Different Countries, Different Issues, Same Question: Where is the Money?

Different Countries, Different Issues, Same Question: Where is the Money?

Two women hold a banner at ICASA 2011: Where's the Money for HIV? Credit: MSH.


Last week I had the privilege of attending the International Conference on Family Planning in Dakar, Senegal, where over 2,200 family planning and global health advocates, funders, and supporters gathered to voice support for family planning.

This week I am in Addis Ababa, Ethiopia, attending the International Conference on HIV and STIs in Africa (ICASA). More than 10,000 advocates, funders, and supporters of HIV/AIDS and global health from around the world have gathered together in support of HIV & AIDS.

I listened to the opening plenary session on Sunday evening as former US President George W. Bush talked about the tough financial environment, particularly in the US. Bush reminded the US Congress -- none of whom are here -- that while it may seem easy to pull back on financial commitments to global health, priorities must be made to save human lives.

I applauded President Bush’s call to the US Congress. I believe that it is imperative for the US to fund all global health accounts -- especially those that have suffered underfunding for years, like family planning and maternal and child health. I was struck that the elephant in the room remained: where is the funding from African Nations?

Michel Sidibé, UNAIDS Executive Director, was the only plenary speaker to openly call out the African Leaders in attendance to own their epidemic and prioritize funding. I was disappointed that every speaker did not do the same. Most speakers focused on praising President Bush. Yes, Bush deserves praise; but, why hasn’t his leadership sparked more nations to do it for themselves?

The Abuja Declaration in 2001 -- 15 percent of government expenditure for health -- was for Africa by Africans. Only six countries have met their targets. Many African nations are not honoring their commitments of investing in their own people. For example, in Dakar I visited a massive statue called African Renaissance Statue. Its estimated cost was $27 million USD. Why wasn’t that money used for family planning or to fight HIV/AIDS?

Two men hold handmade signs calling for funding for AIDS at ICASA 2011. Credit: MSH.


I spend my days advocating to US Members of Congress for funding for global health for the poorest people in the world because it is the right thing to do and it helps the development of nations. This advocacy will become more difficult as the financial climate gets more restrictive. It is clear that leaders of all nations must step up not only with their wonderful statements on global health issues, but also with real money to support global health. High income nations must honor the commitments to other nations.

I wait anxiously to see not just what the US commits for global health in the upcoming years, but what African nations commit. As Peter Piot, former Executive Director of UNAIDS, said, "the solutions of African problems, can only come from Africans.”

Crystal Lander is Director of Policy and Advocacy at Management Sciences for Health.


Kolawole A
Most of the work I do is in rural Nigeria working directly with HIV/AIDS patients and funding for the entire program: ARVs, lab kits and machinery etc is entirely foreign. I'm glad that someone else is raising this issue. I wonder when the GON will decide to get serious with HIV/AIDS. We are a major producer of crude oil but spend billions of dollars in subsidy payments to private companies that import gas for domestic use - a sorry situation by itself. Anyway, now that the GON is going ahead with plans to stop gas subsidy funding, I do hope our healthcare partners eg.USAID can convince the GON to divert a fraction of those funds towards HIV/AIDS. My fear is that there will come a day when PEPFAR would suffer massive budget cuts and unfortunately, its not our policy makers but the poor PLWHAs that would bear the brunt.
I agree with what you said.However it would be catastrophic to pull out at this time in time when good governance is not yet on its feet in Africa.High income countries not only must honor the commitments but refrain from being donated.
Two points. 1. HIV/AIDS only directly affects a minority of the populations of African countries. Even in countries where infections is as high as 25%, that means there's an entire 75% of the population with other health needs that the government has to address. There are billions of dollars being donated and invested by foreign entities, so why should national governments fund an already highly funded health problem, especially when they are often the only ones addressing issues such building and updating clinics and hospitals, and paying salaries and all the social benefits that come with them? Isn't it only logical to allow HIV/AIDS earmarked (PEPFAR, Global Fund, etc) money to address HIV/AIDS and direct government funds to other areas? To do otherwise would be equivalent to a student on a scholarship insisting on also paying tuition out of their own pocket. 2. "African problems can only be solved by Africans" is mere rhetoric. No one in the development community believes that. Certainly not enough to act on it. If it was the case we wouldn't have foreign consultants devising and writing national strategies and plans for African countries. Pick an African country, read their health/education/economic sector strategic plan and I guarantee you will find it is written or sponsored by a foreign entity (WB, NGO, etc).
Crystal Lander
Thanks for your comment Shiwa. I agree that if 25% are infected by HIV, the reality is many more are affected by it. However, PEPFAR and Global Fund are not controlled by any African nations. Having other countries address one of the largest global health emergencies and decide how people in your country will receive treatment, care and prevention doesn't make sense to me. Also, my issue is not just with funds for HIV; I am talking about all health funding and specifically HIV and reproductive health funding. Regarding Peter Piot's quote: MSH and I both believe in country ownership -- that does not mean doing things alone. Giving someone a solution to their problem rather than having a partnership mentality is what the quote is all about. This links back to my first point (which seems like you agree with me on); African governments cannot continue to complain about how donors are earmarking funds for their country if they don't allocate their own funding for whatever they believe are their priority issues. I don't believe anyone thinks a $27 million dollar statue is a priority in a country with 50% plus unemployment. My favorite part of the ICASA conference was the willingness of speakers to debate these issues; I only hope the debate turns into leadership.

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