Mercy Global Concern - 2003
Briefing Paper Number 2 - December 2003
Commission for Social Development
Forty-second Session
4th - 13th February 2004
Item 3a of Provisional Agenda
Priority Theme: Improving Public Sector Effectiveness
Statement submitted by: Sisters of Mercy, Franciscans International,
Maryknoll, Dominicans.
HIV/AIDS is not just a health issue, but a global problem that
is setting back decades of development gains and constitutes
a veritable threat to human security. Noting that less than 5
per cent of those who could benefit from antiretroviral treatment
have access to the drugs" (Secretary General's Report
on the "Follow-up to the outcome of the twenty-sixth special
session: implementation of the Declaration of Commitment on HIV/AIDS:
Progress towards implementation of the Declaration of Commitment
on HIV/AIDS" P.8. A/58/184 ), the above named NGOs, members
of the NGO Working Group on HIV/AIDS, have prepared specific
recommendations to improve the effectiveness of the public sector
in addressing this urgent challenge.
We believe that the "3 X 5" initiative, with the
goal of treating 3 million people infected with HIV/AIDS with
antiretroviral drugs by 2005, is possible if governments have
the political will to direct their energies and resources to
realizing this goal. This is a social development issue, which
engages the public sector. WHO (World Health Organization) is
offering support structures to enable the health systems to respond
effectively in implementing the programme. NGOs have already
experience and development models, which demonstrate it is indeed
a possibility to significantly roll-back the HIV/AIDS by 2005.
With a concerted effort of all groups, and very specific steps
to meet the 3X5 goal, we make the following recommendations.
At the ICASA meeting (International Conference on AIDS and STIs
in Africa) in Nairobi, Kenya, September 2003, UNAIDS brought
together for a consultation officials from national coordinating
bodies and relevant ministries of African nations, major funding
mechanisms, multilateral and bilateral agencies, NGOs and the
private sector. They agreed on the importance of:
- linkages between national HIV/Action Frameworks and poverty-reduction
and development frameworks, including the MDGs;
- Engagement of civil society and the private sector in delivery
of services, while retaining adequate capacity in the public
sector;
- Rationalizing drug procurement to ensure the lowest pricing,
assured quality and continuity in supply;
- National AIDS authority as an overarching coordinating body
and policy leader.
At the same ICASA meeting WHO launched its "3
x 5" Initiative which has as its aim to assure the treatment
of 3 million people living with HIV/AIDS with antiretroviral
drugs by the year 2005.
We agree with the leadership of WHO that this effort of treating
3 million persons by the year 2005 is possible.
Successful pilot programs carried out by Doctors without Borders
in eleven countries give strong evidence for the grounds of this
hope. Their project in Khayelitsha in the Western Cape, South
Africa demonstrates:
- ARV therapy can be safely and effectively used in resource
poor areas;
- Management of ARV therapy can be easier and more economic
in the long run than of persons living with AIDS not on therapy;
- The approach to AIDS bolsters the entire health system by
easing the need for hospitalization and treatment of opportunistic
infections;
- The positive effect of treatment gives sufferers hope and
encourages others to willingly be tested;
- By improving the quality of life of persons living with
AIDS and extending their life, they can remain part of the
productive work force and their children are spared from becoming
orphans.
We, too, are convinced that the experience
is replicable.
According to Doctors without Borders, after the introduction
of the widespread use of ARVs in Brazil, the incidence of AIDS
dropped 50% between the years 1996-99, and the government saved
an estimated $472 million otherwise needed for hospitalization
and treatment of persons with opportunistic infections in 1997-99.
*** [Cfr., Upendo in Naivasha, Kenya, as one example
of a programme which combines a treatment centre
approach with a community out-reach programme for
care of persons in their own homes and advocacy.]
