel, pragmatic approach are stunning. Since its inception, the fund has approved grants in 137 countries, with priority given to those with the greatest present disease burden and those at risk of future disaster. These grants have provided more than two million antiretroviral treatments, 4.6 million TB treatments and 70 million insecticide–treated bed nets to protect families from malaria. In addition, they have also helped strengthen local health systems and fund training, prevention and education programs. But the fund’s bottom line is that it has helped save 3.5 million lives in its short existence.

The fund, with its bottom–up, results–oriented approach, is a model mechanism for mobilizing resources to address the most serious global health problems of our time. Its unparalleled success has prompted the model to be used in other areas, such as sanitation and possibly education.

The fund realized earlier this month that it faces a shortfall of $5 billion to meet the demand for the funding of projects in 2009 and 2010. This is largely due to a significant scale–up effort by many countries in malaria interventions, particularly for coverage with insecticide–treated bed nets. This was in direct response to UN Secretary General Ban Ki–moon’s call for universal coverage in Africa by 2010. Today is World Malaria Day, one year since this bold, but achievable goal was set. The fund is the world’s largest funder of malaria control programs.

Due to this unexpected shortfall, donor countries are being asked to top off their existing contributions. Canada has been a strong supporter of the fund in the past. In fact, 40 per cent of our overall spending to combat AIDS, TB and malaria flows through the fund. We need to build on this support and leadership.

Currently, we are second–last among G8 countries in terms of total pledges. Our fair share of five per cent of the shortfall would be an additional $250 million over two years. Senior officials from the fund have been in Ottawa this week meeting with MPs and key government officials, trying to instil a sense of urgency and to stress that many worthy, life–saving project proposals will be turned down without adequate new funding commitments from Canada and other donor countries.

Failure to contribute our fair share would be a major stain on our reputation of being a caring nation. We cannot act like innocent bystanders while the carnage from AIDS, TB and malaria causes millions of people to suffer and die needlessly.

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