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Africa: Health Updates

AfricaFocus Bulletin
Oct 15, 2007 (071015)
(Reposted from sources cited below)

Editor's Note

"Donors are expected to give the Global Fund [to Fight AIDS, TB, and Malaria] at least $9.7 billion over the next three years, 57% more than they gave over the past three years. The pledges made at last week's Global Fund Replenishment Meeting in Berlin, chaired by Kofi Annan, constituted the largest single financing exercise for health that has ever taken place." - Global Fund Observer, September 30, 2007

This good news comes from the authoritative Global Fund Observer (, a newsletter that reaches 10,000 subscribers around the world and that recently shifted its principal operations from New York to Nairobi. As newsletter editor Bernard Rivers notes in the excerpts below, this means that countries can now submit more ambitious proposals in the Fund's next round, with confidence that all technically approved proposals will be funded. For the first time, there can be a reasonable expectation that "demand" for funding will be met.

However, "demand" in the form of well-crafted proposals ready for funding still falls far short of the "need" of efforts to confront these three diseases and the more general health crisis confronting Africa and the world. This AfricaFocus Bulletin, in addition to excerpts from the latest Global Fund Observer, has a roundup of short excerpts and links to other recent reports related to Africa's health.

For previous AfricaFocus Bulletins on health and related links, see

"No Easy Victories: African Liberation and American Activists over a Half Century, 1950-2000" is now shipping, and still available for ordering on-line at a 20% discount until the end of October. The book will also be on sale at the African Studies Association 50th anniversary meeting in New York City, October 18-21.

The editors, along with Africa World Press, the Association of Concerned Africa Scholars, and AfricaFocus Bulletin invite New York activists, attendees at the African Studies Association, and others who are interested to join them for a celebration of the book's release on October 20, 2007.

For more information:

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Donor Governments Pledge Record Amounts to the Fund

Global Fund Observer (GFO)

Issue 77 - 30 September 2007. [excerpts]

Donors are expected to give the Global Fund at least $9.7 billion over the next three years, 57% more than they gave over the past three years.

Twenty-six donor governments and one foundation, gathering at a Replenishment Meeting in Berlin, Germany that ended on Friday [Sept. 28], promised that during the years 2008-10 they would give at least $6.3 billion to the Fund. With the Fund projecting that other donors will give at least $3.4 billion, this leads to a total of $9.7 billion.

The G8 has declared that in the year 2010, the Fund will need to spend $6 billion, or possibly as much as $8 billion. (This compares with its likely expenditure this year of $3.2 billion.) The Fund says that its total needs over the three years 2008-10 will be $12-18 billion. Over the past few months, donor government studied the Fund's needs and effectiveness and deliberated over how much each would commit to for the three years 2008-10. They then came to Berlin last week to announce their decisions.

The Replenishment Meeting was chaired by Kofi Annan, former UN Secretary General, and opened by German Chancellor Angela Merkel.

The pledges constitute the largest single financing exercise for health that has ever taken place. The amounts pledged were as shown in the table below [see for table]. Some highlights of the pledges were as follows:

  • The three countries that pledged (or are projected to pledge) the most for 2008-10 were USA ($2,172 m.), France ($1,274 m.) and the UK ($729 m.).
  • The three countries that pledged the largest percentage of their Gross National Income (GNI) were Norway (0.087%), Ireland (0.076%) and Sweden (0.075%).
  • The country that pledged the largest amount per capita was the Netherlands. (Of course, as one participant humorously pointed out, the Bill and Melinda Gates Foundation pledged considerably more per capita.)
  • The three developed countries that pledged the smallest percentage of their GNI were Japan, Finland and Switzerland (0.004% each).
  • The three countries whose pledges grew the most since from their pledges for the previous three years were Russia (increased 8.7 times), Saudi Arabia (3.6 times) and Spain (3.4 times).

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Record Amount in New Grants Recommended for Approval in Round 7

Round 7 applicants to the Global Fund submitted fewer, but bigger and better, proposals than applicants in all previous rounds.

The Global Fund's Technical Review Panel (TRP) has reviewed the 150 eligible Round 7 proposals that were submitted to the Fund, and has recommended that the board approve 73 of them. The grants recommended for approval will cost a total of $1,112 million over two years. This is a record amount: in the six previous rounds, the two-year value of approved grants ranged from $571 million to $968 million.

The percentage of proposals recommended for approval was also a record - 49%, up from an average of 38% over the previous rounds.

The average two-year cost of the proposals recommended for approval in Round 7 was $15 million - again a record, up from an average of $10.3 million over the previous rounds.

On the other hand, the number of eligible proposals submitted in Round 7, at 150, was the lowest ever.

The TRP's recommendations regarding Round 7 will be reviewed and voted on by the Board of the Global Fund at its next meeting on November 12-13. (In previous rounds, the board has always followed the TRP's advice regarding which proposals to approve.) GFO does not have information regarding which particular proposals have been recommended for approval; the Fund will release that information once the board has made its decisions in November.

