Unrealistic goals, impossible targets.
Posted on June 27th, 2006
At a recent summit, after a whole three days deliberations African leaders announced that they will rid Africa of malaria by 2010, in four years. Yes you heard correctly, in four years. This despite having failed to rid even one nation of the malaria scourge in the last century. African Leaders Pledge To Work Toward Providing Universal Drug Access For HIV/AIDS, TB, Malaria Treatment. One just has to wonder what decision making processes were used. But as I said they did have three days. I keep saying De Nile really is a river in Africa and the Ostrich is really found in Africa.
Such headlines and statement annoy me intensely. African leaders are not alone in making grandiose, sweeping declarations. All politicos from all over the world are guilty of this. If there is one thing I’d like politicians, policy makers, planners etc to do, it would be to Stop…. Stop setting impossible targets because they only set one up for a fall when they are not attained. Stop setting unachievable goals and if possible making unrealistic claims of the likelihood these fanciful targets will ever be achieved. It’s a forlorn plea, and unlikely to ever happen, but I ask please, please cease and desist. Stop making empty promises and giving people false hope.
Goals and targets are useful, because they set a mark against which one can measure one’s efforts and achievements. In times past goals and targets were set based on research, analysis, debate and after due consideration by a group of gray experts in a gray office. In the public health arena, these days, the goals are set publicly, likely to be influenced by more by politics and possible media attention.
No matter that the target will never be reached, no matter that the goals are (and here I used the thesaurus) unfeasible, impractical, unworkable, unattainable, unachievable, improbable, the important thing is for the person(s) in question to appear to be doing something bold. Because if there is one way to get headlines, make a splash, and appear to be doing something when you are not (or never have any intention off doing) it’s to make a big bold statement. And what politician, public health czar, development supreme, international aid guru can resist that.
Examples that spring to mind… Bush’s $15 billion dollars for PEPFAR, phantom aid if there was ever a better instance. Who knows how much has been disbursed? Or how about the 3×5 (three million HIV infected people on treatment in 5 years) set by the WHO.
Live8 and the G8, where would I be without this…remember this, when was it? Just a year ago, stars from the world over, except Africa, for which they were raising money. Sir BishBob and Saint Tony, goals and promises… where’s the money now. Oxfam had a thing or two to say about this…by the way remember Oxfam allied themselves perhaps a little to closely to the politicians on this. A lesson to be learned for them..
Yes goals and targets are useful, except when they are unrealistic. Why, because they set people up to fail leading to loss of morale. They divert valuable resources, lead to wasted effort as health workers try to reach impossible targets. They are quite simply a waste of time, worth nothing beyond the nanosecond after their pronouncement, and the time it takes to read them.
So I beg please stop.
About time as Africa rises to HIV drug challenge
Posted on June 13th, 2006
A story cross posted on from the BBC reports how some Africans are trying to respond to the HIV drug crisis, by manufacturing their own drugs – http://news.bbc.co.uk/1/hi/business/5027532.stm And about time to! This is such a long over due development…lives have been lost and years have been wasted negotiating with two faced pharmaceutical companies (and western governments who are) only interested in profits and the bottom line… big pharma has have fought a rear guard action to prevent cheap ARV’s getting into the hands for those who need them the most. No tactic has been deemed to low, from taking governments to court, to using international organsations such as the WTO to beat nations such as India to toe the line on unfair patents, to creating bogus drug donor programs that benefited only a handful of HIV suffers while trying to look like they cared…
Road deaths as bad as malaria and TB?
Posted on June 12th, 2006
This headline came over the wires recently – ‘LONDON (Reuters) – Road deaths are a global epidemic on the scale of malaria and tuberculosis and world leaders must do more to address the issue, a report said on Thursday. 1.2 million people and injure 50 million annually mostly in developing countries’…
The headlines are dramatic and attention grabbing but they should be put into context. It may be true that road accidents may have almost as many deaths as malaria worldwide, but their magnitude / impact is not the same the world over – 90%of malaria deaths are in Africa where it kills an estimated 3000 children a day. How many people drive cars or travel by road transport on the continent? Few of these children will live to see their first road trip.
Such headlines make me wish for the days of a more regional focus on tackling health issues – Africa needs its own health office – oh wait it has one… the WHO already has a regional office headquartered in Brazzaville, yet there are almost no pronouncements on the major health problems from WHO-AFRO, especially HIV/AIDS … it seems all the champions for Africa are from the West. Why? I suspect it could be a resource/ funding issue…with a more global approach to tackling health problems, and a finite and limited amount of funds available, not only does it seem Africa gets an ever diminishing share of the pie, but its problems get less and less attention…
Welcome news for the worlds children
Posted on June 12th, 2006
There’s welcome news for the youngest and most vulnerable as the ILO marks first-ever decline in child workers. The International Labour Organization is taking advantage of the world cup by using soccer-themed events to highlight its World Day Against Child Labour.
