This is fine ,but we need to appreciate everyody's contribution,it is a consultation on what should be the next plan of action that will have good impact.I believe each contributor has what I would call "a culture area approach to the fight against HIV&AIDS,TB and Malaria".I believe a bottom up approach would involve us all...unless the e-forum is for a certain class of people...Each country and the NGOs and CSOs as well as the private sectors have working strategic plans on the diseases just like the GF and other INGOs have and if this is considered and partipatin of all stakeholders strengthened we can make a headway and positive long term impact...let us be fair to every contribution...it may be what is felt in that part of the world...or may lead to a re-look at the situation on the ground and appropriate intervention given...Thank you...

MY COMMENT AS A PRIORITY IS IMPLEMENTATION Since the foundation of Globalfund comes in place it has made a tremendous impact in the lifes of people but they have to look into implementation of funds. This funds are put in place to help people to prevent, treat and care for those living with HIV/AIDS, TUBERCULOSIS AND MALARIA but in most cases some corrupt government used this funds for their own purpose not the people that funds are made for. My suggestion is that globalfund should have direct grant to NGOS,CIVIL SOCIETIES, COMMUNITY BASE ORANGIZATION than their govenment. My reason is that, if there is a mismangement of funds by those groups their government will automatically intervene and these will assure accurate distribution of funds to people but when this grant is given to government and there is mismangement there is no intervention only suspension of the country as the action affacts the people so greatly. Yours Faithfully Wisdomworldsolution

Hapana Collins, How can you address counseling and care if you leave people illiterate and fail to build institutional capacity? Hapana...how many times must I teach you people that even in the developed world, in Michigan for example, an article appeared that clearly highlighted functional health illiteracy in 140 English- speaking, emergency room patients (Online publication of July 08 Annals of Emergency Medicine). 78% of the patients did not understand at least one area and about half did not understand two or more areas. The greatest confusion surrounded homecare instructions, about things like medications, rest, wound care and when to f/u with a doctor. The study concluded that people are not prepared for self-care, and that is what is bringing them back. “Dr. Coleman said, adding that as many as half of the patients are considered to lack the ability to process and understand basic health information that they need to make decisions.” This article is worth studying to understand how deep the issue of functional health illiteracy is and how this is linked to good or poor patient outcomes and whether they will become re-infected or die as a result of not understanding the treatment modality, the symptoms, the severity of the disease, the transmission of the disease or the diagnosis or simply the instructions given regarding management at home. In developed countries functional health literacy statistics are expected to be much higher--- but we are seeing instead that functional health illiteracy are a monstrous challenge in the USA, Britain and other developed countries, let alone poor sub-Saharan Africa, India, Haiti and other South East Asian countries. It is worse than a debacle, it is a human catastrophe. This is also why I firmly believe that much of the treatments given for Malaria and TB are re-infections and that patients are coming back because they don't understand all the mechanics associated with their infections and may becoming more ill, have drug resistance and done even know it. They may not seek medical help and just die. This is the snapshot of functional illiteracy better stated functional health illiteracy and it doesn’t get any better. Similar results were also found with patients leaving the hospitals. This is a tragedy and it seems that only a few people on this e-forum have a grip on things, people like Javed, Dr. Ali, Dr. Jama and a few enlightened ones on this e-forum. For the rest of you, I throw my hands up in the air and I will have to ask God to take my life, because I don't know how else to get you all functionally literate enough to understand how deep the problem is. It is even worse because the e-forum facilitators are not experts in this field and don't understand it either. There is huge measure of functional illiteracy in this specific area. I admit that all of us may not be competent in all areas, but when it comes to functional literacy it requires us to be very conversant and competent in this area if we want to meet the MDGs as a GF priority. The GF doesn’t have the right people on board to achieve the MDGs because most of them don’t understand the magnitude of the problem. In order to solve the challenges associated with meeting the MDGs we must offer a built-in functional health literacy strategy. As the global expert in the field of functional literacy through worldview transformation I have been teaching till my fingers turned blue and the result is that less than 1% of you understand the magnitude of the problem why we have failed to achieve the MDGs at the halfway mark in 2008. There is no "if" or "but" here...it’s a “must” if you are dealing with people's life and you want to safe them. You can't build capacity within communities if you leave them functional illiterate. Your medicines for Malaria, AIDS and TB are meaningless and a mere bandaid, because our people don't understand the cause-and-effect issues of the diagnosis, the pathophysiology of the disease and the mortality associate with it. Worse yet, they don't understand the drug interactions and don't know at what point they are developing drug resistance. They don't understand strict drug adherence. Their level of understanding is extremely limited in terms of looking through the lens of traditional knowledge to understand "white diseases and terminologies". Hapana, that doesn’t work. This simply doesn't cut it, since that vehicle that accommodates traditional language was not designed to accommodate a new language system and a whole new thought and learning including modern medicine diagnosis, terminology and a whole new culture. It is imperative for them to create a whole new language system to accommodate this whole new knowledge. What must I do with you people on the e-forum that claim to be educated and still fail to get the point. This is actually a case of one of the highest levels of functional illiteracy on the e-forum where I have been involved in months of dialogue. That is one of the big reasons why initiatives are miserably failing in your countries and also a primary reason why we have not achieved the MDGs at the 2008 halfway mark. I don't know what else to do as this e-forum is coming to a close and make this discovery? Being educated with College of University Degrees doesn't automatically equite to us being functionally literate in a given area of critical necessity to the survival of others. These days universities around the world in developing countries are graduating stark illiterates and I have seen much proof of it across Africa and other areas. You people are leaving your people disempowered and illiterate and expect miracles to happen with a few (dosages) pills over a period of time and a bednet over their head. Hapana, this is not how it goes. Functional illiteracy accounts for wananchi becoming reinfected with STIs (Sexually Transmitted Infections) on a high scale, Tuberculosis or they develop drug resistance or go into other chronic phases of the disease as seen in Malaria and TB or they develop co-morbidities or opportunistic infections in the case of HIV. This is a problem directly associated with the lack of functional literacy and is actually functional illiteracy. People can be literate --they can count and read and spell their name, and talk to their community, tell stories and some simple mathematical calculations, but quietly watch them how quickly they resort to traditional languages and expressions to make their communications more meaningful to themselves. Functional literacy is a whole other ball game Collins. Hapana, you need to do better than this. How can you give counseling if they have to deal with diseases known in the muzungu world but not known in traditional African life and communities? Please don't take this as an insult or reprimand... the problem is much bigger and much deeper than you think. Even at the conference they admitted that the problem is very big. My voice was heard and taken very seriously on the global level and I hope that in my final communications in this e-forum every member will take these communication death serious and take action to ensure that this becomes enshrined in the GF programs and mechanisms on the ground. Drs Bacchus + 254 728 76 9090 fennabacchus@hotmail.com; fennabacchus@fireinc.org

