Health in the Third World.
My favourite coffee shop is a place called THINK because it serves tasty tuna-artichoke sandwiches, chocolate-flavoured herbal tea, and often plays music I own on its soundsystem. (I'm one of those sad sacks who gets a huge kick out of hearing music I own played in public.) They also subscribe to Foreign Affairs which is how I found this fascinating article by Laurie Garrett on the health crisis in the Third World.
Garrett argues that the global focus on AIDS is having adverse effects on health infrastructure-building and primary care in the Third World. For instance, in Haiti, "the past several years have witnessed the successful provision of antiretroviral treatment to more than 5,000 needy Haitians, and between 2002 and 2006, the prevalence of HIV in the country plummeted from six percent to three percent. But during the same period, Haiti actually went backward on every other health indicator."
In part, this is because the influx of foreign money into AIDS clinics and the like discourages governments from integrating these specialty clinics into their public health system, creating a sort of two-tiered health system for people with and without HIV. Another problem is the effect on health personnel:
Compounding the problem are the recruitment activities of Western NGOs and OECD-supported programs inside poor countries, which poach local talent...PEPFAR-funded programs, UN agencies, other rich-country government agencies, and NGOs routinely augment the base salaries of local staff with benefits such as housing and education subsidies, frequently bringing their employees' effective wages to a hundred times what they could earn at government-run clinics.
A concrete example of why "stovepiping" can be a problem comes from West Africa:
There is also an intimate relationship between HIV and malaria, particularly for pregnant women: being infected with one exacerbates cases of the other. Physicians administering ARVs in West Africa have noticed a resurgence of clinical leprosy and hepatitis C, as latent infections paradoxically surge in patients whose HIV is controlled by medicine. HIV-positive children face a greater risk of dying from vaccine-preventable diseases, such as measles, polio, and typhoid fever, if they have not been immunized than do those nonimmunized children without HIV. But if financial constraints force health-care workers to reuse syringes for a mass vaccination campaign in a community with a Vulindlela-like HIV prevalence, they will almost certainly spread HIV among the patients they vaccinate.
This seems to complement a bit something Brad Plumer wrote a couple of weeks ago, commenting on another recent article about AIDS in Africa:
Oster discovered that the difference between HIV infections rates in the United States and Africa can be largely explained by a greater prevalence of other STDs, especially herpes, in Africa. Because many STDs cause open sores, HIV transmission is four to five times more likely for each sexual encounter in Africa. If Oster's right, that means that one of the most effective HIV-prevention program might actually be to just treat those other STDs. The good news is that herpes, say, can be treated for as little as $3.50 a year, as opposed to the $300 a year it costs to treat AIDS. And it could save more lives. Although it's not clear that donors would get as enthused about opening their checkbook to pay for herpes treatment.
Garrett writes some stuff about encouraging health profit-centers and working to make the Third World self-sufficient in health that didn't strike me as particularly realistic, considering that African countries have doubled and in some cases quadrupled their own health spending over the past decade without yet much affecting outcomes. But the points on the dangers of stovepiping, and the potential benefits of redirecting resources toward a broader health picture, are well-taken.
Garrett argues that the global focus on AIDS is having adverse effects on health infrastructure-building and primary care in the Third World. For instance, in Haiti, "the past several years have witnessed the successful provision of antiretroviral treatment to more than 5,000 needy Haitians, and between 2002 and 2006, the prevalence of HIV in the country plummeted from six percent to three percent. But during the same period, Haiti actually went backward on every other health indicator."
In part, this is because the influx of foreign money into AIDS clinics and the like discourages governments from integrating these specialty clinics into their public health system, creating a sort of two-tiered health system for people with and without HIV. Another problem is the effect on health personnel:
Compounding the problem are the recruitment activities of Western NGOs and OECD-supported programs inside poor countries, which poach local talent...PEPFAR-funded programs, UN agencies, other rich-country government agencies, and NGOs routinely augment the base salaries of local staff with benefits such as housing and education subsidies, frequently bringing their employees' effective wages to a hundred times what they could earn at government-run clinics.
A concrete example of why "stovepiping" can be a problem comes from West Africa:
There is also an intimate relationship between HIV and malaria, particularly for pregnant women: being infected with one exacerbates cases of the other. Physicians administering ARVs in West Africa have noticed a resurgence of clinical leprosy and hepatitis C, as latent infections paradoxically surge in patients whose HIV is controlled by medicine. HIV-positive children face a greater risk of dying from vaccine-preventable diseases, such as measles, polio, and typhoid fever, if they have not been immunized than do those nonimmunized children without HIV. But if financial constraints force health-care workers to reuse syringes for a mass vaccination campaign in a community with a Vulindlela-like HIV prevalence, they will almost certainly spread HIV among the patients they vaccinate.
This seems to complement a bit something Brad Plumer wrote a couple of weeks ago, commenting on another recent article about AIDS in Africa:
Oster discovered that the difference between HIV infections rates in the United States and Africa can be largely explained by a greater prevalence of other STDs, especially herpes, in Africa. Because many STDs cause open sores, HIV transmission is four to five times more likely for each sexual encounter in Africa. If Oster's right, that means that one of the most effective HIV-prevention program might actually be to just treat those other STDs. The good news is that herpes, say, can be treated for as little as $3.50 a year, as opposed to the $300 a year it costs to treat AIDS. And it could save more lives. Although it's not clear that donors would get as enthused about opening their checkbook to pay for herpes treatment.
Garrett writes some stuff about encouraging health profit-centers and working to make the Third World self-sufficient in health that didn't strike me as particularly realistic, considering that African countries have doubled and in some cases quadrupled their own health spending over the past decade without yet much affecting outcomes. But the points on the dangers of stovepiping, and the potential benefits of redirecting resources toward a broader health picture, are well-taken.
2 Comments:
Wow! Great post Laura.
Kind of goes to a lot of what I witnessed in Africa many years ago but clearly the problem is getting worse.
Stupid ODA, stupid tied aid. HIV/AIDS is obviously a very serious problem but as such it is also a glamour cause. Giving billions of $ in assistance specifically for HIV/AIDS (or any other glamour issue) is sometimes more for domestic political consumption in donor states, than part any real, methodical, long-term strategy for meeting the challenge.
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