By Josh Ruxin
jnr4@columbia.edu

President Bush’s first trip to Africa in five years might be seen as part of the traditional effort of a lame-duck president to aggrandize his legacy before he exits office, but Africa is one area where President Bush need not embellish his accomplishments. Whether the Bush administration is viewed as a success or failure on any number of issues is open to debate, but the results Bush has achieved in Africa in terms of the prevention and treatment of AIDS and malaria are indisputable.

And yet, although Bush’s spending in Africa has been considerable, there is still more that needs to be done. The overall picture of public health across sub-Saharan Africa remains grim with tens of millions in need of treatment and hundreds of millions lacking adequate primary health care. U.S. spending also needs to be more comprehensive. The focus on addressing individual diseases rather than their underlying causes – poverty foremost– is short-sighted.

Here are some questions that reporters covering Bush’s trip to Africa should consider:

Q. What has been the impact of ideology over science in the President's Emergency Plan for AIDS Relief (PEPFAR) programs?

Abstinence-only programs have garnered a major proportion of PEPFAR funding, despite that fact that they are not part of a scientific approach to fighting HIV/AIDS. Under the current policy, as much as one third of the money allocated to HIV prevention goes to abstinence-only campaigns. For many, the lack of information about sex and how to prevent HIV/AIDS, coupled with little or no access to condoms only increases the risk of transmitting HIV/AIDS.

A November report by the United Nations estimated that of the 2.5 million children in the world with HIV, nearly 90 percent live in sub-Saharan Africa and the overwhelming majority of those acquired the infection from their mothers. Yet funding for family planning has fallen in spite of recent studies showing it is more effective in limiting the number of HIV positive children.

According to Population Action International, the budget President Bush has proposed for contraception in controlling pediatric HIV has declined and is currently less than one-third the amount spent in 1995, when adjusted for inflation.

Without addressing these two key issues, the situation will become even more dire in the next few years, as an increasing number of individuals are affected by HIV/AIDS.

Q. How does PEPFAR compare with the Global Fund?

PEPFAR works through a network of sub-recipients whereas the Global Fund to Fight AIDS, Tuberculosis and Malaria puts governments in the driver’s seat and provides direct grants for government priorities.

Q. What’s the role of governance in the effectiveness of PEPFAR programs?

Good governance is essential to making sure that aid from PEPFAR and other organizations is distributed effectively. Corruption is one of the primary reasons why many of those who need the money most never see it.

A government inquiry in Uganda recently revealed that tens of millions of dollars in Global Fund grants to the country were plundered by high-ranking government officials. This is not the first time this type of situation has occurred, either. The Global Fund has had to pull grants out of Nigeria, Kenya, and Uganda due to non-performance.

Q. PEPFAR and the President’s Malaria Initiative have brought focus on counting numbers -- patients, etc. -- around these diseases. The Bush administration has poured nearly $5 billion annually into AIDS, but nowhere close as much into economic development. How could a holistic approach improve overall outcomes?

The president has called on Congress to reauthorize a $30 billion, five-year extension of his AIDS program, which would treat 2.5 million people, prevent 12 million new infections and provide care for 12 million more. Activists are seeking an additional $20 billion to enable the program to adopt a more comprehensive approach. The president should take a close look at their request during his African stay.

We currently spend close to $5 billion a year on AIDS, which has resulted in countless lives saved. But we cannot fight this disease, or any other, in a vacuum. What good is an antiretroviral for AIDS, for instance, if the patient has no food? AIDS is a disease of poverty, and to beat it and the many other scourges out there, we need to take a holistic approach to fighting poverty.

As we focus on health care advances, we must also understand that health care without economic development will fail. To be successful, health care improvement must be accompanied by efforts to address overall living conditions: sanitation; the availability of fresh water; the ability to earn a living. Funds targeting agricultural productivity, business loans, and infrastructure improvement would go a long way in health care.

With a focus on economic development, fighting hunger, restoring access to clean drinking water and building infrastructure, we will save millions of people each year, whether they suffer from AIDS, TB, malaria or other diseases borne from poverty. We need to foster and cultivate growth in Africa as well by creating new markets and business opportunities. We can do that by creating co-operatives, building new business incentives, working with local entrepreneurs, and focusing time and energy on strengthening women's issues. The President’s support of Millennium Challenge Accounts has been a good start for rewarding well-governed countries with funding for infrastructure which stimulates business. However, much, much more funding, particularly at the grassroots level, is needed to spur prosperity creation.

Josh Ruxin is the founder and director of the Access Project in Rwanda, an initiative of the Center for Global Health and Economic Development at Columbia University. He is currently based in Kigali, Rwanda. E-mail: jnr4@columbia.edu

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