Where is the aid for HIV/Aids?

I was once told by my history teacher that the very reason why history is taught is that we need to learn from the past in order to improve the future. But when I read about the Marshall Plan, I really wonder whether the world has refused to learn anything from the Marshal Plan and just decided to behave like a big ostrich.

The development cliché, “If you give me fish, you will have fed me for a day, but if you teach me how to fish you will have fed me for life”, truly captures the ultimate reality in effective aid. It means that investment in aid, once made, should continue producing dividends indefinitely, at least while the fish stocks last. The above adage was vindicated by history through the Marshal Plan which turned Western Europe after the Second World War, from a beggar to a donor. I was once told by my history teacher that the very reason why history is taught is that we need to learn from the past in order to improve the future. But when I read about the Marshall Plan, I really wonder whether the world has refused to learn anything from the Marshal Plan and just decided to behave like a big ostrich.

Available data indicates that the total world official development assistance from the governments of 22 richest industrialised countries and EU in 2007/08 excluding grants from private philanthropists, was 121.3 billion US dollars, more than the budgets of many poor countries combined! I want to assume that much of that aid was spent in funding development interventions related to the Millennium Development Goals (MDGs) which is the framework all countries are striving to achieve by 2015.

Whether the MDGs are going to be achievable or not by 2015, I leave it to the test of time. However, a mere mention of MDGs, reminds me of the famous Uganda Poverty Eradication Action Plan (PEAP) which was supposed to be the means or a miracle maker for eradicating extreme poverty (MDG 1). When I analyse the design of PEAP, it does not take me by surprise that the PEAP was put in the planning dust bin. This was the right thing to do. In fact this should have been done earlier.

Allow me express my humble opinion on MDG 6 which is combating HIV/Aids, malaria and other diseases, and refer to the survey conducted by the Coalition for Health Promotion and Social Development, (HEPS-Uganda) and other civil society partners under the banner of Uganda Coalition for Access to Essential Medicines (UCAEM) done in September 2008 that assessed the availability and management of essential medicines for Aids and TB.

First of all the study revealed existence of two parallel and contrasting drug distribution systems in which one was reported to be occasionally associated with erratic and wrong deliveries of nearly expired drugs. This clearly showed lack of seriousness especially given the fact that funds were availed. How can someone give you money and you fail to plan and deliver a service adequately, leave alone failing to provide for its sustainability? How would drugs expire amidst unmet demand?

Secondly, the facilities studied had a combined total of 15,971 patients registered for ART, and it was revealed that the total of 8,460 PHAs qualify for ART each month. But due to inadequate capacity most are not considered for ARVs, problem being the persistent stock-outs of prophylaxis treatment. The effects of shortages of prophylaxis drugs include but not limited to faster progression of the disease in individuals concerned, which raises many questions about HIV/Aids interventions.

Thirdly, the study revealed that less than half of all the facilities studied had paediatric ARV formulations though most of them reported having paediatric patients. The poor availability of paediatric ARVs implies either poor care for paediatric patients, who risk being over-dosed with adult tablet formulations, or exposing them to drug resistance, the consequences of which cannot be overemphasised. In the struggle against the HIV pandemic, availability of TB drugs is as important as HIV/Aids drugs and yet the study revealed that fixed dose combinations of TB medicines were available in only two thirds of public facilities.

The study also revealed that diagnostic kits were available in only 70 per cent of government and in 59 per cent NGO facilities! Other findings of the study revealed limited availability of laboratory facilities that are important for monitoring the side-effects of ARVs and TB medicines.
According to the findings of the study, less than a third of public facilities were found with laboratories capable of performing liver and renal function tests. Shortage of such vital laboratory equipment leads to serious consequences to the health of individuals living with HIV because absence of the vital organ function test facilities means that some of the side effects are only detected from the signs and symptoms, which means problems are detected late.

For HIV/Aids preventive, diagnosis, treatment, care and support interventions to be successful, diagnostic kits are critical ingredients, mainly because it is HIV counselling and testing which is an entry point to HIV/Aids prevention, care and support. Is this not the very reason why all Ugandans are being urged to test for HIV? Limited availability of diagnostic kits points to major challenges not only in planning, coordination and implementation but also funding of HIV/Aids interventions. There is need for a well coordinated and integrated system catering for all the thematic areas of HIV/Aids prevention, diagnosis, treatment, care and support.

There are many examples that can be given to highlight shortfalls and challenges in HIV/Aids interventions and service delivery. However, talking about our failures may appear as if one is apportioning blame and yet we are all responsible for these failures. Since we are all facing the challenge, it suffices to ask the following questions: Are donors funding the right interventions? Are we implementing appropriate interventions? Are we doing the things right? Are benefits of our interventions really reaching all intended beneficiaries? If the benefits are not reaching all the beneficiaries, how are we selecting those who benefit? Can someone somewhere dig beneath the science of their selection? Finally, according to the UN Secretary-General Ban Ki-moon, since time is short, we must seize this historical moment to act responsibly and decisively for the common good. Otherwise we shall all answer for our mistakes.

Mr Okalo comments on health issues
okalopaul@gmail.com