Addressing the Importance of Health Care and What Further Actions can be taken on the International Scale for Developing Countries
According to Garrett, the revolution started in 1996 as an international AIDS meeting in Vancouver, Canada. It was at this meeting that scientists introduced the extremely benefits to ART and how they can improve a person??™s quality of life and increase their lifespan period (others would later argue that ART would not be as successful in sub-Saharan Africa because they do not have a concept of time and part of the keys to ART is TIME??”any missing dose can have drastic effects on a person??™s overall health and could potentially allow the HIV strain to mutate and become drug-resistant). Since the conference and practically overnight, tens of thousands of men and women in wealthy countries started the new treatments and by mid-1997, the visible horrors of AIDS had almost disappeared entirely in the United States and Europe.
The downside to ART is that it??™s overwhelmingly expensive and because of its price, developing countries almost didn??™t even stand a chance to afford it at the time. Priced in 1996 at about $14,000 a year while still requiring $5,000 a year for tests and medical visits, the treatment just was unaffordable for the majority of the HIV-infected world population. Because of this, between 1997 and 2000, a worldwide activist movement slowly but surely developed to address this problem by putting pressure on drug companies to lower their prices or allow the generic manufacture of the new medicines. The activists demanded that the Clinton administration and its counterparts in the G-8, to pony up money to buy ART and donate them to poor countries. And by 1999, total donations for health related programs (including HIV/AIDS treatment) in sub-Saharan Africa hit $865 million??”up more than tenfold in three years (Garrett, 17; Pfeiffer 12).
While it may seem great that the world recognized in the late 1990s the importance to handle the HIV/AIDS pandemic and how it relates to the world??™s overall health with such incredible donations and many organizations like the Gates Foundation and individual donations are still coming in large and strong, the money is not getting to where it needs to go directly in order to have a noticeable impact. Why Well there are some factors for this. The first factor is that people who donate in large amounts pull out their wallets as an emotional response. An example of this was the tsunami that hit on Christmas Day 2004. Because of the devastation that hit such a developing nation like Thailand, people reached out the best they could and ended up raising over something in the range of 7 million dollars. But knowing that global health is an issue that isn??™t going to go away and keeps making people donate money, the consistency is hard. Garrett even mentions in her article that it??™ll take almost another two to three generations of consistent donations on the same scale that they are being given now (and maybe even more so) before the world will even see a slight dent in improvement for the health standards in developing countries.
Another point that is preventing from developing countries from receiving all the donations and funds necessary are that most funds (specifically) come with strings attached and must be spent according to donors??™ priorities, policies, politics and values. One detailed branch of this is that not all the funds appropriated end up being spent effectively. In an analysis prepared for the second annual meeting of the Clinton Global Initiative in September 2006, Dalberg Global Development Advisors concluded that much current aid spending is trapped in the bureaucracies and multilateral banks (Garrett, 22). Simply stripping layers of financing bureaucracy and improving health-delivery systems, the firm argued, ???could effectively release an additional 15-30% of the capital provided by the HIV/AIDS, TB, and malaria programs??? (Garrett, 22).
This points to yet another problem, which Butler describes as ???stovepiping??? which is when aid goes down narrow channels relating to a particular program or disease (Butler, 754) From an operational perspective, this means that a government may receive considerable funds to support, for example, an ART-distribution program for mothers and children living in the nation??™s capital. But the same government may have no financial capacity to support basic maternal and infant health programs, either in the same capital or in the country as a whole. So HIV-positive mothers are given drugs to hold their infection at bay and prevent passage of the virus to their babies but still cannot obtain even the most rudimentary of obstetric and gynecological care or infant immunizations.
In ???The fight back starts here???, Butler describes how stovepiping tends to reflect the interests and concerns of the donors, and not the recipients, which again brings attention to a previous point made how the recipients in the developing countries get the short end of the straw even with donors best intentions. Disease and health conditions that enjoy a temporary spotlight in rich countries garner the most attention and money. This means that advocacy, the whims of foundations, and the particular concerns of wealthy individuals and governments drive practically the entire global public health effort. This alone is problematic because if the wealthy nations are controlling the effort, then the developing nations facing the brunt of these issues are not able to voice what it is they would like to be achieved most in the effort and address their top priorities in solving such a crisis.
