Australias contribution to global health fund provokes dismay

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Australia’s contribution to global                                         Amounts ($m) pledged to Global Fund to Fight AIDS,
health fund provokes dismay                                                Tuberculosis and Malaria for 2004, compared with “equitable
                                                                           contribution” (calculated as proportion of global fund’s total
Bob Burton Canberra
                                                                           budget relative to country’s gross national product (GNP))
200, 60, 154, 254                                                          Country              GNP          Amount       Equitable     Difference
                                                                                               as % of       pledged     contribution
The Australian government has        countries such as Kuwait and
                                                                                              world total    for 2004
announced it will contribute only    the United Arab Emirates is
$A25m        (£10.4m;     $19.4m;    $500m—a third of the total bud-       United States         32.3           547          633           -86
€15.4m) over the next three          get. The fund’s executive direc-      Japan                 12.3           100          242          -142
years to the Global Fund to Fight    tor, Dr Richard Feachem, met          Germany                6.1           107          120           -13
AIDS, Tuberculosis and Malaria.      Alexander Downer, Australia’s         United Kingdom         4.8            88           94            -6
    While welcoming the govern-      minister for foreign affairs, to      France                 4.4           235           86           149
ment’s participation, Malcolm        press its case. “We’ve already        Italy                  3.7           163           72            91
Reid, spokesman for Oxfam            committed $400m over the              Canada                 2.2            25           43           -18
Community Aid Abroad, the            next two years to work in this        Spain                  2.0            37           39            -2
Australian arm of Oxfam, was         region, and that includes sub-        South Korea            1.5             0           29            29
dismayed by the small grant.         stantial investments in the Pacif-    Australia              1.3             7           25           -18
“We calculated that based on the     ic Islands, in Papua New              Netherlands            1.3            72           25            47
size of its economy… Australia       Guinea, in East Timor, and in         Belgium                0.8            18           15             3
should be contributing about         Indonesia,” Dr Feachem said.          Switzerland            0.8             0           16            16
$A40m this year alone,” he said.         Mr Downer acknowledges
                                                                           Sources: The Global Fund to Fight AIDS, Tuberculosis and Malaria
    The director of Médecins         the problem in the region but         (www.theglobalfund.org) and Aidspan (www.aidspan.org)
Sans Frontières Australia’s cam-     points to Australia’s current six
paign to improve access to           year, $A200m bilateral pro-
essential medicines, Kathryn         gramme to counter AIDS.
Dinh, was also disappointed:             The global fund was estab-        Framework shows countries’ contributions
“We are hoping that they are         lished in 2002 as an indepen-
                                                                           Bob Burton Canberra
going to increase their contribu-    dent       foundation.     While
                                                                           200
tion in the future.”                 developed countries such as
    An estimated 7.4 million         France      immediately     made      A method to determine whether countries are contributing their fair
people in the Asia Pacific region,   major funding commitments,            share to the Global Fund to Fight AIDS, Tuberculosis and Malaria was
an     area    stretching    from    Australia withheld support. “We       drawn up in 2002 by experts in development aid.
Bangladesh through to Japan          didn’t join the global fund origi-        The system, known as the equitable contributions framework, is
and China, and including the         nally because we had bilateral        used by organisations such as Oxfam, Médecins Sans Frontières, and
Pacific Islands, are infected with   programmes in all of those            Fund the Fund to persuade countries not to shirk their responsibilities.
HIV or have AIDS, and the            [disease] areas at the moment,”           The basis of the framework is that funding should be drawn from
region has about three million       Mr Downer said.                       the 37 “most comfortably off” countries in the world.
cases of malaria. Of the 3.7 mil-        Dr Feachem pointed to the             The fund has stated that it needs to receive $1.56bn (£0.83bn;
lion cases of tuberculosis report-   symbolic importance of the            a1.24bn) during 2004. Consequently, the authors of the framework
ed worldwide in 2002 about 60%       Australian government’s contri-       divided the $1.56bn between the 37 richest countries according to their
were in the region.                  bution. “It’s not just the            percentage share of the total GNP.
    The fund’s target to be          numbers of dollars,” he said. “It’s       The table shows that certain countries, such as France and Italy,
raised in 2004 from Japan,           the voice that Australia carries      have contributed more than their fair share and others, such as Japan
Canada, Australia, and oil rich      in international forums.”             and the United States, have contributed less.




World Bank                           how well the bank’s programmes
                                     are reaching the poor, the con-
                                                                           diseases of the poor, but that
                                                                           assumption is increasingly ques-
                                                                                                                  project in which the distribution
                                                                                                                  of insecticide treated bed nets
conference                           ference reflected growing aware-
                                     ness in the international
                                                                           tioned, he said.
                                                                               Delegates at the conference,
                                                                                                                  was “piggy backed” to measles
                                                                                                                  campaigns in Ghana and Zam-
debates how to                       development community that            which was funded by the Bill           bia. He said this resulted in over
                                     “health systems are unconscious-      and Melinda Gates Foundation           90% coverage. Researchers from
reach the poor                       ly regressive and tend to bias        and the Swedish and Dutch gov-         the University of Cape Town and
                                     against the poor and most             ernments, learned that many            the London School of Hygiene
Jocalyn Clark BMJ                    needy.”                               health, nutrition, and popula-         and Tropical Medicine described
200                                      In his opening address,           tion services, because they            how the multidisciplinary nature
                                     Davidson Gwatkin, principal           favour the better off, themselves      of two large scale voluntary
Health services designed to          health and poverty specialist at      contribute to disparities in           counselling and treatment pro-
favour the poor do not necessar-     the World Bank and organiser of       health status. Such disparities        grammes for HIV/AIDS in
ily reach the most needy in soci-    the conference, said the focus        are found not only in routine          South Africa contributed to
eties. That was the conclusion of    must be on not just the presence      health services but often also in      comprehensive coverage among
a group of World Bank policy         or absence of health and nutri-       programmes run especially to           disadvantaged socioeconomic
makers and programme officers        tion services but also on their       benefit the poor.                      and ethnic groups.
working in developing and tran-      distribution. Programmes aimed            In a series of case study pre-        But these successes were said
sitional countries who met last      at preventing or alleviating HIV      sentations commissioned by the         to have been achieved in the
week in Washington, DC, to dis-      infection,    tuberculosis,  and      bank—one third of them from            face of severe challenges to
cuss better ways to reach the        malaria, for example, are often       the    developing      world—Joel      adequately reaching the poor,
most vulnerable people.              assumed to reach the poor             Selanikio of the American Red          such as the lack of infrastructure
    Described as “taking stock” of   merely because these are seen as      Cross described a collaborative        and efficient health systems.


486                                                                                                     BMJ VOLUME 328 28 FEBRUARY 2004 bmj.com