Leonard S. Rubenstein, executive director of Physicians
for Human Rights, has clearly stated, "Our
analysis shows that there is no reason to be skeptical
that widespread treatment for HIV/AIDS can be administered,
despite the health infrastructure deficits in many
poor countries, particularly in Africa. We have
found that many components necessary to jumpstart
HIV/AIDS treatment are already in place. What is
needed now is a firm commitment by the world to
fund programs that prevent and treat the greatest
public health crisis of our time. It is time for
the international community to commit itself to
making the WHO goal a reality."
We also, however, noted in the Secretary General's
Report ("Follow-up to the outcome of the
twenty-sixth special session: implementation of
the Declaration of Commitment on HIV/AIDS: Progress
towards implementation of the Declaration of Commitment
on HIV/AIDS" A/58/184), "Financing
trends still suggest that global funding for HIV/AIDS
programmes will fall far short of the estimated
$10.5 billion required annually by 2005 . . . And
almost $15 billion by 2007. To finance the global
response needed to ensure achievement of the Declaration's
future commitments, annual funding for HIV/AIDS
programmes must increase three fold over current
levels by 2005, and five fold by 2007" (P.1,
50, 59i)
For these reasons, the NGO Working Committee on
HIV/AIDS recommends that governments direct their
energies and resources to realizing the "3X5" goal.
It is possible to reverse the scourge of the HIV/AIDS
pandemic in keeping with the Millennium Declaration.
Policy recommendations
A To developing countries
- Governments of countries with high incidence of HIV/AIDS
should endorse and promote the WHO 3X5 Initiative.
- To improve
the health services in the public sector, those
same governments should optimize those services offered by WHO
to facilitate the realization of the "3x5" Initiative
by:
- Encouraging the adoption of the simplified, standardized
treatment guidelines published by WHO on 1st December 2003;
- Using the AIDS Drug and Diagnostic Facility, established
by WHO, to assist in the advantageous purchase of necessary
drugs, especially ARVs;
- Studying the eligibility of sector personnel to benefit
from the emergency expansion by WHO of training and capacity
development for health professionals to deliver simplified
and standardized antiretroviral treatment.
- Governments should foster greater collaboration
between the public sector and NGOs in order to provide their
populations in need with ARVs and coordinate a national strategy
to address the prevention and treatment of HIV/AIDS.
- Governments
should particularly encourage NGOs in their efforts to develop
community-based care programmes.
B To industrialized countries
- Governments should honour their pledges to the Global Fund
and incrementally increase their investment in global human
security.
- Governments should seriously consider the International
Financing Facility proposed by the UK to obtain the greatest
benefit as soon as possible.
- Creditor governments should
actively negotiate "debt
swaps" so that debtor countries burdened with domestic
health crises can redirect into their health budgets what
they need now for the service of debts. This would have
a significant impact on country's ability to improve
the effectiveness of the public sector. At the High Level
Dialogue during the General Assembly meeting on HIV/AIDS
in September 2003 President Olusegun Obasanjo stated that
Nigeria had to pay out in servicing its debt eight times
what was needed for the health services and the country
could currently only afford 6.4% of the national budget
for health.
- Encourage the private sector to be open to
initiatives such as the one brokered in September 2003
by the Clinton
Foundation in favour of drastically reducing the cost of
ARVs to countries in greatest need.
Conclusion
Civil society has been very deeply touched by seeing the human
face of the HIV/AIDS pandemic. It is increasingly alarmed that
more is not getting done, especially in directing resources to
the Global Fund, in order to reverse this terrible plague of
our time. It is a dramatic example of how social development
cannot be fostered without economic inputs. But we are also heartened
to see how public pressure and concerted efforts have greatly
reduced the cost of antiretroviral drugs, which offer hope to
millions around the globe. WHO and Doctors without Borders both
believe that the possibility to redress this situation is now
within reach. We ask governments to ensure that the public sector
seizes this moment to become a more effective channel of hope
for the world's affected population, especially the poor
and vulnerable groups who depend upon it.
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