The Human Cost of Misplaced Priorities

I’ve been writing about the need for donors to step up their contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria.  However, the money for fighting these diseases and for improving health generally should not just come from donors – the governments of low and middle-income countries must also step up.

In 2001, the heads of state of African governments got together in Abuja, Nigeria, and pledged to contribute 15 percent of their national budgets to health.  Like donor governments’ pledges to commit 0.07 percent of their gross national income (GNI) in official development assistance, progress in meeting this target has been slow.

According to a report by the Global Fund, in 2007 only three of 52 sub-Saharan African countries met the Abuja target: Botswana, Djibouti, and Rwanda. Another seven had consistently allocated more than 12 percent of their budgets to health: Benin, Burkina Faso, Gabon, Malawi, Mali, Namibia and Tanzania. Overall, 25 of the 52 countries had increased the percentage of government spending on health between 2001 and 2007, but the remaining 27 countries decreased spending. Swaziland— the country with the biggest HIV burden in the world — decreased spending from 11.8 percent of the national budget in 1999 to just 9.5 percent in 2007.  Uganda decreased spending from 11.3 percent to just 8.9 percent, and Zimbabwe’s declined from 10 percent to 8.9 percent. (The report, Trends in Development Assistance and Domestic Financing for Health in Implementing Countries, is available as a PDF from the Global Fund.)

While many developing country governments use poverty as a reason for their limited investments in health, it may just be that their priorities are misplaced.  The AIDS and Rights Alliance of Southern Africa (ARASA), an Open Society Institute grantee, is currently running a brilliant campaign called Eye Spy, which draws attention to the choices governments are making on how they spend their money.  Too often it seems, governments are spending exorbitantly on luxury transportation or whittling away the money that is available through corrupt deals and private off-shore bank accounts, instead of investing in health.  According to ARASA, the annual cost of corruption to the African continent is about US$148,000,000,000. That amount of money could buy one year of HIV treatment for 704 million people. Check out their eye-opening Lords of the Bling video:

While thousands of people who need anti-retroviral therapy are being turned away in Uganda, Yoweri Museveni bought a private jet for US$48,000,000. That’s the cost of providing a year of HIV treatment for 229,524 people.

The $500,000 spent by Swaziland’s King Mswati III to buy a state-of-the-art luxury car could have been used to provide TB treatment for 21,001 people. And the $250,000 used for Zimbabwe President Robert Mugabe’s 85^th birthday party could have treated 10,500.

At the Global Fund’s first replenishment meeting in The Hague in March, donors rightly showed indignation about the lack of investment in health by developing country governments and said they needed to see greater commitment. Developing countries do need to get their priorities in line and they do need to be held accountable for spending more on health.

But then again, so do the donors.  According to the Organization for Economic Cooperation and Development, in 2010 the 22 richest countries will give on average only 0.33 percent of their GNI in official development assistance. Only six will meet or exceed the 0.07 percent target. The U.S. and Japan tie for last place at 0.02 percent.

And, as ARASA helpfully reminds us, the US$700 billion spent on the bank bailout in 2008 was more than 100 times the budget of the U.S. President’s Emergency Plan for AIDS Relief.

What do you spy with your little eye?