In the meantime, elswhere women called for better health and opportunities for their counterparts, to help the many mothers in poor countries who are suffering excessive health dangers and children not getting access to education….Middle East Times/Agence France-Presse
AIDS 25 years on…25 years after
Posted on June 7th, 2006
Another milestone passed in the AIDS era – 25 years since the virus was first discovered. That was last century, a quarter of a century ago. The most recent UNGASS has just ended. No mention of the word historic. Perhaps better forgotten. It seemed to have been characterized by acrimony, finger pointing and disputes. African AIDS activists were up in arms about some leaders wanting to dilute the messages they were giving, vis a vis homosexuality and gender. Others were irked at the luck of commitment to funding the fight against AIDS. The UN secretary general had unusually for him some harsh words on the progress that has been made in the fight against AIDS. And no wonder, what with all the same old arguments and debates being trotted out, to the background of global fund mismanagement, ABC disputes, data recounting or miscounting, lack of access to treatment …. It seems nothing has changed…
But much has changed in the last quarter of a century… the price of treatment has fallen 10 fold, scientific knowledge about the virus has advanced tremendously, funding has increased greatly…what is needed is the commitment and dedication that was brought to bear in the first decade of the fight against AIDS.. a renewal ceremony…oh yes that was what the UNGASS was supposed to be about. Oh well in another 5 years or 25….
And what of the future. At the moment it seems that we have we have arrived at an impasse in the fight against AIDS …people have run out of ideas, no one knows what to do next or how to take the fight forward. I have a radical solution; stop concentrating on HIV/AIDS as if it were the only health problem in world. The laser like focus on AIDS has led to a kind of tunnel vision, a seemingly myopic world, one in which if you are not somehow connected to AIDS, you are doing nothing for health in the developing world. This has led to the erosion and diversion of much needed resources, financial, material, manpower from other equally important health problems, and has probably led to a real decline in effectiveness of existing health programs.. True belatedly Tb and malaria were tacked onto the fight against AIDS but only as neglected orphans TB and malaria programs are still hugely underfunded in comparison to AIDS.
The fight against AIDS has had unexpected bonuses, if you can call them that. It brought about much needed attention to the lack of health workers, the high cost of treatment and drugs, unfair copyright and trade practices in health, the profound lack of infrastructure and woeful state of health systems in Africa to name not a few….
But the early successes in the first few years against the elusive HIV virus have not been repeated and are unlikely to be repeated…because if there is one other lesson that AIDS has shown, only a multi-pronged approach, a simultaneous systematic attack at all different levels is required. This is the basis of all successful public health endeavours. The current tactic where one method, for example prevention is abandoned in favour of something more in vogue such as ARV treatment has not had much success. What is needed is a back to basics approach and this in my opinion means reducing the emphasis on AIDS and increasing the efforts in tackling other health problems.
Doing this is not an admission of defeat. It is just a change of tactics. AIDS has never been and is not a war of its own; it’s just part of the wider struggle to improve the health of billions. And winning such a war should be by any and all means necessary, if the next 25 years are going to be different from the previous quarter century.
A Universal Pledge for Health
Posted on June 3rd, 2006
Recently African leaders at the end of the three-day African Union summit on HIV/AIDS, tuberculosis and malaria in Abuja, Nigeria, pledged to work toward providing universal treatment access for people living with the diseases on the continent, AFP/Today Online reports…
As welcome this is…and as much as it makes for good headlines – compared to simple anti-biotic drugs, anti-helminthics (deworming drugs) to treat children – in the light of the recent report from UNICEF on child health – why restrict the pledge to treatment for only OVP (CABA) – it would make more sense to go after conditions that can be treated, the greatest good for the greatest number and at the same time free resources for AIDS.
Meanwhile just ahead of the soon to be held UNGASS, a survey /evaluation has found that many African nations are getting a failing grade in the fight against AIDS.
“JOHANNESBURG, 23 May (PLUSNEWS) – African countries have failed to meet prevention targets agreed upon in 2001 at the United Nations General Assembly’s Special Session on HIV/AIDS (UNGASS), according to a statement issued recently by over 80 representatives of African civil society. “
The statement noted that no African country has met the UNGASS goals of reducing HIV prevalence amongst young people by 25 percent or ensuring 90 percent access to HIV/AIDS information and education. These failures are likely to come under scrutiny as government representatives converge on New York at the end of this month to review progress on their 2001 commitments to combating HIV and AIDS.
Prevention was supposed to be the cornerstone in the fight against AIDS. It is 25 years after HIV/AIDS was first discovered, and it seems depressingly the message has not yet got through. The recent debate on ABC, and now the emphasis on Abstinence as the preferred method for prevention attests to this fact. Depressing, because after 25 years the same old tired arguments are being trotted out, in denial of what is actually taking place.
SO we hear from Kenya’s first lady asking “why should kids use condoms.”, we hear We hear Uganda’s first lady promoting abstinence only. Kenya once had the highest birth rate in the world, and was leading in teenage pregnancies – abstinence is not working. Uganda once the poster child for success against the fight in AIDS, has announced an increase in new cases. Now the govt is staking the future on drugs. Prevention it seems has been abandoned or taken a back seat. So what next for the future, it’s anyone’s guess.