Comments on: World Bank AIDS Drive crowds out other health programs – but fails to make progress on AIDS

By: Alanna

Alanna — Tue, 05 May 2009 08:58:51 +0000

I am trying to look at this as a good thing. The WB is recognizing its own mistakes, and the worm is turning on our obsession with funding HIV programs at the expense of health systems.

By: Ben Clark

Ben Clark — Mon, 04 May 2009 11:31:08 +0000

This is not terribly unexpected. There are so many instances in public policy and in our spending priorities, that for whatever reason we have ultimately valued to life of a person with one particular disease more so than a person with another disease.

Breast cancer is one such issue that parallels HIV/AIDS versus TB/malaria. There are far more active and involved political and public faces pushing for breast cancer support than for lung cancer, yet more people die of lung cancer. This parallel isn’t necessarily an perfect one, but it does demonstrate that HIV/AIDS is not the only disease that has garnered more support for is cause than other disease that are afflicting more people. This is not necessarily a good or bad thing in my view, but it is the reality of our world

By: Adam

Adam — Mon, 04 May 2009 05:10:57 +0000

The problem is the WB is not listerning to the people and they do what is their agenda to be seen as caring for the poor. HIV.AIDS has been turned into platform for gaining money and votes for both rich and poor politicians. Until people’s voice are heard in planning for aid there will be no change.

By: Anonymous

Anonymous — Fri, 01 May 2009 21:34:20 +0000

How much of the political reason by the World Bank to choose AIDS is because of grassroots advocacy on AIDS?

By: Scarlet Pumpernickel

Scarlet Pumpernickel — Fri, 01 May 2009 03:52:04 +0000

How likely is it that those decisions were informed by the Bush Administration emphasis on AIDS? While it’s not as though the US “owns” the World Bank, it’s not exactly like it doesn’t either.

If that’s the case, then could politics fix the unintended problem it may have caused?

By: kim dionne

kim dionne — Fri, 01 May 2009 03:34:39 +0000

I'm surprised to see this done by the bank (even if by an "independent" group within the bank). Though they're not the first to say it, I'm still impressed that they're early on the train critical of AIDS exceptionalism. Roger England has written about AIDS exceptionalism recently in the BMJ [ungated here], calling for an end to UNAIDS:

It is no longer heresy to point out that far too much is spent on HIV relative to other needs and that this is damaging health systems. Although HIV causes 3.7% of mortality, it receives 25% of international healthcare aid and a big chunk of domestic expenditure. HIV aid often exceeds total domestic health budgets themselves, including their HIV spending. It has created parallel financing, employment, and organisational structures, weakening national health systems at a crucial time and sidelining needed structural reform. Massive off-budget funding dedicated to HIV provides no incentives for countries to create sustainable systems, entrenches bad planning and budgeting practices, undermines sensible reforms such as sector-wide approaches and basket funding (where different donors contribute funds to a central "basket," from which a separate body distributes money to various projects), achieves poor value for money, and increases dependency on aid. Yet UNAIDS is calling for huge increases: from $9 billion today to $42 billion by 2010 and $54 billion by 2015. UNAIDS is out of touch with reality, and its single issue advocacy is harming health systems and diverting resources from more effective interventions against other diseases.

Some colleagues and I are writing up findings of public opinion surveys in sub-Saharan Africa, as well as data from a demographic and health survey in Malawi to show that folks who are facing the epidemic in their everyday lives prefer resources be allocated to other pressing issues.