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Bethesda, Maryland, Abt Associates, Partners for Health Reform Plus, .  p. (USAID Contract No. HRN-C-00-00-00019-00)The Global Fund to Fight AIDS, TB and Malaria aims to attract, manage, and disburse resources that will make a significant and sustainable impact on the three focal diseases. The Global Fund has also stated its commitment to support programs that address the three diseases "in ways that contribute to the strengthening of health systems." The Global Fund is likely to have a variety of direct and indirect effects upon health care systems that could be positive or negative in nature. To be effective and sustainable in the long run, interventions will depend upon well-functioning health systems. This is true not only for the Global Fund, but also for other initiatives, such as the World Bank Multisectoral AIDS Program (MAP), the President's Emergency Plan for AIDS Relief, and others that aim to substantially increase the scale of response to specific diseases, particularly HIV/ AIDS. (excerpt)
Working in partnership to boost reproductive health commodity security. [Trabajar en sociedad para mejorar la seguridad de los productos de salud reproductiva]
Population 2005. 2004 Sep-Oct; 6(3):10-11.As USAID, through its sub-contracted American NGO John Snow Incorporated (JSI), continues to phase out support to developing countries for reproductive health commodities— contraceptives and essential drugs—the UN Population Fund and interested donor bodies are concerned with how best to marshal and direct commodity assistance for the future. The current focus is on nine countries in the Latin American region: Bolivia, the Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Nicaragua, Paraguay and Peru. To ensure a smooth transition and to help these countries to eventually achieve reproductive health commodity security, or RHCS, USAID and JSI are working closely with partners, including UNFPA, the International Planned Parenthood Federation (IPPF), the Pan American Health Organization (PAHO) and the World Bank. (excerpt)
Nature. 2005 Jan 13; 433(7022):91.For Mrs Luat, the H5N1 avian flu virus could bring economic ruin. Three years ago, she and her husband borrowed US$12,500 to establish a small chicken farm in Hay Tay province, near the Vietnamese capital Hanoi. They raise 6,000 chickens at a time in their single shed, selling the entire stock every couple of months to a Thai company that distributes the meat within Vietnam. But last year, their shed lay empty for six months after H5N1 flu hit neighbouring farms. Mrs Luat estimates the couple's losses at $1,500. If it happens again, they may be unable to service their debts. While smallholders such as the Luats face the most immediate threat, the continuing presence of the H5N1 virus in Vietnam and neighbouring countries could spell a global disaster, in both economic and humanitarian terms. H5N1 is deadly to both chickens and people, but thankfully isn't easily transmitted from person to person. But if it exchanges genes with a mammalian flu virus, H5N1 could become a mass killer that would rapidly sweep the globe. If that happens, tens of millions of people could perish. (excerpt)
Science. 2005 Jan 7; 307:33.It seemed like a classic case of bait and switch. In 2004, the World Health Organization (WHO) and the Global Fund for AIDS, Tuberculosis, and Malaria threw their weight behind a radical change in the fight against malaria in Africa. Old, ineffective drugs were to be abandoned in favor of new formulations based on a compound called artemisinin that could finally reduce the staggering death toll. More than 20 African countries have signed on. But the catch is there aren’t nearly enough of the new drugs to go around. Just before Christmas, WHO—which buys the tablets from Novartis for use in African countries—announced that it would deliver only half of the 60 million doses anticipated in 2005, leaving many countries in the cold. “It’s a very cruel irony,” concedes Allan Schapira of WHO’s Roll Back Malaria effort. (excerpt)
In: While the world sleeps: writing from the first twenty years of the global AIDS plague, edited by Chris Bull. New York, New York, Thunder's Mouth Press, 2003. 401-412.Public concern over the global AIDS epidemic, particularly in Africa, has grown enormously in recent years, but there is considerable debate about what the international community can and should do about it. Especially controversial has been the high cost of antiretroviral drugs used to extend the lives of people with AIDS. The pharmaceutical companies that make these drugs price them beyond reach of the world's poor, but in November 2001 at the WTO meeting in Doha, Qatar, these companies were forced to accede to pressure from developing-country governments, nongovernmental organizations, and activists, and allow poor governments to adjust certain rigid patent rules applying to vaccines and drugs in order to protect public health. Despite this apparent triumph of international pressure, far more needs to be done. A coalition of governments and nongovernmental organizations, led by the UN, recently launched the Global Fund Against AIDS, Tuberculosis, and Malaria (referred to here as the Global Fund), and its performance will test how well such a global institution can confront the most serious health crises of our time, and perhaps in all of human history. (excerpt)
BMJ. British Medical Journal. 2003 Nov 22; 327:1188.The Global Fund to Fight AIDS, Tuberculosis and Malaria is under intense scrutiny from malaria researchers, who say that its limited resources are being wasted on useless malaria drugs. The controversy was sparked by the latest figures on the fund’s spending on malaria treatment in Africa. More is being spent on chloroquine, which costs just $0.10 (£0.06; €0.08) for each dose but which is largely ineffective in Africa, than on combination treatments based on artemisinin, which are highly effective but cost at least 10 times as much. The result, say the researchers, is that lives are being lost needlessly. (excerpt)
Economists tell scientists AIDS drug projects can be scaled up. Calls for more money dominate the agenda but economists say more can be done with current funds.