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Analysis: New Donor Pledges Free Round 8 Applicants to Submit Bold Proposals

The pledges made to the Fund for 2008-10 at last week's Replenishment Meeting in Berlin, as reported above, were impressively large. Global Fund staff said that over the last few weeks, their private estimates of how much would be pledged steadily climbed from $7 billion to $8 billion to $9 billion. The final number was nearly $10 billion.

The total of $9.7 billion that the Fund published was made up of two parts; $6.3 billion from countries that made commitments, and $3.4 billion estimated by the Fund as likely to come from countries that did not make commitments in Berlin. (Countries like the USA and Japan have legislative procedures that make it impossible for them to make financial commitments for future years.)

Both numbers are somewhat conservative. ... But even with no new pledges at all for 2008-10, the $9.7 billion that the Fund currently and conservatively expects to receive will be enough money to enable the Fund to continue operations at least at its current level for at least another three years.

This is very significant. In past years, many applicants to the Fund worried that if they collectively submitted ambitious proposals, the Fund might not have enough money to pay for them. (Although in fact, no proposal that the TRP has recommended for approval has ever gone unfunded.) But now, potential applicants for Round 8 grants can confidently assume that even if Round 8 costs, say, $1.5 billion (50% more than the largest-ever previous Round), the Fund should be able to afford it. ...

If we regard the term "the need" as meaning how much money should be spent on tackling the three pandemics if all people are to receive the services they deserve, and the term "the demand" as meaning the cost of actual projects that implementing countries choose to put together to meet that need, it's fair to say that although the Fund has certainly not raised enough money to meet the "need", it has raised enough money to meet the "demand", unless countries scale up the quality and size of their proposals. This means that a major emphasis by the Fund and its allies over the next few years must be raising "the demand" so that it starts to approach "the need".

No country need now worry that if they work hard on writing a high-quality Round 8 proposal that the TRP likes, the proposal will go unfunded. But the time to start that work is now, not on March 1, when the formal call for proposals is issued. And indeed, many countries are already hard at work designing their Round 8 proposals.

Ending Malaria Deaths in Africa: One of the world's worst killers can be stopped soon if we make the investment

By Jeffrey D. Sachs

For article go to:

September 18, 2007

For Africa, the epicenter of the world's malaria scourge, an historic breakthrough in health and economic development is now within reach. A combination of new technologies, new methods of disease control and rising public awareness is poised to bring malaria deaths down by 90 percent or more - if we will follow through.


Efforts at malaria control in the 1950s and 1960s successfully used the insecticide DDT and the medicine chloroquine to eliminate the disease in many temperate and sub-tropical regions. But malaria persisted in the tropics and especially in Africa, where the intensity of transmission is the world's highest for ecological reasons. Africa pays a fearful price for its ongoing malaria burden, not only in more than one million deaths each year but also in significantly reduced economic growth.

Until very recently, things were getting worse, not better. The malaria parasite became widely resistant to chloroquine. Confusion over DDT's prudent anti-malaria application (sprayed as a thin film on the inside walls of houses) and its function as an insecticide in open fields (which is environmentally unsafe and promotes resistance) also curtailed use of the chemical.

... a confluence of advances gives a chance for a breakthrough in the near term. The first is the invention of long-lasting insecticide-treated bed nets, which protect sleeping individuals against indoor nighttime biting. These nets last for five years, unlike earlier nets that needed re-treatment every few months.

The second advance, which can save countless lives, is a new generation of highly effective medicines based on artemisinin, an herbal extract discovered by Chinese scientists. (Artemisinin should be used only in combination with more traditional drugs, however, to prevent the onset of resistance in parasites.)

The third advance is a new approach to disease control. In the past, the U.S. government and other donor agencies favored the sale of bed nets at a discount. The result was a very slow uptake of the nets because most African rural households were too poor to buy them. ...

The new strategy is based on mass free-distribution of nets, with one net for every sleeping site. Everybody is protected from illness and no group is left as a reservoir for transmission. The artemisinin-based medicines should also be available for free within the villages. This approach is highly affordable for donor countries, because the cost of each net is only $5, and each treatment dose of medicine about $1. Free distribution of nets is already being applied successfully in several impoverished countries.

Malaria control is the bargain of the planet. A study that my colleagues and I undertook recently showed that comprehensive coverage of nets and medicines, and indoor insecticide where advisable, can be accomplished for $3 billion per year in the next few years, which equals just $3 from each person in the high-income world. Or to put it another way, the equivalent of two days of Pentagon spending could save more than a million lives per year.

Reclaiming the Resources for Health

EQUINET Steering Committee

October 2007 - Newsletter 79 [excerpt from editorial]

Within Africa, millions of people experience deprivation of the most basic rights to water, shelter and food, millions of children have lost parents due to early adult death, a majority do not have secure incomes and many live in situations of conflict and social disruption. Also within the continent, health workers, teachers and others provide valuable services, state officials and university staff take on intense workloads with limited resources, and civil society and community organisations implement innovative local ways of improving life.

An enormous gap continues to exist between global attention and local reality.

