In these times of global meltdown, it is all the more critical to focus on how can TB care and control, be still seen as a smart investment to governments, private sector and other stakeholders.
There is enough evidence to substantiate that TB care and control is a smart investment. In December 2007, a World Bank report had revealed that high burden TB countries can earn significantly more than they spend on TB diagnosis and treatment if they signed onto the Stop TB Partnership's Global Plan to Stop TB. This study made it clear that the economic benefits of TB control are greater than the costs. Most highly affected countries could gain nine times or more their investments in TB control.
However, when the 3rd Stop TB Partners' Forum is about to begin in Rio de Janeiro, Brazil (23-25 March 2009), World TB Day (24 March 2009) is hardly few hours ahead, and the high-level Ministerial meeting on M/XDR-TB will commence during 1-3 April 2009 in Beijing, China, it is certainly a food for thought on how can we still salvage TB care and control programmes in these times of economic recession.
Just few days back, the American International Group (AIG) was in the news for disbursing nearly half a billion US dollars as bonuses of the bail-out money.
In most countries, leaders are resorting to extreme cost-cutting measures that threaten funding for TB treatment and control measures across the globe. The cuts will be made, and the investment will only occur in 'smart' areas.
Clearly more needs to be done to convince the world that TB care and control is a smart investment. In the past months, the indications have been worrisome. While the Global Fund to fight AIDS, TB and Malaria (GFATM) continues its search for the US$ 5 billion in funding still needed for 2009-2010, Wall Street corporations gave themselves $18 billion in holiday bonuses.
The money for these bonuses came from tax payers but would tax payers rather fund holidays for bankers, or save lives in countries hit hard by the three diseases - AIDS, TB and Malaria? The Merrill Lynch bonuses alone would have paid off GFATM's funding short-fall in full.
Jeffery Sachs, Director of Columbia University's Earth Institute and a Special Adviser to the UN Secretary General, had called on the US government to take back the $18 billion and use the money to help buy antiretroviral drugs and mosquito nets.
Calling the bonuses, "unbelievably egregious" Sachs said, "Those bonuses are being paid out of our bailout funds . . . I suggest the US government reclaim that funding and put the money into the Global Fund immediately."
The GFATM provides a quarter of all international funding for the response to HIV, two-thirds of all the money that goes to tackling TB and three quarters of all money spent on stopping malaria.
But GFATM has only collected $3 billion of the $8 billion needed to fund projects around the world in 2009 and 2010. Sachs says the $5 billion funding short-fall faced by GFTAM is less than half a percent of the money G8 countries have spent on bailing out failed banks in the past three months.
The US has failed to keep its promises to GFATM and has not handed over 0.7% to 1% of its annual gross national product as agreed. The US is at 0.16 of 1% of its income for development assistance. It's the lowest level of all 22 donor countries.
It is clear that unless the TB advocates reach out to decision makers to impress upon them the urgency of strengthening TB care and control programmes, the global economic meltdown is likely to threaten to reverse the gains made in TB care over past decades. "I believe we should not lower our sights one bit. Rather, we should broadcast far and wide irrefutable arguments for more and better TB control now. The fight against TB is more than a humanitarian cause – it is also a smart investment, at a time when many investments seem insecure" said Dr Marcos Espinal, on the Stop TB Forum's blog.
Time is running out. How can the world begin to see TB care as a smart investment?
Unless those who are not yet convinced that TB care is a smart investment, get convinced that they are equal partners in TB programmes, the situation will not radically change.
The answer might be in partnerships - genuine partnerships - not just between TB stakeholders, but with a broad range of partners. This will also mean that people will have to step beyond the mandates of their institutions and organizations to synergize as effectively and genuinely as possible. It is not only the TB advocates, but other potential partners who need to be convinced that TB care is a smart investment.
TB needs to be seen more than a medical or health issue, it is in all earnestness, a development challenge threatening sustainable development in most hard-hit communities.
- Bobby Ramakant
(The author is a World Health Organization (WHO) Director General's WNTD Awardee, part of the Stop-TB eForum Resource Team, HDN, and writes extensively on health and development. Email: [email protected])
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