basilb - Mar 14, 2006

One of the highest and primary priorities for the Global FUND in the war against HIV should be NUTRITION. It is given such a low priority that it is hardly mentioned. Check out the sentence for debate - nets and drugs - nothing on nutrition. The reason I believe this is happening is because there are just too many agendas that drive the interventions. As a result resources put on the ground service mainly outside agendas that often loose the "plot". Many interventions are often clueless about local needs and conditions - as a result resources are incorrectly mobilized and ineffective.

It is for this reason that we believe we are NOT WINNING THE WAR against HIV. The Global Fund should start to work with local solutions and then you might see effective results. To ensure proper nutrition gets to those living with HIV must be the first priority - this way the victims can then start participating in solutions as functional human beings. This function should not only be left to the few among NGOs who only want the cheapest solution in terms of the selection of products made available. Interventions are not sustainable because the people remain dysfuncional and can never become part of a future solution. The net result - they must keep coming back!!!

The Global Fund resources should help develop local industries and production facilities and local farmers for nutrional food support. Local skills and know how should be seen as an asset to be developed. To get better prices - long term contracts that sustain local production initiatives would help bring down prices of locally produced products. Where key technologies of foreign inputs are required - these may be subsidised to take these cost factors out of locally produced products. By working with local solutions that are focused on supplying tailor made local products - more cost effective benefits will be seen sooner.

Lets use the Kenneth Kaunda Foundations CALL TO ARMS - We will keep the Mothers Alive.

Basil Kransdorff

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Moderator:

Dear Members,

The Global Fund is primarily a financing mechanism. Simply stated, its mission is to quickly obtain and channel large amounts of money to help huge numbers of people with the best projects. To ascertain the technical feasibility of projects, it relies upon a number of key partners. For example the question of nutrition is undoubtedly recognized as highly important, especially in treatment interventions, be they for Prevention of Mother to Child Transmission of HIV/AIDS, or the treatment, care and prevention of TB and Malaria, etc. In addition, there is the issue of nutritional medication, highly relied upon by large segments of targeted populations. To decide on the best interventions, the Global Fund, acting mainly as a financing mechanism, relies on the inputs of groups of specialized agencies both inside the countries where proposals are developed, reviewed and pre-approved, and Technical Review Panels recruited through an open and international competitive process. Countries and proposal developers have the option of exchanging international best practice through recruitment of experts in fields where they sense a gap in experience, before, during and after the funding proposal submission process. The Global Fund therefore complements technical efforts by reviewing the forwarded proposals for issues that would affect implementation, mainly from a financier's point of view. The Global Fund's key partners, for instance, have specialized departments that deal with the issue of nutrition, health and development, traditional nutrition, pre-approval of lists of drugs , etc. The World Health Organization, one of the Global Fund's key partners, has a specialized department entirely dedicated to the topic of nutrition and health. Please click on the following link to read more:

http://www.who.int/topics/nutrition/en/

This is the main reason why this week's discussion focuses on having a positive effect on the market for essential health products - since this is where the Global Fund has the most comparative advantage and would therefore complement its local and international partners' efforts in the best way. We thank you all for your innovative messages and encourage you to continue contributing to this topic.

basilb - Mar 20, 2006

Well done Tasleem - You have hit the nail on the head. This point also applies to knowledge technology and local understandings of the problems and issues that need to be addressed.

Sustaimable development will only happen when local people are particpating in delivering local solutions. It is the only way - local and appropriate solutions will evolve that are tailor made to address local issues.

The countries with the problems can no longer only rely on so called foreign experts and foreign products that are linked to other agendas that solve other countries problems.

Tasleem Akhtar - Mar 20, 2006

There is a famous saying ,''Feed a man today and he will be hungry again tomorrow, teach him to fish and he will feed himself for life'. If the Global Fund sincerely aims to help people access essential health products than providing these cheaply to governments is not the answer. This strategy is not only likely to discourage industry from manufacturing these products but also create a sense of complacency among governments who sit back and ignore the development of their indigenous capacity for manufacturing and using these products efficiently and effectively. The Global Fund must help institutions within country to develop their capacity for biotechnology development and health systems research. Each and every country must be encouraged and supported to develop self sufficinecy in the development and manufacture of these essential products.

Dr. Saka Mohammed Jimoh - Mar 17, 2006

I also think positive impact will be more felt at reduced price if GF involve detailers (retailers?) (these are community based pharmacist ) in each zone for products, and to a certain extent depend on local agencies' regulation of the proriety patent medicine vendors to be involved (PPMVs). The present marketing should be more aggresive.