On October 23 2007, EQUINET is launching a new publication- an analysis of equity in health in east and southern Africa. The book, "Reclaiming the resources for health: A Regional analysis of equity in health in east and southern Africa" explores the challenges and options for overcoming persistent inequalities in health in east and southern Africa (ESA). It is written by the EQUINET steering committee and jointly published by EQUINET with three African publishers, Weaver Press Zimbabwe, Fountain Publishers Uganda and Jacana publishers, South Africa.


The evidence in the analysis points to three ways in which "reclaiming" the resources for health can improve health equity:

  • for poor people to claim a fairer share of national resources to improve their health;
  • for a more just return for ESA countries from the global economy to increase the resources for health; and
  • for a larger share of global and national resources to be invested in redistributive health systems to overcome the impoverishing effects of ill health.

The region has the economic and social potential to address its major health needs. Yet improved growth has often occurred with falling human development indicators and increased poverty. In many ESA countries, widening national inequalities in wealth block poor households from the benefits of growth, while substantial resources flow outwards from Africa, leaving most of its people in poverty, and depleting the resources for health. ...

While many of these actions [to address this] lie outside the health sector, the analysis argues that health systems can make a difference, by providing leadership, shaping wider social norms and values, demonstrating health impacts and promoting work across sectors. ...

Addressing these problems demands a strengthened public sector in health. Current average spending on health systems in the region is below the basic costs for a functional health system, or even for the most basic interventions for major public health burdens. Therefore one priority is for governments to meet the as yet largely unmet commitment made in Abuja to 15% of government spending on health, excluding external financing. We argue, however, for "Abuja PLUS" - for international delivery on debt cancellation and for a significantly greater share of this government spending to be allocated to district health systems.


The book will be available after its launch on 23rd October from EQUINET ( from the publishers in the region (Weaver Press, Fountain Publishers and Jacana). ... For further information on the issues raised in this brief please also visit the EQUINET website at

Health Workforce Advocacy Initiative

September 25 letter from Eric Friedman of Physicians for Human Rights (

The Global Health Workforce Alliance is an international partnership hosted by the World Health Organization and is dedicated to identifying and implementing solutions to the global health workforce crisis. The Health Workforce Advocacy Initiative (HWAI) will engage in evidence-based advocacy to advance local, regional, and global efforts to enable all people, at the soonest feasible time, to have equitable and sustained access to a skilled, motivated, and well-equipped, informed, and managed health workforce who have decent wages and good working conditions, and are capable of delivering on such health goals and obligations as Universal Access and the health-related Millennium Development Goals.

HWAI is launching a Campaign for Sustainable Health Workforce Financing. As we all know, greatly increased funding will be needed to create a workforce that is capable of delivering on Universal Access and the MDGs. Given the centrality of increased resources to strengthening the health workforce and the health systems in which they operate, and the advocacy necessary to unlock those resources, we felt that this should be the central focus of our work.

The campaign will have two layers, global and national. Globally, we will engage in advocacy with key international targets such as the Global Fund, support advocacy to remove macroeconomic constraints, and develop material, including evaluations of and recommendations for major development partner investments in the health workforce. At the national level, we will join forces with partners in pilot countries to use the international reach of HWAI to strengthen local campaigning around sustainable financing for HRH. Initially we will be working with partners in Uganda. We plan on developing an advocacy toolkit for health workers (with some focus on sustainable financing for the health workforce) and a set of key principles that can be used to evaluate or contribute to the development of a health workforce plan.

The success of this campaign depends very much on a network of advocates. It requires the development of a movement that is committed to achieving health goals such as Universal Access and the MDGs, is convinced that empowering, enabling, and expanding the health workforce is vital to achieving, sustaining, and building on these goals, and that advocates for the measures necessary to develop that workforce. We need to support one another, including by sharing evidence, ideas, and other information, collectively strategizing, engaging in open discussions, supporting advocacy, and maximizing on our connections and capacities.

We therefore encourage you to join the [HCW] listserv, the virtual home of the HWAI network. is open to anyone who identifies with the vision and goals of this network, including advocates within governments.

Anyone who would like to join should email their name, e-mail address, affiliation, and country to Sharonann Lynch of MSF at, who administers the [HCW] listserv. Please cc me (

Additional new links

AllAfrica Opens News Center and Health Office in Monrovia

Global Coalition on Women and AIDS
Educate Girls; Fight HIV/AIDS

Aids & Rights Alliance for Southern Africa

Latest Reports of AIDS Drug Prices from MSF, WHO
Note that MSF reports reductions in prices from second-line antiretrovirals, but alarmingly high prices for newer less toxic versions of first-line drugs.

Substance Abuse and HIV/AIDS in sub-Saharan Africa
Special free issue of African Journal of Drug and Alcohol Studies

AfricaFocus Bulletin is an independent electronic publication providing reposted commentary and analysis on African issues, with a particular focus on U.S. and international policies. AfricaFocus Bulletin is edited by William Minter.

AfricaFocus Bulletin can be reached at Please write to this address to subscribe or unsubscribe to the bulletin, or to suggest material for inclusion. For more information about reposted material, please contact directly the original source mentioned. For a full archive and other resources, see