This is excellent Jane. I support your suggestions. You are on the ground and understand the challenges and program failures on all levels first hand. Thank you again for such forward visionary thinking. We need more people like you.

Global fund should adress counselling and care as priority Collins Kidega Radio King GULU UGANDA

To,

e-Forum 2008(issues& priorities)

Received reminder.The GF mechanism has Rolling continuation channel
for evaluation of countries pledges,contribution,& distribution of
funding .GF mechanism is still required correct positioning of
fund raised & spent,imbalanced disbursement& irrational use of
funds in many developing countries.In many less GDP& less economical
infrastructure countries,due to Govt's ineffective coverage,Govt's
inability in providing accountability,transparency & awareness of
GF structure & process,above maladjustment could be occured.
For correct positioning of Fund raised& spent,GF mechanism could take
private sector involvement & participation priority for rational
functioning of GF process including grant agreement ,distribution
of fundings,expenditure objectives,projects chosen& rational
funding relationship.
Discussion,Private sector participation for GF process could determine GF priority for selective private sector participation.
-------------------------------------------------------------------

In GF program implementation private sector could give structural
& system strengthening role in prevention of Govt.ineffective
coverage, cycle& government's inability in providing transparency&
awareness.According to GF structure & process -"What kind of private
sector's structure would be taken",this consideration could give
clear perception of private sector involvement.
In Debt conversion initiative,governance policies& procedure,grant
recipient,restricted financial contribution ,replenishment mechanism,
predictability of GF resources mobilization ,price reporting
system,constitutional articles,private sectors can not take up
holistic approaches in implementation of GF program,if private
sectors takes above operations ,desired situation & permissible
operations should be clearly defined.
Best promotion of good practices with inclusion of private sector,
use of representation of facts in order to solve problematic socio-
economical conditions in many countries by providing inferential
& acquisition capabilities.
In Recipient early alert& respose system ,TRP,LFA,price reporting
system ,list of ARV,private sector could represent techniques e.g.
knowledge encoding,reasoning support,subjective attributes &
associated values.
Private sector role could be expanded by inclusion of ethical
practices in governance inability of providing transparency& awareness
empowerment,scientific survey,general equilibrium analysis,
abstinence campaigns,accessibility of the country's constitution,
anti-discrimination provisions,statistical & data representation,
goods,products& services procurement.
Private sectors involvement could be useful in wide spread consumers
expectation,need of affected population& universal coverage of
products & services ,reducing inter-continent disparities by providing
capability of products& services procurement,qualitative support,
rational use of products,price control mechanism including fix or
price revisions, private sectors's specific pricing favoured
consumers expectations.

