Obama Plan Helps Countries Create Health Systems

The Obama administration will soon name countries that would receive additional assistance under his Global Health Initiative. That's where all global health programs come under the same umbrella, and the focus is on helping poor countries provide better health care. AIDS still gets most of the money. But critics complain the noble idea will cut into funding for AIDS treatment.

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The Obama administration is set to name the countries that have been chosen for the global health initiative. It aims to make better use of U.S. aid by helping poor countries improve health systems and focusing on mothers and children. NPR's Brenda Wilson reports.

BRENDA WILSON: The Obama administration's global health initiative would work with poor countries to create health systems tailored to their needs. There's a concern that other basic health needs have been neglected in favor of AIDS.

Dr. Anthony Fauci�of the National Institutes of Health says that the initiative would provide $63 billion over six years.

Dr. ANTHONY FAUCI�(National Institutes of Health): Which is the largest amount of money that has ever been committed to any global health initiative. It isn't only HIV that is in that program. There's maternal health, child health, neglected tropical diseases, nutrition, malaria, etcetera.

WILSON: The initiative preserves the Bush AIDS relief plan and adds funding and assistance for nine countries to build up basic health systems; among them, Bangladesh, Malawi and Ethiopia. The aim is to allow patients to get care at one location, rather than having to seek care in different places.

For example, family planning at one facility and HIV care at another. But what worries AIDS advocates like Mark Harrington, is when you look at the administration's budget for HIV/AIDS the increases in coming years are not as steep as in previous years.

Mr. MARK HARRINGTON: The resources available that have been proposed and put on the table by the White House, are totally grossly insufficient to achieve the vision of the president's own global health initiative.

WILSON: Even though five million people in developing countries are being treated now, millions more are waiting.

Dr. FAUCI: There are no resources in the world, right now, that are going to treat every single person who needs to be treated.

WILSON: Again, NIH's Dr. Anthony Fauci.

Dr. FAUCI: We definitely need to do more. And let me go on the record. I'm in total favor of universal access for everyone who's infected who needs to be on therapy. Is that going to be feasible given the current resources? No, it's not. So we have a problem, and I think to deny that there's a problem, is being unrealistic.

WILSON: But one country where health officials say they are already seeing the affects of the administration's slow down in funding for HIV/AIDS is Uganda. The country was considered an HIV/AIDS model during the Bush administration, but it's not on the list of countries being phased into the global health initiative. Uganda's Dr. Peter Mugyenyi says he's disturbed by this shift in international health.

Dr. PETER MUGYENYI: We still have a crisis in Africa. The crisis is not over. The emergency is not over. We are not able to treat all those people who are coming to us in need of treatment, so clinics are turning away patients.

WILSON: Mugyenyi says Uganda has 170,000 people on anti-AIDS drugs, less than half of the people who need treatment now. Those already on treatment will continue to get the medicines. Mugyenyi says when one person in the family is getting the drugs and another is being turned away from clinics, families face painful choices.

Dr. MUGYENYI: A woman just returned the drugs to me. She said she couldn't take the drugs herself when the rest of her family could not access treatment.

WILSON: Similar stories are being told by Doctors Without Borders, of HIV patients turned away from clinics in Malawi, Kenya and South Africa.

Experts say that in many cases it's not that AIDS drugs are in short supply, there's a lack of coordination among clinics that provide treatment. A problem the global health initiative hopes to address.

More details of the global health initiative are expected to be announced soon. But already the administration is on the ground in countries, merging U.S. programs like maternal and child health, family planning, malaria and AIDS. Because fewer staff are required, money is being saved that can be used to provide services elsewhere.

Brenda Wilson, NPR News.

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