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USA/Africa: Global Health Policy
Feb 25, 2009 (090225)
(Reposted from sources cited below)
"We believe that U.S. health and development assistance should
address both the root causes of ill health - poverty and inequality -
and be directed toward building public sector institutions to help
governments respond to the needs of their people. Aid should be
transparent on both donor and recipient sides and accountable to
the target population - the poor who need services most." - Global
Health Recommendations for a New Administration and Congress
This AfricaFocus Bulletin contains (1) an editorial from The New
York Times urging that funds for global health be maintained and
expanded, despite budget pressures, (2) the executive summary of a
set of recommendations on global health policy from six leading
U.S. health and development groups, and (3) excerpts from a poll
from late 2008 showing strong support for government responsibility
for basic health care in 24 countries, including the United States.
Another AfricaFocus Bulletin sent out today contains a summary of
a new report from Oxfam International countering arguments against
primary reliance on private-sector health care expansion, and brief
references to two resources fo health care planning in development
For previous AfricaFocus Bulletins on health issues, visit
++++++++++++++++++++++end editor's note+++++++++++++++++++++++
Boosting Global AIDS Funds
New York Times Editorial - February 24, 2009
The international AIDS community is buzzing with anxiety over
unconfirmed reports that the Obama administration may hold down
American financing for international AIDS programs that need
greatly increased support. We hope that the new budget blueprint to
be released this week will leave enough room to grant these and
other vital health programs the money they need to care for
millions of sick people and to prevent the spread of additional
disease around the world.
Just last year, we celebrated passage of a bill that authorized
spending $48 billion over five years to fight AIDS, tuberculosis
and malaria through bilateral agreements with hard-hit countries,
a substantial increase over past efforts. To meet that goal,
Congress would have to appropriate at least $9 billion a year. It
fumbled. The House is poised to approve appropriations of only $4.9
billion for bilateral AIDS programs in fiscal year 2009 plus
another $900 million for the Global Fund to Fight AIDS,
Tuberculosis and Malaria.
AIDS activists fear that the Obama administration is now planning
to ask for only slightly more than that for the fiscal 2010 budget
and will also hold American contributions to the global fund well
below the levels that program is seeking.
We recognize that the new administration is searching for ways to
stimulate the domestic economy and slow the erosion of jobs. But
there are strong arguments - moral and strategic - for why the
United States should do a lot more to help fight AIDS, malaria and
tuberculosis around the world.
Left uncontrolled, infectious diseases can destabilize whole
regions, especially when hunger is spreading around the globe.
Improving the health systems of impoverished countries would help
burnish our tarnished image, and it would contribute to our
security by lessening the risk of importing infectious diseases.
Global Health Recommendations for a New Administration and Congress
For Further Information
Partners In Health
Donna Barry firstname.lastname@example.org 617-432-5256
Fran‡ois-Xavier Bagnoud Center for Health and Human Rights
Fuller email@example.com 617-432-0656
Physicians for Human Rights
Pat Daoust firstname.lastname@example.org
Health Alliance International
Wendy Johnson email@example.com
Paul Jensen firstname.lastname@example.org 202-783-7100
We are at a pivotal point in United States history as the Obama
Administration and the 111th Congress begin. We embrace the message
of change and hope that brought this new administration to
ascendance and look forward to the application of these principles
in all sectors of government. While the U.S. financial crisis is
likely foremost on the minds of many in Washington, the current
global crisis threatens to worsen the extreme privation suffered by
those in the developing world. At the writing of this document, 25%
of the developing world lives in dire poverty and 80% of the world
lives in countries where income inequality is worsening. Such
social inequity threatens not only the health of the globe but
peace, security, and the prospects of financial recovery. The U.S.
government role in providing aid for health and development has
never been more critical.
In the year 2000, the 189 member states of the United Nations
agreed upon a set of goals the Millennium Development Goals (MDGs)
the achievement of which would be prioritized by both developing
countries and the wealthier countries that provide assistance. The
MDGs highlighted the critical links between improving health,
education, and the status of women and children and achieving
meaningful and equitable development for the world's poor. However,
with little financial commitment from the developed world, meager
progress has been made towards achieving the MDGs.
Much of the assistance to poor countries in the last three decades
has been given with the goal of building market-based strategies to
attain development, with the idea that these strategies would be
self- sustaining. Yet, as we see in our own country today, the
private sector has insufficient responsibility to protect the
vulnerable. Not surprisingly, market strategies in the developing
world have failed to provide the services needed to the world's
poorest. Additionally, money for health has typically been given to
U.S. organizations to deliver a single or small cluster of
interventions as opposed to building systems to deliver care and
addressing the root causes of disease. We believe that
accountability and a rights-based approach is best served if
services are delivered in the public sector in a democratic society
in which the populace has a say in the implementation.
