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Tropical Medicine and International Health. 2008 Oct; 13(10):1245-56.OBJECTIVE: To estimate recurrent costs per patient and costs for a national HIV/AIDS treatment programme model in Rwanda. METHODS: A national HIV/AIDS treatment programme model was developed. Unit costs were estimated so as to reflect necessary service consumption of people living with HIV/AIDS (PLWHA). Two scenarios were calculated: (1) for patients/clients in the year 2006 and (2) for potential increases of patients/clients. A sensitivity analysis was conducted to test the robustness of results. RESULTS: Average yearly treatment costs were estimated to amount to 504 US$ per patient on antiretroviral therapy (ART) and to 91 US$ for non-ART patients. Costs for the Rwandan HIV/AIDS treatment programme were estimated to lie between 20.9 and 27.1 million US$ depending on the scenario. ART required 9.6 to 11.1 million US$ or 41-46% of national programme costs. Treatment for opportunistic infections and other pathologies consumed 7.1 to 9.3 million US$ or 34% of total costs. CONCLUSION: Health Care in general and ART more specifically is unaffordable for the vast majority of Rwandan PLWHA. Adequate resources need to be provided not only for ART but also to assure treatment of opportunistic infections and other pathologies. While risk-pooling may play a limited role in the national response to HIV/AIDS, considering the general level of poverty of the Rwandan population, no appreciable alternative to continued donor funding exists for the foreseeable future.
Asia Pacific Journal of Clinical Nutrition. 2002; 11 Suppl:S498-S509.Scale up 'we are what we eat' and nutrition is revealed as an aspect of world governance. The quality and nature of food systems has always tended to determine not only the health and welfare but also the fate of nations. The independence of nations depends on their development of their own human and natural resources, including food systems, which, if resilient, are indigenous, traditional, or evolved over time to climate, terrain and culture. Rapid adoption of untested or foreign food systems is hazardous not only to health, but also to security and sovereignty. Immediate gain may cause permanent loss. Dietary guidelines that recommend strange foods are liable to disrupt previous established food cultures. Since the 1960s the 'green revolution' has increased crop yield, and has also accelerated the exodus of hundreds of millions of farmers and their families from the land into lives of misery in mega-cities. This is a root cause of increased global inequity, instability and violence. 'Free trade' of food, in which value is determined by price, is imposed by dominant governments in alliance with industry when they believe they can thereby control the markets. The World Trade Organization and other agencies coordinate the work of transnational corporations that are the modern equivalents of the East India companies. Scientists should consider the wider dimensions of their work, nutrition scientists not least, because of the key place of food systems in all societies. (author's)
In: The global possible: resources, development, and the new century, edited by Robert Repetto. New Haven, Connecticut, Yale University Press, 1985. 255-98. (World Resources Institute Book)Everyone uses fresh water. Water is the most used substance by industry. Even though industry only makes up 5-10% of current worldwide water use, it contributes a disproportionate amount of toxic contaminants to the water supply. The most important socioeconomic factors of municipal water demand are household income and size. Agricultural demand is the single largest demand for water. In the US, it makes up 83% of annual total water consumption. Water demand has resulted in some of the world's biggest construction and weather modification projects which greatly alter basic ecosystems. Multinational institutions such as the World Bank and the International Development Association support most of these projects in developing countries. We have abused water perhaps more than any other resource. These abuses have caused considerable adverse effects. For example, after farmers in Africa and Asia began irrigating fields, many people fell ill with schistomosiasis. Other waterborne diseases include typhoid fever and diarrheal diseases. Investments in water supplies as well as in wastewater treatment are needed to improve public health. The largest consumers of fresh water in the world are those countries with the largest populations (49% of the world's population) and largest total land area (32% of the this area): China, India, the US, and the USSR. These 4 countries have 61-70% of the world's total irrigated land, but China and India have most of it (54%). Most US water expenditures are for water pollution control. The US has a very efficient agricultural system but the efficiency is technical rather than economic. Most water expenditures in the USSR and India are for irrigation. China spends most of its water resource funds on irrigation and drainage systems. All countries in the world should conduct a rational analysis of fresh water uses, implement rational water pricing policies to conserve water use, and stabilize water supplies such as capturing surface runoff.