Browsing articles in "Development Aid"
6 February 2016
Shawn Clackett

Priorities for India’s Health Policy

Brookings
By Shamika Ravi and Rahul Ahluwalia

India’s health care sector is poised at a crossroads, and the direction taken now will be critical in determining its trajectory for years to come. In a recent Brookings India paper on the Indian government’s health care policy, we argue that it should prioritize expanding and effectively delivering those aspects of health that fall under the definition of “public goods’” for example, vaccination, health education, sanitation, public health, primary care and screening, family planning through empowering women, and reproductive and child health. These are all aspects of health with significant externalities and thus cannot be efficiently provided by markets.

Large gains in the nation’s health, and particularly the health of the poorest and most marginalized, can be made with this limited focus. As just one estimate, a 2010 World Bank study showed that India lost 53.8 billion USD annually in premature mortality, lost productivity, health care provision and other losses due to inadequate sanitation. Importantly, these gains can come very cost effectively, as demonstrated by India’s neighbors Bangladesh and Sri Lanka, which spend less as a percentage of GDP on health than India, but have better outcomes. It is not an expansion in spending that is critical for improving health outcomes. Instead, India needs to set appropriate goals and reform the public health care sector’s governance and management systems so that it is able to deliver on those goals. Evidence gathered globally and within India suggests that without good governance, additional spending would be worth little.

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23 November 2015
Shawn Clackett

Ridding Asia Pacific of malaria by 2030 achievable with $6 million Australian government funding boost

Australian Members of Parliament

Ms Sharon Claydon MP, Hon Sharman Stone MP, Senator Jenny McAllister and Dr Andrew Southcott MP are four of seven Australian Members of Parliament to visit Vietnam with the Global Fund, to witness firsthand the work done being done to reduce malaria rates in the Asia-Pacific Region

Mr. Bill Bowtell, Executive Director of Pacific Friends of the Global Fund to Fight AIDS, Tuberculosis and Malaria has warmly endorsed the Turnbull government’s plan to rid the Asia Pacific of malaria by 2030.

At the East Asia Summit held in Kuala Lumpur over the past weekend, Prime Minister Malcolm Turnbull announced that the Australian government will provide an additional $6 million towards the East Asian regional plan to eradicate malaria from the Asia Pacific.

“The Prime Minister’s commitment is both practical and visionary. The eradication of malaria will not only save millions of people from preventable suffering and early death, but also provides a stimulus to economic growth and promotes health security for our friends and neighbours”, said Mr. Bowtell. “We hope that Prime Minister Turnbull will continue to serve as Co-Chair of the Asia Pacific Leaders’ Malaria Alliance (APLMA) in order to oversee the implementation of this exceptional policy commitment”.

Malaria is a mosquito-borne disease. It is preventable and treatable, however it still claims over 50,000 lives each year in the Asia Pacific region.

“Between 2000 and 2013, thanks to increased funding and better strategies, the global malaria mortality rate has fallen by almost 50%, but we are seeing the emergence of new forms of drug-resistant malaria, especially in the Mekong region”.

This presents new challenges, but with increased funding of new treatments and preventive measures, eradication of malaria in the Mekong region is now an achievable goal.

Malaria – at a glance

  • Malaria is caused by a parasite called Plasmodium, which is transmitted via the bites of infected mosquitoes.
  • If not treated, malaria can quickly become life-threatening by disrupting the blood supply to vital organs.
  • Malaria is preventable and treatable.
  • Malaria claims over 50,000 lives each year in the Asia Pacific region and 600,000 globally.
  • New drug-resistant forms of malaria are emerging, especially in the Mekong region.
  • Preventive measures like the use of insecticide and mosquito nets have helped reduce mortality from malaria.
  • Improved funding and strategies reduced the global malaria mortality rate by almost 48% between 2000 and 2013.
  • Children and pregnant women are particularly vulnerable. In 2013 over three-quarters of all malaria deaths were in children under the age of five.

