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The dangers of attacking disease programmes for developing countries

Roger England has launched yet another broadside attack on programmes for priority diseases in poor countries ( BMJ 2007;335:565 doi: 10.1136/bmj.39335.520463.94 and 2007;334:344 doi: 10.1136/bmj.39113.402361.94). In his latest Personal View, he claims that “disease specific global programmes [are] not the way to help Africa,” instead that they cause “big problems for recipients,” and that money for HIV/AIDS is “the worst.” He claims that off-budget money leads to distortions; that there are duplications of plans, operations, and monitoring; and that priority disease programmes are neither cost effective nor sustainable.

His evidence that little is being achieved is one statistic: HIV prophylaxis is reaching only 9% (actually it is 11%) of pregnancies of HIV positive women. He blames the warped prioritisation of disease programmes on international lobby groups from rich countries.

England's prescription for change says that (1) governments must stop funding global programmes that do not go through countries' planning and budgeting processes; (2) the Global Fund to Fight AIDS, Tuberculosis, and Malaria must disband and be reconstituted as a global health fund; (3) countries must reform their systems and outsource service provision from the government to the private sector; and (4) everyone should drop the millennium development goals because they are more trouble than they are worth.

The evidence on hand rebuts or at least moderates many of England's claims and recommendations.

(1) Contrary to England's claims, priority disease programmes have shown considerable progress in a relatively short period of time. Currently, the Global Fund contributes two thirds of international funding for tuberculosis and malaria, and about 20% of global resources for HIV/AIDS, for example. In its short life it has funded programmes that have already saved more than 1.8 million lives; provided antiretroviral treatment to …