A poignant example of the failure to deliver health to the world's
poor is the fact that the number of women who die in childbirth has
remained constant despite 40 years of development assistance
targeted toward "safe motherhood." Programs taught traditional
birth attendants sterile techniques for home deliveries and when to
refer women for medical care. Yet no money was spent on the
development of modern medical facilities with access to blood,
surgery, and the skilled providers needed to avert maternal death.
The rare services that do exist in poor countries are simply too
costly for the majority of poor women.
We believe that U.S. health and development assistance should
address both the root causes of ill health poverty and inequality
and be directed toward building public sector institutions to help
governments respond to the needs of their people. Aid should be
transparent on both donor and recipient sides and accountable to
the target population the poor who need services most. The new
Administration and Congress have a unique opportunity to redefine
foreign aid policy to help those most impoverished and to save
lives. Implementing the recommendations of this paper would have an
enormous impact. For further details related to each
recommendation, we encourage you to refer to our longer,
accompanying document (which can be found at
Improving Means of Funding
Commit to a comprehensive approach to health:
- Develop sustained financing to effectively and efficiently
disburse funds to health programs with multi-year funding cycles
rather than annual appropriations
- Increase Official Development Assistance to 0.7% of GNI and
proportionately increase funding for all global health programs,
capitalizing on vertical funding currently available, with a focus
on maximizing outcomes.
- Fully appropriate the authorized $48 billion for HIV/AIDS,
tuberculosis, and malaria for 2009 2013 (PEPFAR).
- End the vertical versus horizontal funding debate and commit to
a comprehensive health care approach.
Address inefficiency in aid:
- Develop a framework to better evaluate programs and measure
their effectiveness and efficacy.
- Require all agencies and initiatives to assess performance of
programs and individual projects; examine money flows and the
variability of impact which may not be seen at the macro level so
as to determine more efficient multilateral mechanisms and NGOs
through which to channel money.
- Institute a policy of complete transparency in U.S. foreign aid,
shedding light on the costs that significantly decrease the
percentage of aid reaching recipient countries.
Improving Health Care Delivery
Build local / national capacity:
- Direct more U.S. aid to recipient country public sectors to
develop health systems and encourage other donor countries to
follow suit. Such funds should be allocated to refurbish
facilities, hire and train new clinical and administrative staffs,
compensate existing Ministry of Health staff, and waive patient
- Increase the total number of health workers in resource-poor
areas to, at a minimum, 2.3 doctors, nurses, and trained midwives,
and 1.8 health auxiliaries (including community health workers) per
1,000 residents; provide full support for pre-service training and
retention for at least 140,000 new health professionals.
- Revise U.S. policy regarding compensation of community health
workers for their services, moving beyond an unsustainable model
that relies on local residents to volunteer their time for health
and development projects that benefit the community.
Reduce child mortality:
- Support child health programs with an integrated approach
focusing on family, clean water, nutrition, health care, education,
and social protection to adequately address the essential elements
of children's lives.
- Continue to make greater investments in vaccination campaigns to
address the threat of pneumonia, polio, measles, tetanus, and
diphtheria common killers of children in resource-poor areas.
- Combat malnutrition by enhancing preventive efforts by providing
nutritious foods, increasing use of ready-to-use therapeutic food,
and acknowledging access to food as a vital component in improving
Improve women's health:
- Increase funding for reducing maternal mortality, family
planning, and reproductive health services; revise the ABC policy
using scientific evidence; and repeal the Mexico City Policy (i.e.
the Global Gag Rule).
- Remove financial barriers to care, specifically user fees for
prenatal and obstetrical services, since maternal mortality is
strongly correlated with poverty.
- Address issues documented to be inextricably linked to women's
health, including economic empowerment for women, psychosocial
support, and support for women who are victims of domestic
- Ensure the $48 billion Congress has authorized for HIV/AIDS, TB
and Malaria over the next five years is fully appropriated.
- Remove the social and economic barriers to treatment adherence
by providing "wrap-around services" such as nutrition, clean water,
housing, and childcare support.
- Fund development of new prevention and treatment technologies
vaccines, more reliable diagnostics, and new classes of
- Scale up coordinated TB-HIV services and require PEPFAR
recipients to incorporate the Three I's (intensified case finding,
isoniazid preventive therapy, and infection control) into
programming in high TB-HIV burden countries.
- Create a presidential initiative on global tuberculosis.
- Expand access to TB treatment in high burden countries and
develop a strategy to reach the U.S. target of providing 5 million
successful DOTS treatments.