Half of the world’s population remains vulnerable to malaria. The Global Fund is a 21st-century partnership organization designed to accelerate the end of AIDS, tuberculosis and malaria as epidemics. Founded in 2002, the Global Fund is a partnership between governments, civil society, the private sector and people affected by the diseases. The Global Fund raises and invests nearly US$4 billion a year to support programs run by local experts in countries and communities most in need.

Prevention

Prevention involves the distribution of insecticide-treated nets, the use of indoor residual spraying of households and, if appropriate, interventions targeting the larval stages of the mosquito. For example, in Sri Lanka, larvivorous (larvae-eating) fish were introduced to bodies of water where mosquitoes normally breed. Through the middle of 2015, programs supported by the Global Fund had distributed 548 million nets to protect families. Sleeping under an insecticide-treated net halves malaria cases among children.

Treatment

As of mid 2015, programs supported by the Global Fund had provided 515 million treatments for malaria. In the last decade, we have seen the introduction of artemisinin-based combination therapies (ACTs), a new generation of antimalarial treatment that are highly effective. Unfortunately, however, we are already seeing resistance to the key ingredient, artemisinin, (as well as the partner drugs) develop in certain parts of the world. This is one of the great challenges facing us in the fight against malaria.

3 February 2014
Shawn Clackett

IFRC and Global Fund Target Tuberculosis Treatment for All in Niger

Global Fund News Release

IFRC and Global Fund Target Tuberculosis Treatment for All in Niger

31 January 2014

Geneva – The International Federation of Red Cross and Red Crescent Societies (IFRC) and the Global Fund to Fight AIDS, Tuberculosis and Malaria have signed a grant agreement to fund universal treatment for tuberculosis (TB) in Niger, a country with one of the worst rates of TB in West Africa.

A new two-year Global Fund grant of 10 million euros will allow the population of Niger, estimated at around 17 million, to access quality TB diagnosis and treatment services. The grant will expand and enhance TB services for more than 26,000 people in 200 treatment centres by 2015, targeting vulnerable populations, including those in nomadic communities, migrant groups and prisons.

TB is a major global health concern, killing 1.3 million people every year and infecting a further 8.6 million, despite being an entirely preventable and curable disease. In Niger, while overall numbers of people with TB have fallen in recent years, incidence of the disease is still high. The vast majority of TB cases can be easily cured when medicines are provided and taken as prescribed.

 “Access to sustainable diagnosis and treatment services is a burning priority in a country like Niger, where a lack of predictable funding, sustained technical support and health care workers have seriously undermined the government’s capacity to regularly provide quality TB services and distribute drugs” says Bekele Geleta, Secretary General, IFRC. “With support from the Global Fund, we will be able to ensure access to treatment for people living in the most underprivileged areas, especially those facing discrimination and living on the margins of society.”

In Niger, despite a high degree of political commitment and local ownership of the TB response, the disease is putting a heavy strain on an already overburdened health system. Treatment can take up to six months and requires extensive supervision and patient support by a health worker or trained volunteer. Without this, treatment adherence can be difficult and the disease can spread further.

“This grant will support and strengthen existing in-country capacities, working closely with the National Tuberculosis Program of the Ministry of Health” said Mark Dybul, Executive Director of the Global Fund. “The IFRC is an excellent partner combining a unique community perspective and experience that will accelerate scale-up of TB interventions and provide faster screening of at-risk populations.”

In Niger, only 46 per cent of people with TB are ever tested for HIV. HIV and TB form a lethal combination, each speeding the other’s progress. Someone who is infected with HIV and TB is much more likely to become sick with active TB. The grant will ensure that all TB patients will access HIV testing and early treatment services.

“We believe that no one should be left behind in the fight against TB” said Geleta. “Equitable access to quality diagnosis and treatment services, combined with skilled community volunteers – is the winning formula to accelerate progress towards zero TB deaths, infections and suffering.”

27 November 2013
Shawn Clackett

Global Fund Takes Action to Prevent Wrongful Conduct

GENEVA – The Global Fund to Fight AIDS, Tuberculosis and Malaria announced today that as part of its broad program to prevent abuse of any kind, it suspended contracts with two international suppliers of mosquito nets after uncovering evidence that they committed serious financial wrongdoing in Cambodia.

