Counterfeit medicine — defined by the WHO as any generic or brand-name product that is “deliberately and fraudulently mislabeled with respect to identity and/or source” — is a growing problem across the developing world.

For people reliant on medicines such as antiretrovirals (ARVs), anti-malarials and vaccines, counterfeiting is not just an issue of brand names and packaging — it can be a matter of life or death. Oftentimes, counterfeit drugs lack critical ingredients that make legitimate drugs function properly and effectively ward off infection.

Individuals who take such counterfeit drugs risk suffering from abnormal side effects or even prolonged illness and death. There is also a greater likelihood of fostering drug resistance, which reduces the effectiveness of legitimate drugs over time; gradually eliminates tools that are currently working well in global health; and forces new products to be developed — an important but highly expensive process.

There are many initiatives underway to both help stem the manufacture and trade of counterfeit drugs and also to flush ineffective medicines out of the markets in which they are most needed. As two diverse examples, the WHO created a task force in 2006 devoted to the fight against counterfeits; and the Center for Global Development has its own initiative focused on promoting policy solutions to combat drug resistance.

Health mechanisms have begun to come up with their own innovative programs, as well. The Global Fund — whose operations are reliant upon effective, modern medicines — acknowledge that in many markets, counterfeit or out-of-date drugs for malaria (such as chloroquine) can also be far cheaper than effective drugs, making their purchase more appealing for suppliers or consumers in need of the medicine.

To encourage the purchase of artemesinin-based combination therapy (ACTs) to treat malaria, the Global Fund established the Affordable Medicines for Malaria Facility (AMFm). Through the AMFm, the Global Fund has negotiated lower ACT prices with manufacturers and will pay a large proportion of this directly to manufacturers on behalf of buyers across the public, private for-profit and not-for-profit sectors.

Countries participating in AMFm must also implement “supporting interventions” to ensure the increased availability and safe use of ACTs, including public awareness campaigns, training and supportive supervision for ACT providers, and policy and regulatory measures. For patients who currently pay for treatment, this is expected to result in a significant ACT price reduction, from about $6-10 per treatment to about $0.20-0.50.

To support the Global Fund in this critical replenishment year, sign our petition today. And as always, stay tuned for the latest on efforts across the developing world to fight corruption and improve global health.

As one of the tag lines go, the idea is simple. Help one. Save many. Visit www.goodgoes.org and find out all the ways you can help get the good where it needs to go.

There have been miracle days on this trip.  Yesterday, for me, most of the miracle took place at the Tema General Hospital in Tema, Ghana.  The hospital is a dynamic, living, breathing place, where women and their children are loved and taken care of.  Mothers with HIV find hope and help for both their lives and the lives of their children. Tema identifies women with HIV, gets them into treatment and helps them deliver and care for their healthy babies.  Maybe we just caught the Tema staff on a good day, but they make this very tough work look and feel like a labor of love.

Small simple counseling, testing, and treatment rooms line the hallways. Bigger rooms are used for waiting, dispensing medicine, and perhaps more importantly, for sharing the company of other women.

But particularly seared into my brain are the pictures of the Ghanaian women who are the nurses, doctors and technicians.  These professional women are master organizers.  They are customer service savvy, heavily invested in making things work for their clients.  They understand the emotional and economic challenges these families face.  They are the kind of women who post their goals along the walls and reach them.

I feel honored to have met them.

-Maggie Williams

Another video and post from ONE’s Tom Gavin from last week’s trip to Rwanda.

Monday, July 21:

The U.S. launched PEPFAR – the American global AIDS strategy – at the Masaka Clinic in 2004, so it made for a good place for the ONE delegation to visit and assess how things are going. Our delegation met with doctors, nurses, local officials, and patients seeking treatment and counsel from the clinic’s staff. We heard, time and again, the difference that America’s partnership in health care was making in Rwanda and throughout Africa.

The DATA Report, which ONE released earlier this year, shows the progress being made. It points out that, across Africa, nearly 2.12 million people were on antiretroviral therapy by last December, a huge jump from the 50,000 people on treatment in 2002. That means 30 percent of Africans in need of treatment are receiving it. But there remains a major challenge ahead. An additional 1.7 million Africans became infected with the HIV virus in 2007.

After touring the Masaka Clinic, some of the ONE delegation discussed the site visit and the overall trip with reporters.

-Tom Gavin

African development was again the subject of G8 discussions as world leaders gathered in Toyako, Hokkaido in northern Japan from July 7-9 for the 2008 G8 Summit. While the G8 was confronted with multiple global challenges, including climate change and a weakening global economy, the 2008 Hokkaido Summit marked an important “mid point” moment in the fight against poverty. The Hokkaido Summit came at the critical halfway point to both the Millennium Development Goals (MDGs) and the G8 Gleneagles promises to Africa. The G8 are dangerously behind on their landmark commitments to the region, having delivered only $3 billion of the promised $25 billion in additional assistance to Africa by 2010, according to the 2008 DATA Report.

After difficult negotiations, the G8 summit yielded small gains for the poorest. The bulk of G8 agreements on development and Africa and food security reiterated previous pledges rather than outlining new measures to get the group back on track. The G8 did announce plans for a new effort to tackle the global food crisis, though more details are needed to ensure its effectiveness and delivery. They highlighted the UN High-level meeting on the MDGs in September as an important opportunity to review progress and identify actions needed to overcome remaining challenges.