Let local authority identify their own contribution in Nigeria (Mr. President promised that a certainn % of our debt relief will go towards ART- this is a good development for others to follow).

I also commend Global Funds resumption of grants to this country- it will go a long way to reduce drugs cost.

What can GF do to involve community based distributors (CBDs) these are people right in the community - they understand the language the community speaks. Their involvement will have a postive and sustainable impact. Finally, provision of seed stock to partners will enhance sustainability.
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Dr. Saka Mohammed Jimoh

ODONG999 - Mar 16, 2006

We shall all note that the Generic (ARVs) drugs are cheaper than the brands though a point to note; the quality of these drugs should first undergo quality control to be approved. I do believe this would lower the prices for the generics.

I also do believe that if Industries were constructed in the mother countries this would reduce on the expenses in the long run and enhance sustainability, the GF Management team's duty would remain to oversee(quality and use)
Am a practicing pharmacist in Uganda, and to note that free antimalarial drugs (Coartem) are provided gives me great hope, yet sorrow because I see a bleak future with the expense of this drug; why not reinforce the issues of compliance rather than go in for something whose sustainability is unclear- because all issues with the Fansidar and chloroquine resistance are related with noncompliance, this tells us also that one time that resistance will develop towards the Artemesinin group

dr joseph stephen mambo - Mar 16, 2006

Fine, what the Global Fund is doing now is excellent. Some of my colleagues talked about types of diets eaten, chemical factor in drugs, weather (climatic) changes etc. In my opinion, I think the collegues should also have considered the human rights factor. It is now imperative to deal with the disaster through a different approach. There must be a law guiding people to screen their sero status in their locality, not willingly but as a rule/order.
From there is when the community is instructed to take care of the sero-positives, as we did for leprosy and formally TB. Not necessarily to build things like sanatoriums or leprosariums, but these affected individuals have to stay in their localities well known to everybody. There the community concerned, the govt, and the Global Fund will direct their efforts to those areas. I have seen the war is not effective as the disease itself is acquired in a privacy route. People will at last change behaviour and there will be no more new infections.

Loverne Scott-Heron - Mar 16, 2006

Question:
In your opinion, what should the Global Fund do to have a positive effect (i.e. lower prices, more sustainable supply, etc.) on the markets for essential health products (e.g. ARVs, bed nets, diagnostic tests) used for the prevention, treatment and care of HIV/AIDS, TB and malaria?

Answer
I am not sure if this has been mentioned before but I believe the Global Fund and its partners could benefit tremendously from having a standard list of supplies relevant to HIV/AIDS, Malaria and TB.
Having said that, I am aware that other parties have been working on similar documents for e.g. Sources and Prices of HIV/AIDS Medicines and Diagnostics. I am also cognisant of the fact that it is challenging to make an essential list of supplies seeing that each country has specific program needs but I strongly believe that all parties could benefit from having a standard list of essential supplies relevant to the Global Fund priorities.



Loverne Scott-Heron
Procurement Services UNDP/IAPSO

basilb - Mar 16, 2006

Pramod - I believe you are right - there is little understanding of the importance of going back to basics of addressing the NUTRITIONAL issues. So often the issue of nutrition is ignored because it is confused with feeding and "junk" food. What the "experts" ignore is that the food chain is PART OF THE PROBLEM. Many problems would dissapear if the nutritional issue was first given the priority. Too often the "so called experts" only like to address the consequences of bad nutrition which is the health problems that they love to treat with the drugs.

vss94 - Mar 16, 2006

Health sensitiveness among BPL families in India and other developing countries is very low. They don’t know and understand malnutrition and its bad effects which is a part of their lives. A patient in the rural communities should be looked at as well. There is a great need for services to reach these people as they have no access to most of the health facilities.Hunger is a common and serious problem among them. The death rate is increasing in BPL families due to TB, Malaria and Kal-azar and non-supply of medical /health facilities. We feel that Global fund is ignoring the burning issue of kal-azar and hunger. We believe Training , awarenessand advocacy is very key and should be treated seriously.