The Global Fund has zero tolerance for wrongful conduct. It actively investigates and uncovers fraud, takes swift action against wrongdoers, and pursues recovery of misused funds. Committed to an exceptional degree of transparency, the Global Fund openly publishes its investigation reports.

The Global Fund’s Office of the Inspector General today published an investigation report that found that between 2006 and 2011, two international suppliers paid commissions to two Cambodian officials totaling approximately US$410,000 in return for awarding contracts for insecticide-treated nets that prevent the spread of malaria. Based on recommendations of its Sanctions Panel, the Global Fund has suspended contracts with the two suppliers, Vestergaard Frandsen and Sumitomo Chemical Singapore, pending a full review.

Vestergaard and Sumitomo both fully cooperated with the investigation, have taken action against the employees involved, and have taken preventative steps to deter wrongful conduct in the future, agreeing that stronger measures will better serve the common goal of preventing the spread of malaria, particularly in high-risk countries.

“We cannot tolerate unethical conduct anywhere,” said Mark Dybul, Executive Director of the Global Fund. “Although this case had no direct impact on Cambodia’s fight against malaria, taking commissions in exchange for contracts violates our mission of public service. We remain fully committed to pursuing fraud and taking action when we find it.”

The Global Fund has supported programs in Cambodia fighting AIDS, TB and malaria with US$331 million disbursed since 2003, achieving striking success and playing a key role in Cambodia’s achievement of an 80 percent decline in malaria deaths, a 45 percent fall in TB cases and a 50 percent decline in cases of HIV.

Over the past two years, the Global Fund has taken multiple actions to protect its investments by significantly strengthening deterrence and minimizing the risk of abuse.

Strong financial oversight, paired with heightened risk mitigation, is now built into the implementation process for each grant, no matter how big or small, and a governance and execution mechanism has been established to recover misused funds.

A new framework for procurement was established, with a comprehensive approach to ensure all bulk purchasing is consistently undertaken in a fair, transparent, lawful and ethical manner. Over the past year, the Global Fund has tripled the value of products covered by safer pooled procurement practices. In 55 countries identified as high-risk for procurement, 83 percent of products are now in pooled procurement, just above the benchmark 80 percent used in the private sector.

The investigation found that, while a Global Fund grant in Cambodia was compromised by the commission payments, all the mosquito nets procured by that grant were provided as intended.

The investigation report identified wrongful conduct in three entities in Cambodia disbursing funds from the Global Fund. In addition to the two Cambodian officials who accepted financial inducements from suppliers of nets, the report also cites improper charges and manipulation of procurement practices at two other organizations. The wrongful conduct identified in the report involves a total of approximately US$431,000.

The Global Fund Sanctions Panel, with both internal and independent experts, evaluates cases where sanctions may be warranted. The Sanctions Panel recommended that the two suppliers named in the Cambodia report be suspended pending a full review of the case.

Other steps were taken in Cambodia. The Principal Recipient for a malaria grant was replaced, after the evidence identified two officials of the National Centre for Parasitology, Entomology and Malaria Control (CNM) who accepted commissions in exchange for awarding contracts. Fiduciary and procurement agents were appointed to work within another implementer, the National Centre for HIV/AIDS, Dermatology and STD Control (NCHADS) and fiduciary controls are being strengthened at key higher-risk sub-recipients.

The Global Fund’s investigation began in 2011, and the report took two and a half years to complete. It involved analysis of a wide scope of data and a complex investigation of multiple entities. In addition, to be fair and to follow due process, those affected by the report and their legal counsel were provided with multiple opportunities to assess the findings and to respond appropriately, at various stages of the investigation.

The Global Fund’s systematic work on risk management and controls, and its effective use of audits and investigations, reflect a strong commitment to preventive measures and are expected to lead to fewer cases of wrongdoing in the future.

15 October 2013
Shawn Clackett

Time to eliminate malaria in southern Africa

As published in the Business Day Wednesday, 9 October 2013.