Thank you
ASHISH SRIVASTAVA
ex-International Marketing
&e-Forum 2008(SEAR-INDIA)81237

 

This may very well be my last comment in this forum for awhile. I am sad to see the ending of these discussions for now but I do think that we must all commend the Global Fund for having this forum and for allowing us to voice our thoughts regarding their methods and their policies. Once more, I must admit that I don't feel worthy to post with others who are much more deeply involved in the global health issues that the Global Fund attends to but, as someone who is sincerely concerned for the future of the world's poorest people, I am offering my ideas for consideration. I must agree with Jane above - I do like how she has clearly stated her concerns about the Global Fund and its operational methods. I have two main concerns in addition to those that Jane stated above about the Global Fund which I will state here: 1) understanding that working within a country's governmental & social structures is necessary to ensure co-operation from that nation, I would also like to see MORE GRASSROOTS INVOLVEMENT from NGO's within the countries that receive Global Fund monies and less government bureaucratic involvement when possible 2) I still have not seen an effective mechanism in my country, the USA, within which ordinary citizens can promote the work of the Global Fund within our communities, except through the EXCELLENT organization (RED) and then that direct involvement within our local communities for the Global Fund through (RED) is also very limited. (www.joinred.com) I would really like to see the Global Fund have "citizen co-ordinators" (for lack of a better word) in major metropolitan areas who would be responsible for putting together informational & possibly fund-raising programs for the Global Fund in their communities. We could involve schools, churches, community groups , etc in this endeavor and generate REAL GRASSROOTS SUPPORT for the Global Fund in the "developed" countries while engendering more grassroots involvement in the countries which receive Global Fund disbursements. These are just some of my fondest hopes and wishes for the Global Fund. Whatever decisions emanate from these discussions, I thank all of you for your patience with me and for your discussions. I have learned a lot in the last few weeks and I look forward to more of these discussions in the future. LONG LIFE & GOOD HEALTH FOR ALL. THANKS TO ALL AT THE GLOBAL FUND! ALWAYS FOREVER, ONE - debbie :) www.mpwn-uganda.org

Thank you, Fenna. I appreciate your kind comments very much and I also want to take this opportunity to thank other Forum friends who supported my ideas about regionalization and bringing GF closer to the grass roots. I agree with you that problems of poverty are too deep and serious. Treatment of one, two, or three diseases is important and urgent but not a lasting solution. It is true that, the governments are the ones, who should basically assume responsibility of taking care of their people. Outsiders’ help can never be a substitute, sufficient, or sustainable. If used properly, it can be a catalyst and a harbinger of technological change. If used improperly, it can easily become a crutch, a symbol of false sense of progress, and a cause for delaying change in the fundamentals. That is why I believe, and you also agree, that people at the grass root should be made aware of the situation and made partners in finding sustainable solutions. Hence, health promotion, functional literacy, and appropriate higher education, you are promoting, are all steps in the right direction. I, therefore, keep harping on the same theme, that if donors really want to help they should help develop institutional capacity (that includes building capacity of higher education institutions) so that eventually people are able to take over and manage their own development issues. This involves building capacity to think, plan, and make decisions, as well as to take advantage of the available technological, financial and human resources. This has not been done in the last 50 years but let’s hope it changes at some point soon. May be people like Bill Gates and Warren Buffet may dare to break the tradition and change the paradigm. Poor of the world can only hope and pray.