Lancet. 2003 Jul 19; 362(9379):215.Economists said at the international AIDS conference on HIV pathogenesis and treatment in Paris on July 14 that nations with a high HIV/AIDS burden should spend more of their resources on antiretrovirals, a move which directly contradicts current medical opinion. The medical community has said that handing out antiretrovirals would be a waste of resources; could worsen drug resistance; and instead it urged preventative measures. Three pilot studies presented at the meeting from the Ivory Coast, Senegal, and Uganda—funded by UNAIDS—found that with a little help to set up medical infrastructure, drugs can be delivered, even to remote areas, without increasing drug resistance. (excerpt)
[Unpublished] 1986. 80 p. (WHO/CDD/84.17)This listing of research projects funded since 1980 by the Diarrheal Diseases Control Program of the WHO is arranged by broad priority area and scientific working group. Project title, investigator, and budget allocation for each are listed. Scientific working groups which are included are: bacterial enteric infections, parasitic diarrheas, viral diarrheas, drug development and management of acute diarrheas, global/global groups, global/regional groups, and research strengthening activities. Projects are also classified according to geographic area: African region, American region, Eastern Meditterranean region, European region, Southeast Asia region, and Western Pacific region.
[Unpublished] 1984. 51 p.This listing of research projects funded since 1980 by WHO's Diarrhoeal Diseases Control Programme, is arranged by project title, investigator and annual budget allocations. Project titles are listed by Scientific Working Grouping (SWG) and include research on bacterial enteric infections; parasitic diarrheas; viral diarrheas; drug development and management of acute diarrheas; global and regional groups and research strengthening activities. SWG projects are furthermore divided by geographical region: African, American, Eastern Medierranean, European, Southeast Asian and Western Pacific. The priority area for research within each SWG is specified.
AFRICA HEALTH. 1997 Nov; 20(1):7.UNAIDS has launched an 'HIV Drug Access Initiative' in the Ivory Coast, Uganda, Chile, and Vietnam; the pilot project will attempt to improve access to HIV drugs. Public and private sector efforts will be coordinated. The Glaxo Wellcome, Hoffman-La Roche, and Virco pharmaceutical companies will participate. Each country will 1) adapt its present system with regard to HIV and 2) establish both an HIV drug advisory board and a non-profit company which will import the drugs. Health ministries within each country will be required to find sources of funding for the programs. Uganda will probably use funds from its sexually transmitted disease (STD) program, which is supported by the World Bank; the Ivory Coast will combine corporate contributions, new tariffs, and non-profit insurance system monies into a 'solidarity fund.' UNAIDS funds will be used for oversight and evaluation. UNAIDS also released a review of 68 studies which examined the impact of sex education on the sex behavior of young people; it indicated that, in 65 of the studies, sex education did not increase the sexual activity of youth. UNAIDS concluded that quality programs helped delay first intercourse and often reduced the number of sexual partners, resulting in reduced rates of STDs and unplanned pregnancy. UNAIDS further concluded that effective sex education should begin before the onset of sexual activity, and curriculums should be focused. Openness in communicating about sex should be encouraged, and social and media influences on behavior should be addressed. Young people should be taught negotiating skills (how to say 'no' to sex and how to insist on safer sex).
BMJ. British Medical Journal. 1989 Jul 29; 298(6694):277-8.Under the Bamako initiative, UNICEF will provide free drugs to participating countries for the 1st few years; drugs will be sold to patients; and communities will control the finances. The aims are to establish a revolving drug fund to pay for future drug supplies and to use leftover money to maintain and improve primary health care services. Several problems with the initiative are foreseen. Firstly, charging users may reduce utilization by the poor. Although UNICEF agrees that provision of free service for indigents in necessary, systematic identification of these people may be difficult. Secondly, financing will be difficult to implement given the rarity of managerial skills and the poor quality of local supervision. The sustainability of the initiative is also in doubt. UNICEF initially proposed large mark ups on the basic cost of the drugs; now partial recovery of the cost is proposed, although how charges will be set is unclear. The question of whether services will be dependent when the free drugs stop remains to be answered. A further objection to the scheme is the almost inevitable deterioration of rational prescribing; paying patients will feel justified in demanding drugs and injections. UNICEF's solutions and strategies for implementation of policy remain vague and lack attention to detail. For instance, initial training courses aide community management of drug funds, but there is no commitment to continued support and local evaluation. Other sources of funding need to be considered. Host governments should commit to continued financial and supervisory input and to maintaining control over their own health services. Communication between staff and government should be established and maintained. Gradual and sensitive introduction, with careful monitoring of equity, utilization, and rational drug use, is essential to prevent failure of this important proposal.