[afro-nets] A war chest for fighting AIDS

["Claudio Schuftan" <claudio@hcmc.netnam.vn>]

A war chest for fighting AIDS
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Finance and Dev,  42:4, Dec 2005.
By M Lewis. (excerpts).

25 million living with HIV in Africa; 7,000 adults and children die per day. For some of the countries in the continent, external funding for AIDS is growing so rapidly that the concentration of funds effectively replaces health budgets. The threat of corruption and waste, when too much money must be spent in too short a time, is to be kept prominently in mind. AIDS monies exceed overall public health budgets in some countries (Eth, Ug, Zam). It is puzzling how countries can accommodate and wisely allocate new resources for AIDS while their overall health spending declines or only rises modestly. Simply having good intentions and the right priorities does not guarantee effective programs.

Donors have shown an increasing preference for off-budget and vertical programs. Vertical funds lead to poaching of public sector workers.

What would help:
* Setting up AIDS stabilization funds to absorb resources and save them until circumstances permit their effective use.
* Taxing incoming funds at, say 10% on all incoming funds to pay for upgrading of health care systems.
* Attacking poor health sector performance; could be using day-beds, issuing vouchers for AIDS patients and using supervised paraprofessionals. (it is noted that absenteeism among health staff is often high; moreover, up to 80% of non-salary health budgets never reach the frontline clinics; the money is spent at higher levels. This raises doubts about the value of simply increasing funding, or of the need for just more health workers). 
* Setting up non-governmental involvement with greater reliance on NGOs in the delivery of services.

--
Claudio Schuftan
mailto:claudio@hcmc.netnam.vn