The HIV/AIDS pandemic continues to be the primary driver of global concern and action about health, even if some developing countries may feel as though that the virus is not the greatest threat to their community. At the 2006 national AIDS conference, Bill Clinton spoke and suggested ???If you first develop the health infrastructure throughout the whole country, particularly in Africa, to deal with AIDS,??? Clinton argued ???you will increase the infrastructure of dealing with maternal and child health, malaria and TB. Then I think when you build it up, you??™ll be helping to promote economic development and alleviate poverty??? (Garrett, 23). I must argue against Clinton??™s analysis because there is evidence in some countries, like in Haiti for example, where even though cases of HIV/AIDS have decreased, they have backtracked in every other health focus. In the case of HIV/AIDS donations specifically, it is a stand-alone disease and program??”there are sites for HIV testing, hospices and orphanages, ART distribution centers and HIV/AIDS education centers and if all the donations from WHO or other private organizations solely focuses on these programs, then no money is distributed to help eradicate or even educate about other viruses and diseases infecting the country and back-tracking is almost inevitable.
Another issue facing developing countries in their quest for access to health care and treatment to disease is due to a concept coined ???brain drain???. Non-governmental organizations often contribute to the human resources ???brain drain??? crisis in Africa particularly, when they lure government health workers away into highly paid NGO positions. In Mozambique, this internal ???brain drain??? has had a more severe impact on the local health system then has the more widely recognized international migration of health workers. The NGO salaries may be 5-10 times higher than that of what they were getting in their home country??™s public-health sector salaries while providing more comfortable working environments and benefits (Pfeiffer, 2137). Kadoma is another African country which has seen the effects of ???brain drain???. Eight years ago, there was one nurse for every 700 residents, which seems pretty bad but is nothing compared to the statistics now??”today, there is one nurse for every 7,500 residents (Garrett, 27). Unbelievable!! So in the case of ???brain draining??? what can other NGO??™s do to prevent residents of African countries from losing those who could serve as the highway to their health
A structural-adjustment program should be implemented in the majority of African countries (this program could be applicable in other countries but for the sake of the argument and because of the statistics given, I will focus on Africa). NGOs should strengthen local human resource capacity by working within existing salary structures and complementing local training capacity. Rather than hiring workers out of the public system to work in a parallel program, NGOs can introduce and integrate projects into local systems and fund additional workers in the public system in accordance with the local pay structures. Nongovernmental organizations can also support other incentives to retain staff, such as payment for overtime or after-hours service expansion, or stipends for extra training and additional job responsibilities.
So what where should the targets be directed Instead of setting a smorgasbord of targets aimed at fighting single diseases, the world health community should focus on achieving two basic goals: increased maternal survival and increased overall life expectancy. Why Because if these two markers rise, it means a population??™s other health problems are also improving. And if these two markers do not rise, improvements in disease-specific areas will ultimately mean little for a population??™s health and general well-being.
Laurie Garret, again, supports this point with her reference of Dr. Francis Omaswa, leader of the Global Health Workforce Alliance-a WHO affiliated coalition??”who argues that in his home country of Zambia, which has lost half of its physicians to emigration over recent years, ???maternal mortality is just unspeakable.??? When doctors and nurses leave a health system, he notes, the first death marker to skyrocket is the number of women who die in childbirth. ???Maternal death is the biggest challenge in strengthening health systems,??? Omaswa says. ???If we can get maternal health services to perform, then we are very nearly perfecting the entire health system.??? (Garrett, 33)
Maternal mortality data is a very sensitive surrogate for the overall status of health-care systems since pregnant women survive where safe, clean, round-the-clock surgical facilities are staffed with well-trained personnel and supplied with ample sterile equipment and antibiotics. If new mothers thrive, it means that the health-care system is working,
and the opposite is also true.