- Address drug-resistant TB by expanding laboratory capacity and
treatment in high burden regions, and funding development of new,
effective diagnostic tools and drugs.
- Fully fund U.S. bilateral TB programs supported through PEPFAR,
USAID, and CDC; contribute the U.S. fair share of funding to
programs such as the Global Fund to Fight AIDS, Tuberculosis and
- Require the PMI Coordinator to comprehensively evaluate all
programs to determine effective and ineffective programs and
policies; use these findings to promote best practices with all PMI
- Place a greater focus on implementation and health care delivery
via a newly developed Malaria Initiative Strategy.
- Set concrete limits on the use of PMI funds, which may go to
technical assistance and consultants.
- Fully fund U.S. bilateral malaria programs through PMI, USAID,
and CDC and contribute the U.S. fair share of funding to programs
such as the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Decrease extreme poverty and hunger:
- Immediately fund additional emergency food assistance to prevent
further death and disease.
- Direct the State Department, USDA, USAID, U.S. Treasury, and
other agencies to assist governments in developing food sovereignty
by allowing them to support small-hold farmers, improve market
access in developing countries, and utilize protective tariffs for
- Collaborate with recipient countries to institute progressive
policies on land reform and agricultural development.
- Track food aid to ensure its efficient and effective delivery
and substantially decrease the large amounts of aid to U.S.
transport companies and agribusiness.
Revising Development Policies and Financing Architecture
Redefine foreign aid policy and goals:
- Instruct the Department of Treasury to work with the IMF
Executive Board to review and change the restrictiveness of IMF
macroeconomic policies, and widely publicize such policy changes.
- Work with the Department of Treasury and IMF to develop
increased public spending policy options, which have been fully
vetted by a broader group of stakeholders.
- Require U.S. government contractors to adhere to the principles
of the NGO Code of Conduct.
Recognizing the Full Scope of Human Rights
Ratify the currently signed treaties:
- The International Covenant on Economic, Social and Cultural
- The Convention on the Elimination of All Forms of Discrimination
- The Convention on the Rights of the Child
- The International Convention on the Protection of the Rights of
All Migrant Workers and Members of Their Families
- The International Labor Organization Conventions
- The International Criminal Court 7. The Kyoto Protocol
World Publics See Government as Responsible For Ensuring Basic
Healthcare, Food, and Education Needs
But Big Variations on How Well Their Government is Performing
November 10, 2008
[excerpts of summary only see http://tinyurl.com/avwr7h for
complete summary and full report]
A new WorldPublicOpinion.org poll of 21 nations around the world
finds that large majorities in every country say their government
should be responsible for ensuring that citizens can meet their
basic needs for food, healthcare, and education.
On average, across all countries polled, nine in 10 say that their
government has the responsibility to ensure access to food,
healthcare, and education.
"Clearly there is universal consensus that governments have a
responsibility to address the social and economic needs of their
citizens," comments Steven Kull, director of
However, the poll found major variations in how well people
perceive their governments to be fulfilling these responsibilities.
Overall, respondents expressing the highest levels of satisfaction
with their government's performance in meeting such needs are found
in China, Great Britain, Jordan, and the Palestinian Territories.
The lowest levels are found in Russia, Ukraine, Argentina, and
These results show overwhelming public support for the principles
presented in the Universal Declaration of Human Rights which is
celebrating its 60th anniversary this year. It states that:
"Everyone has the right to...food, medical care...[and] education."
Signatories to the declaration commit "by progressive measures,
national and international, to secure" these rights.
The poll of 21,321 respondents was conducted between July 15 and
September 26, 2008 by WorldPublicOpinion.org, a collaborative
research project involving research centers from around the world
and managed by the Program on International Policy Attitudes (PIPA)
at the University of Maryland. Margins of error range from +/-2 to
Interviews were conducted in 21 nations, including most of the
largest nations--China, India, the United States, Indonesia,
Nigeria, and Russia--as well as Argentina, Azerbaijan, Egypt,
France, Germany, Great Britain, Italy, Jordan, Kenya, Mexico, the
Palestinian Territories, South Korea, Thailand, Turkey, and
Ukraine. Interviews were also conducted in Taiwan, Hong Kong, and
Macau. The publics included represent 61 percent of the world
Government Responsibility for Basic Needs
When asked whether their "government should be responsible for
ensuring that its citizens can meet their basic need for food," or
whether "you think that is not the government's responsibility,"
majorities of 70 to 97 percent in all 21 countries say government
should be responsible for this. The average is 87 percent.
The most universal support is found in eight publics where more
than nine in 10 believe the government should be responsible for
citizen's need for food: Indonesia (97%), China (96%), Jordan
(96%), Kenya (96%), Argentina (94%), Azerbaijan (93%), Germany
(93%), and Italy (92%). Even the lowest majorities saying the
government is responsible in this case are well above half,
including Indians (70%), Americans (74%), and Russians (77%).