Malaria continues to be a drain on our people and our economies but, with adequate resources and commitment, we can imagine a malaria-free southern Africa, write Richard Feachem and Yvonne Chaka Chaka

Richard Feachem

Richard G A Feachem is Director of the Global Health Group at UCSF Global Health Sciences

Yvonne-Chaka-Chaka

Yvonne Chaka Chaka is a South African singer and Roll Back Malaria Partnership Goodwill Ambassador

One of the largest gatherings of the malaria community, the Multilateral Initiative on Malaria, takes place in Durban this week. This year’s theme, Moving towards malaria elimination: Investing in research and control, calls for stakeholders to take stock of the gains made in the global fight against malaria and to commit to a goal that many believed unreachable a decade ago: a malaria-free southern Africa.

Success in the fight against malaria has been remarkable over the past decade: malaria deaths fell 33% in Africa and 21% worldwide between 2000 and 2011. Southern Africa, in particular, has seen dramatic progress. South Africa, for instance, has cut malaria cases 85% between 2000 and 2011, thanks to steady malaria control in the three malarious regions of Limpopo, Lubombo and Mpumalanga. Today, much of South Africa is malaria-free and the country aims to eliminate it by 2018. Similarly, Swaziland has achieved a 98% decrease in reported cases from 2000-2011 and is on track to eliminate malaria by 2015, which would make it the first country to eliminate malaria in mainland sub-Saharan Africa — a historic achievement.

But maintaining momentum depends on overcoming a number of important challenges, including insufficient funding to finish the job. With the major external source of funding for malaria, the Global Fund to Fight AIDS, TB and Malaria, changing its funding model to prioritise applications from low-income and high-burden countries, countries in southern Africa are vulnerable to a decrease in support for their activities. This could undo years of work and millions of dollars of investment and, worse, it could allow a resurgence of malaria. Given this risk, governments must step up and commit resources to get the job done.

One opportunity for additional support lies with South Africa. As the leading economy in the region, South Africa can make an important contribution by supporting malaria control efforts in neighbouring countries where the malaria burden is higher, as a way of protecting itself from imported cases. In 2010, at least 70% of the malaria cases in Mpumalanga were imported from other countries. Preventing malaria at home will also reduce the number of South Africans exporting malaria.

As malaria knows no borders, regional initiatives that encourage collaboration between countries can help address the challenge of malaria importation. For example, the Elimination 8 is a regional initiative that supports the goal of malaria elimination in the eight southernmost African countries. Chaired by Namibian Health Minister Richard Kamwi, it encourages cross-border initiatives between countries, such as the Lubombo Spatial Development Initiative between Mozambique, South Africa and Swaziland, and the Trans-Kunene Malaria Initiative between Angola and Namibia. The malaria control programmes of these countries support each other’s malaria efforts by harmonising interventions, such as use of insecticides or malaria testing in border regions. But these partnerships are challenging to implement. Lack of funding to support cross-border projects, as well as political and administrative hurdles, can hamper success. Additional support from governments across southern Africa is needed to facilitate these partnerships.

While governments are strengthening national and regional efforts to eliminate malaria, researchers and implementers are rising to other challenges, developing innovative solutions, tools and technologies to eliminate malaria.

The progress of the past decade is impressive but fragile. We know from experience that once malaria is eliminated or driven to low levels, if efforts wane, it can be easily reintroduced. With the unstable economic situation of many donors, external support is at risk. The governments of southern Africa must renew their political and financial commitment to malaria elimination, and to essential regional collaborations.

Southern African leaders and governments need to act now and commit to malaria elimination — and to dedicate national resources to the goal. Malaria continues to be a drain on our people and our economies. But with adequate resources and commitment, we can imagine a day when we will be able to drive from Cape Town to Dar es Salaam through a completely malaria-free southern Africa.

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Pacific Friends operates as a program within the Kirby Institute at the University of New South Wales.

Pacific Friends

Professor Janice Reid AC
Chair
Bill Bowtell AO
Executive Director

Pacific Friends of the Global Fund to Fight AIDS, Tuberculosis and Malaria is a high-level advocacy organisation which seeks to mobilise regional awareness of the serious threat posed by HIV & AIDS, tuberculosis and malaria to societies and economies in the Pacific. In pursuing its goals Pacific Friends has a specific interest in highlighting the need to protect the rights of women and children in the Pacific.

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