AIDS, tuberculosis and malaria
“Traditional” communicable diseases may not have totally disappeared but the focus nowadays is on HIV/AIDS, tuberculosis and malaria due to the devastating effects of these diseases.
The stakes involved in fighting AIDS, tuberculosis and malaria
HIV/AIDS has become the main cause of premature deaths in Sub-Saharan Africa and the fourth cause of death in the world. Out of the 40 million people infected with the HIV/AIDS virus 3 million die each year and 6 000 new cases of infection are registered every day. Today women are the first victims of the disease due to their physiological, cultural and social vulnerability. Over 13 million children are HIV/AIDS orphans and the figure is likely to double by 2010. The epidemic is by far predominant in East Africa but is spreading dramatically in all the world’s regions in spite of all the efforts made. Prevention programmes may well slow down the spread in some countries, treatment and care programmes may well be on a difficult scaling up path, but the conjunction of both these approaches is the only way likely to stabilize the epidemic. Brazil and Thailand are two examples of this successful approach. Such interventions are, however, complex, costly and require a truly sustainable political and financial commitment basis and functional health systems.
Tuberculosis has never been eradicated in developed countries and still causes 1.7 million deaths a year in South countries, half associated with HIV/AIDS, despite strategies with sound cost-effectiveness ratios to fight this disease. Treatment duration and methods as well as the difficulty of testing do however pose a serious operational challenge. The emergence of resistance to treatment partly due to a lack of healthcare is alarming in terms of contagiousness and costs incurred.
Malaria still causes 500 million morbidities and between 1 and 3 million deaths a year, mainly among children. This disease mainly affects South populations. Low profit perspectives in these regions of the world explain the marked scarcity of medical research programmes in this field, while resistance to traditional drugs and insecticides are increasingly widespread. New artemisinine (ACT) combinations are now available but at a much higher price than the current antimalarial treatments and more effective prevention methods also exist such as long-lasting treated mosquito nets.
Against this backdrop, the current issues in fighting these diseases are mainly a massive increase in patient care, prevention, monitoring drug resistance and research and development for new affordable drugs/vaccines.
France’s huge multilateral commitment to fight against communicable diseases (in particular through the Global Fund and UNITAID) lead to focusing bilateral aid on institutional and technical capacity building in countries to allow them to effectively implement this funding in coordination with the entire health system.
Strengthening national structures
AFD finances technical assistance to support national structures in charge of coordinating the fight against HIV/AIDS, malaria and tuberculosis in countries where health is a concentration sector, or in any other country identified in agreement with governments or supervisory authorities. Given France’s role in the decision making process of the Global Fund, AFD regularly provides the French Ministry of Foreign Affairs with regular updates on the functioning of such national structures and any difficulties encountered. Technical assistants provide support notably in identifying obstacles to programme implementation in order to mobilize the technical expertise available on the regional platforms supported by French multilateral aid through theWorld Health Organization. They also contribute to strengthening good governance within these structures by ensuring an active participation of civil society and the private sector.
Technical support for stakeholders and developing public private partnerships
Scaling up programmes to fight against the three main communicable diseases (prerequisite for achieving Millennium Development Goal n°6) is technically difficult due to the lack (or even acute shortage) of staff trained in global patient care and the lack of management or supervision. AFD therefore aims to target financing on issues of transferring skills, technical support and training. In line with international recommendations, AFD supported interventions seek to mainstream actions to fight against HIV/AIDS into health services, particularly maternal andinfant, programmes to fight against tuberculosis and sexually transmitted infections as well as projects targeting affected children. The performance of national information and monitoring systems is also a specific focus.