Posted by Debbie Koh
Trends are a part of our lives. Fashion, YouTube videos, Twitter hashtags – they all come and go. International health and development is not immune to these cycles either. On January 30, Bill Gates announced the commitment of pharmaceutical companies, public and private donors in the “London Declaration” to eliminate neglected tropical diseases (NTDs) by 2020. This overdue focus certainly should be celebrated – you know it’s bad if the fact that nobody pays attention to this group of diseases has been worked into their name.
Two days later, the New York Times ran an op-ed by Paul Farmer,“Why the Global Fund Matters,”in which he essentially pleads for the continued existence of the formerly behemoth funding mechanism. Before the establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria and the Presidents Emergency Plan for AIDS Relief (PEPFAR) in the early 2000s, development assistance for HIV/AIDS was less than $1 billion. By 2005, more than $3 billion was being spent to fight HIV/AIDS. Throw TB and malaria into the mix (and the establishment of the President’s Malaria Initiative) and the total amount of development assistance for health by mid-decade was more than $17 billion. Between 2001 and 2008, the total development assistance for health more than doubled.[i]
So what’s the problem? By 2008 and 2009, development assistance for HIV/AIDS and TB slowed while areas like maternal, newborn and child health enjoyed rapid growth. This is in no doubt aided by the rapidly approaching 2015 deadline for achieving the Millennium Development Goals, including Goal 5 – reducing the maternal mortality ratio by three quarters.As someone working in maternal health, I already get the sense of needing to strike while the iron is hot, before the attention and funding moves on, if it hasn’t started to already.
Agriculture and food security, social franchising, and mobile health technology are just a few areas gathering momentum. I am not arguing for any one over the other, and reality is that the total amount of funding for HIV/AIDS still remains high, even if growth is slowing. I’m as guilty of following the herd as anyone else: I jumped from HIV/AIDS work to maternal health and eagerly track what’s new and upcoming in the field. I do worry, though, that these recent developments are indicative of shortening attention spans in a field that requires sustained commitment and focus.
The fight against HIV/AIDS continues to be a drawn out, difficult battle with “wins” that are very different from what we envisioned a decade ago. Truly reducing maternal mortality in the world will require a long-term and complex combination of health interventions, economic growth, political will, education and empowerment. NTDs are low hanging fruit now, but who will be there to address the social, environmental, and other unanticipated factors that will inevitably thwart these new efforts?
Paul Farmer’s plea serves as a reminder that achieving true, lasting impact in global health is a long haul. Lives are at stake in our work. Let’s not forget our commitment to them.
[i]Institute for Health Metrics and Evaluation. Financing Global Health 2011: Continued Growth as MDG Deadline Approaches. Seattle, WA: IHME, 2011.
Debbie graduated from Wagner in 2010 with her MPA in Health Policy and Management, International Health. She returned to her native California in 2011 and currently works for Venture Strategies Innovations. Follow her on Twitter at @thedebkoh or connect via LinkedIn. All views expressed are her own.