Pramod Kumar Singh
Director
Vidyasagar Samajik Suraksha Seva Evam Shodh Sansthan
A-22, R.D. Tower, New Punaichak, Patna,Bihar, India-800023
Tel—00612-2281197, 9431419356
E-mail- vss94@sancharnet.in
_________________
Pramod Kumar Singh
Decreasing lifting of alloted grains & corrupt practices under nutrition/social security schemes is also causing food insecurity in BPL / deprived persons/school children. Hence many hunger deaths reported in Bihar. Monotring needed.

ddungu - Mar 15, 2006

The Global Fund is commended for its efforts to fight the three diseases. In order to have a more positive effect I would suggest the following and I am sure other members might agree:
1. Sustainable supply of drugs, nets and public sensitization is very important. There is a tendency for stakeholdrs to relax and a situation comes when all the above are not readily available.
2. Quality control is also very important. There is need to ensure that good products are utilised even when they are generics. If products especially drugs are not meeting the necessary standards, then more problems especially drug resistance might happen.
3. A patient in the rural communities should be looked at as well. There is a great need for services to reach these people as they have no access to most of the health facilities.
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Dr. H. Ddungu

African Palliative Care Association

hicham9669 - Mar 14, 2006

Hi,
Yes Helping Ourselves first is the key here. We need to change our mentalities and enlarge our mind scape. Well I see that in Volunteering. If we can set altruism as our long term objective, we will certainly limit many of our problems. So if we have local volunteering medical organisations ( like the international ones) especially in developing countries, health problem will not be that dangerous. Volunteering doctors and medical agents are very needed this time.

Another thing that the Global Fund can set as a short or medium term is to support organisations caring for the old, disabilities and children. This will be in sort of money, equipments and much more important Training staff on medical treatment. I am a member in a local association for disabilities; but my-our- roles are very limited since none of us knows anything about medical treatment. One thing we at least should be trained for is gymanstics or medical sport. I believe Training is very key and should be treated seriously.
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We need to be Humans.

basilb - Mar 14, 2006

The point I am trying to make is that viewing and better understanding local problems and their causes and developing local solutions is the issue.

A good example is the malaria issue which has now become a pandemic on the continent. It is being driven by 2 issues - the HIV issue which is contributing to the destruction of the protective immune system and a nutritional crisis that has destroyed peoples' own immune systems, and which has resulted from changes brought about by people moving away from traditional foods to processed foods. 200 years ago - malaria mosquitoes were rife and yet many local people did not die of malaria. I was recently at a mission station in Malawi - the local cemetery was full of Scotish Missionionaries from the age of 2 days to 30 years - no locals. What this tells us - something has hapened to local people's immune systems. Much of the destruction has been bought about by the change from traditional foods to processed foods - combine this with povety - BINGO people are not getting the minerals and nutrients needed to run our bodies and immune systems as God designed our bodies to be run. Where the nutrition agenda is needed is is to reverse this situation. Of course use mosiquito nets, drugs and other means - but lets first go back to basics and give people back their natural protection.

The same arguments go fo TB. TB is a poverty related diseases. 50 years ago - Norway had a massive TB problem. Today NO TB and NO DRUGS - what has happened -they discovered oil - became more affluent - eat better food and BINGO - no TB.

Drugs are great - on nutrient deficient bodies - a BIG PROBLEM.

Yes we need the nets and the beds and the programs to kill the nasty mosquitoes but most important we need people to become functional again through addressing the nutritional crisis.

A LOCALLY understood solution is needed.

Basil Kransdorff
basilb@iafrica.com

Darren Fast - Mar 14, 2006

This is a very interesting discussion. Perhaps the best solution will depend on the exact location of the people who have to implement. In some areas, mosquito nets would be huge, in others nutrition, in yet others better access to drugs. I would argue that there is not one solution, but many and the more involved the local community is in making the solution work, the more effective it will be in the longer term.

Is there a community that has the resources/ability to manufacture mosquito nets? Could this be a source of revenue that could then be used to improve their condition? Perhaps by building some local micro industry, they will be able to lift their communities to a higher standard where avoidance of disease would be the standard instead of treating it.

Jack Mann - Mar 14, 2006

I applaud the Global Fund's objectives and efforts to date.

I do not think this idea of influencing pricing etc was a reasonable expectation of the fund. There are too many variables in a market to expect one fund to control or reduce pricing etc.

So I do not think it has failed as this was not a reasonable expectation.
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Jack

vmarencop - Mar 14, 2006

It is important to look at the local context and find ways in which local resources could be used (e.g. Labor), for the manufacturing of some of these products. It is feasible to create local microenterprises that could learn how to make malaria nets. How about spending some money on tranfering the know how of production of some of these products? I can understand the difficulty of more elaborate product such as anti-retroviral medicine, but let's not forget that goverments also have the responsibility to aid in the acquisition and distribution of these products. The Global Fund is aiding Goverments to increase their capabilitites and these goverments should start leveraging resources outside of pharmaceutical companies to bring the necessary welfare to the local levels not just as recipients but as actors in the market of these products.
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Vanessa Marenco
International Programs Director
Institute for Behavioral Change and Research
Washington, DC
USA