Im from Orlando FL and I agree with you. I would like us to discuss the above. I am currently in Kenya. This comment is very critical fennabacchus@hotmail.com

Angie, This is an international disgrace and debacle. We need to call for with greater urgency ...Congressional Hearings to hold the Global Fund accountable once and for all. This equals to man slaugher and murder. I do believe it needs an urgent overhaul since people simply don't know what the hell they are doing but wasting our hard earned taxpayers dollars. I will make sure I save your letter in my archives since you have brought this up a second time and they have turned a deaf ear to you. Please contact Senator Ranglin and also Senator Joe Biden. In a time where we are sufficating economically these irresponsible people at the Global Fund are literally mismanaging. This needs to stop because our monies are in PEPFAR, and other foundations and private benovolent donors. This is our right as US Citizens to protect vulnerable and marginalized people and we will not stand for failure. I'm in Africa and he he he I am not asleep. More power to you!! This has no other name but institutional incompetence. Fenna fennabacchus@hotmail.com + 254 728 769090

Way to go Javed, you are a true thinker and doer. Kudo's for this comment and its well stated. I support you 100%...we need 1 million more thinkers like you to transfrom the GF from inefficiency to streamlined efficiency. Cost cutting measures are hardly employed. For that reason I have brought up the issue is TB and Malaria reinfections in high density population areas such as the slums in and around Nairobi and also the rural areas. Fenna

Respectfully Asish, I have read your presentation and concur with most of your suggestions. Strangely, the two most critical ingredients that are key to the implementation to your wonderful strategy were left out. Why do you think certain societies gender inequality or better stated the impact of a patriarchal society is so strong? Yes, we speak of gender sensitive social equity, but there is something huge underlying to the issues that have been discussed. We cannot begin to effectively address the increasing prevalence of HIV/AIDS, TB and Malaria and just keep applying bandaids as noted for the past 5-6 years. We need a critical shift in paradigm with thinkers like you. Asish the people the Global Fund is serving are primarily low literates to illiterates or lack of functional literacy and the are dirt poor and live under $1 a day. If you would like your model to work you must add a Functional Literacy and Poverty Reduction Strategy. Please allow me to give you the same example I gave the Managing Partner of the GF when I was in Nairobi Oct 2007. If you give sick people living in crowed slums and communities (high population density areas) TB drugs you are on one hand alleviating the disease. On the other hand, a few times we see people being cured; however don't jump the gun too fast. You still leave these marginalized populations 100% vulnerable to become reinfected because they will become reinfected because many live in pig sty conditions where raw sewage is the order of the day, and where "flying toilets (Kibera Slums,pray it doesnt land on you)" are routine operations. This is in no way a healthy environment for any woman, child or man to thrive and not have a recurrence. This is the perfect feeding ground for Malaria and TB, don't even talk about HIV yet. People in these places hardly use rubbers as evidenced by a high teen pregnancy. They are having unprotected sex at a very high rate. These people are poor and barely get by for the next day.The hustle for long hours to make a day's earning to feed many hungry mouths living in crammed up conditions. Hence, no one from the GF Secretariat has the guts and is willing to release information I requested how many repeat treatments are being been given annually or is it that it doesnt matter anymore. If that is the case then I dont' think we should continue being so inefficient in our approach. We must become a people that is accountable. It is 100% impossible to administer treatments in high populations density areas without seeing reinfections especially in Tuberculosis. People are living virtually ontop of each other for 7km such as in Kibera and many are not under bednet. I don't know if you have been visiting the slums in Kenya, Kariobangi, Kibera, Karangware, Mukura, Dandora, Korogocho, Mathare, Gachie etc and also the rural areas. Many people are still not under bednets. The slums are swelling everyday and the quality of life is decreasing for slum dwellers due to insanitory conditions and foul quality of the air which makes them far more susceptible to disease. I am aware that the GF doesnt get into Poverty Reduction Strategies; however, the GF must be held 100% accountable for failing to include a functional health literacy strategy instead of only giving sick people some tablets and health education they don't even comprehend because their diseases are of cause-and-effect origins that are not in the context of their worldview. Therefore, people don't understand much of the preventative health care education being taught around the world because of their low literacy status. You must empower people with actual functional literacy and then scale up to functional health literacy so that you can see community progress towards the achievement of the MDGs. If Swaziland women were that functionally literate, many of them would not be dying to have their daughters lining up for the wreath dance (naked) to ensure that the King gets their daughter. This is a tradition that has not been broken and is still being perpetuated. I use this example to tell you that one of the countries where a gender policy is meeting huge challenges is because of the status accorded to women. If women have concerns they must voice their displeasure through their husbands. I guess the best way to know how strong Swazi women are is to suggest to them that from now one they have a national boycott of the wreath dance. This will certainly startle the King because I think he is on to wife # 13 at last count. He will have to think of something else. When one is truly functionally literate they have a transformed worldview and will not subject themselves to these oppressive practices. Hence, I'm renewing my calls for a critical shift in paradigm for us to deliver credible results and also decrease the incidence of re-infections. Drs Fenna E. Bacchus President/CEO FIRE, Inc; FIRE Africa: FIRE Kenya