The publics with significant numbers saying the government does not
have the responsibility to ensure access to food include the United
States (25%), the Palestinian Territories (17%), Egypt (14%), and
When asked the same question about "the basic need for healthcare,"
majorities of the same magnitude (70-97%) in all countries polled
see ensuring that people can meet their need for healthcare as one
of government's responsibilities. The average majority is 92
percent and in all but five countries support is greater than 90
Ninety-seven percent say the government should have this
responsibility in Argentina, Italy, Ukraine, Jordan, and Indonesia,
and 96 percent agree in Azerbaijan, Mexico, Russia, Turkey, Kenya,
and China. Ninety-five percent take this view in Germany and
Nigeria, 93 percent in Britain and South Korea, and 92 percent in
France. Only India (70%), the United States (77%), the Palestinian
Territories (79%), Egypt (81%), and Thailand (88%) have less than
90 percent saying the government has the responsibility to provide
In only a few publics do significant numbers reject the government
having the responsibility to ensure access for healthcare; 21
percent of Americans say the government is not responsible,
followed, again, by Palestinians (19%), and Egyptians (14%).
On education, majorities ranging from 64 to 98 percent also see the
government as responsible for ensuring that people can meet their
basic needs. The average majority is 91 percent and in only six
nations do majorities of less than 90 percent take this position.
Virtually unanimous majorities in Argentina (98%) and China (98%)
say the government has the responsibility to ensure its citizens'
educational needs are met. In three countries, 97 percent agree
(Indonesia, Turkey, and Jordan), 96 percent in two countries
(Mexico and Great Britain), 95 percent in four countries (Italy,
Ukraine, South Korea, and Kenya), 94 percent in Russia, 93 percent
in Germany, and 91 percent in Nigeria.
Very large majorities slightly below the global average say the
government has this responsibility in Thailand, (90%), Azerbaijan
(89%), France (89%), the Palestinian Territories (85%), and the
United States (83%). Egypt (77%) and India (64%) have the smallest
majorities in support, although 19 percent in India volunteer
"depends" as their answer.
Egyptians have the largest minority saying the government is not
responsible for education (19%), followed by Americans (16%).
These results show overwhelming public support for the standards
offered by the Universal Declaration of Human Rights. Article 25
states that: "Everyone has the right to a standard of living
adequate for the health and well-being of himself and his family,
including food, clothing, housing and medical care." Article 26
adds that: "Everyone has the right to education. Education shall be
free, at least in the elementary stages." (The Declaration does not
imply that state education should be the only means to achieve
universal education; in fact, the article also states that "parents
have a prior right to choose the kind of education that shall be
given to their children.")
Assessments of Government Efforts
Respondents were asked how well they feel the government is
ensuring that people can meet their basic needs for food,
education, and healthcare. They were not asked to assess how well
their government was fulfilling these responsibilities in absolute
terms, but rather in the context of "the limits of the[ir]
...government's resources." Broadly, publics answered in ways that
clearly distinguished between different responsibilities and took
into account constraints on the government's means. Improvements
over recent decades, as measured by bodies such as the World Health
Organization, seem to have been registered by publics.
The UN Development Programme rates 177 countries by their level of
human development (the Human Development Index). In reporting this
poll, countries that receive a ranking of 1-35 were classified as
"developed," 36-80 as "middle tier" and 81-177 as "developing."
Among the six developed countries in the poll, the one public that
gives their government positive ratings in all categories is Great
Britain. The United States gets positive ratings in regard to food
and education, but not healthcare. Germans give positive ratings
for food and healthcare, but not for education. The French give
positive ratings for education and healthcare, but not for food.
South Koreans give a positive rating for education, but not for
food or healthcare. Italians give poor rating for food and
healthcare, and divided ratings for education.
Among the five middle tier countries, views are consistently
negative. Argentines, Russians, and Ukrainians give their countries
negative ratings in all areas. Mexicans are negative in regard to
education and food, though positive about healthcare. Thais give
negative ratings on food and healthcare, though lean positively on
Interestingly, views tend to be the most positive in the 10
developing nations--underscoring how governments are assessed
relative to their efforts and progress rather than in absolute
terms. In China, India, Jordan, and the Palestinian Territories,
majorities give positive ratings for all categories. In Turkey,
Indonesia, and Kenya majorities are satisfied in all areas except
food. Azerbaijanis are satisfied in all areas except healthcare.
Egyptians are only satisfied in the area of education, while
Nigerians are dissatisfied in all areas.
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
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