According to a recent report from The World Bank entitled “Averting a Human Crisis During the Global Downturn” (pdf available here), millions of people that are currently undergoing medical intervention for HIV/AIDS with antiretroviral treatment (ART) are faced with the risk of their medicines being interrupted. As international organizations and African governments are experiencing budget cuts due to the financial crisis, the health community fears that increasing unemployment will lead to reduced food security. The resulting loss of quality of nutrition will continue to put pressure on already weak health systems.


Specifically, the World Bank reports that continuity of treatment could be threatened for around 70% of people currently on ART in eastern and southern Africa. The report also addresses commitments that may need to be cut from international aid organizations. According to NAM, a non-profit community based HIV information provider based in the UK, Michel Kazatchkine, Executive Director of the Global Fund to Fight AIDS, TB and Malaria has announced a funding shortfall of $4 billion in 2010. Organizations like the South African Treatment Action Campaign are speaking out to advocate for greater health funding during the crisis, pointing out that “…The region of sub-Saharan Africa bears the greatest burden of disease, and has 68% of the world’s HIV-positive people but only 1% of the global expenditure on health, and 2% of the global health workforce.”


This financial struggle during the global crisis highlights an already alarming problem. In April 2001, the members of the Heads of State and Government of the Organisation of African Unity, met in Abuja, Nigeria, and created the Abuja Declaration, committing to set aside 15% of their national expenditure towards health, specifically to fight HIV/AIDS. According to Paula Akugizibwe, regional advocacy coordinator of Windhoek-based AIDS and Rights Alliance for Southern Africa (ARASA) in Namibia, “”Very few countries have met this goal. The money is there. It’s all about prioritisation of resources. The situation is very frightening, because governments cut back on already insufficient HIV treatment and care programmes.” (Click here for full article and Akugizibwe’s comments.)


The World Bank’s report calls for “a combination of efficiency improvements, being selective in cutting of certain types of expenditures, and/or income support mechanisms can allow governments to maintain services that are critical to the most poor and vulnerable.” The report also lists the hazards of stopping treatment for those who are receiving it, including:


- Severe consequences for households (”children orphaned, loss of human capital, increased household poverty”), and the loss of experienced workers to the economy.
- Increased infectiousness of those who stop being treated.
- Diminished drug effectiveness, “requiring use of extremely costly second-line drugs and placing additional demands on health systems to monitor their use.”


Summary of the World Bank’s Key Policy Recommendations regarding HIV/AIDS
- A more rigorous and determined push for efficiency and cost-effectiveness helps countries better prioritize resource allocations across HIV/AIDS treatment and prevention programs.
- For countries with high reliance on external financing for AIDS programs, national authorities and their development partners should identify impending cash flow interruptions and provide bridge financing that, at the very least, prevents treatment interruptions.
- A simple early warning system can help track and minimize treatment interruptions, including better monitoring of drug supplies and use of key health services.
- For countries receiving emergency budget support, an appropriate base level of funding for HIV should be included as part of the social protection package.

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Interesting links:
- May 18, 2009: South Africa’s Netcare seeing revenue growth as demand for private health care increases
- May 16, 2009: Op-Ed in the New York Times discussing the need to prioritize maternal health in Sierra Leone
- May 14, 2009: African Response to influenza A(H1N1)


May 11, 2009