At a time when G8 credibility is at risk due to slow progress in delivering on commitments, there was a strong call for greater accountability in the G8 Communique. The G8 agreed to track progress against previous commitments in health, education, water and agriculture, as well as its compliance with anti-corruption measures.

Overall, the US, UK and Germany provided strong leadership in negotiations and have significantly increased their funding for Africa in recent years.

After the jump, the following brief overview of outcomes for Africa from the 2008 G8 Summit.

-Ben Hubbard

……

OVERALL DEVELOPMENT ASSISTANCE

Reiteration of 2005 commitment to increase aid to Africa by $25 billion by 2010

The G8 included a reiteration of its 2005 commitment to increase Official Development Assistance (ODA) to Africa by $25 billion a year by 2010 (starting from a 2004 baseline). The G8 also recommitted to their global target of an additional $50 billion by 2010. They did not commit to an accountable timetable for delivering on these 2005 promises. The G8 also made an important acknowledgement that ODA from G8 and other donors may need to increase after 2010 and therefore beyond their current commitments.

HEALTH & INFECTIOUS DISEASES

Reiteration of 2005 commitment to universal access by 2010; new commitment to make progress on malaria

The G8 identified the remarkable successes underway in the fight against infectious diseases as a result of G8 support. The G8 stated that they intend “to honor in full their specific commitments to fight infectious diseases, namely malaria, tuberculosis, polio and working towards the goal of universal access to HIV/AIDS prevention, treatment and care by 2010.” Importantly, the G8, for the first time, provided matrices showing G8 progress in implementing past commitments to ensure accountability. In addition, the G8 committed to work through public and private sector partnerships to deliver 100 million bednets by 2010 as part of a broader effort to deliver on existing malaria commitments.

HEALTH FINANCING

Reiteration of commitment to provide $60 billion for health

The G8 reiterated their 2007 Heiligendamm commitment to provide $60 billion to fight infectious diseases and improve health systems. However, this year the G8 assigned a five-year timetable to the commitment this year. While $60 billion is a large figure, it is not dedicated to Africa or to specific health outcomes nor is it all new financing. Moreover, it does not reflect the likely increases already in the pipeline. For example, the United States Congress passes a $50 billion five-year bill to fight AIDS, TB and Malaria this summer as expected, then the US alone would fill $50 billion of the $60 billion commitment, leaving very little for other donors to contribute.

HEALTH SYSTEMS

New commitment to work toward WHO minimum health worker density

The G8 continued the increasing donor attention to building health systems as a focus of health ODA. They said, “The G8 members will work towards increasing health workforce coverage towards the WHO threshold of 2.3 health workers per 1000 people, initially in partnership with the African countries where we are currently engaged and that are experiencing a critical shortage of health workers.” The mention of the quantitative WHO endorsed baseline of 2.3 health workers per 1000 people is a firm target, but there were not financial commitments made to reach this outcome. A majority of the health portion of the communiqué was focused on health systems and a more comprehensive approach to health development. This is a departure from past G8 Summits. In addition, a separate Summit document titled the “Toyako Framework for Action on Global Health” spells out, in even greater detail, the importance of health systems strengthening in meeting G8 commitments and improving overall health. The G8 “welcomed” this contribution but its recommendations were not adopted in a binding manner.

MATERNAL & CHILD HEALTH

Acknowledgement of need to address slow progress in improving maternal and child health

A separate paragraph on maternal and child health was included in this year’s communiqué. It included recognition that many countries are seriously off-track in their progress towards meeting the MDGs on these two areas. The G8 committed to blending HIV/AIDS programs with sexual and reproductive health programs, a critical part of reducing maternal mortality.

WATER AND SANITATION

Reiteration of the Evian Water Action Plan with stronger accountability

The G8 acknowledged, on numerous occasions throughout the Communique, the cross-sectoral impact of water and sanitation and the slow pace of progress in meeting the water and sanitation MDG targets. The G8 committed to “reinvigorate” their efforts to implement the Evian Water Action Plan from 2003, in which they agreed to prioritize the water and sanitation sector within overall aid levels. Importantly, the G8 also committed to preparing a progress report on G8 efforts in the sector by the 2009 summit. Although the communiqué recognizes the International Year of Sanitation and calls upon national governments to prioritize sanitation, the G8 made no new commitments or financing targets towards scaling up access to sanitation

EDUCATION

Commitment to fill $1 billion 2008 funding shortfall for FTI endorsed countries

The G8 promised to meet the $1 billion funding shortfall for Fast Track Initiative (FTI) endorsed countries in 2008. They also committed to monitoring G8 support to the FTI in a report to be delivered at the 2009 Summit. G8 leaders identified the critical shortages of teachers in Africa and the need to focus on improving learning outcomes in conjunction with increasing access. They also said they would promote synergies between the education sector and other development sectors through, for example, school feeding programs. The G8 did not include the phrase “no country seriously committed to Education for All shall fail for lack of resources,” which marks a retreat from past communiqués.

GLOBAL FOOD SECURITY

Announced plans to establish a new global partnership on agriculture and food security

The G8 announced that since January 2008, they have collectively committed more than $10 billion, for short and long term efforts to respond to the global food price crisis. They did not provide a breakdown of this figure by donor or purpose and did not stipulate a time period over which it would be spent.

The G8 acknowledged that tackling the global food price crisis will require “leadership, ambition, and an appropriate scale of resources.” Without spelling out concrete measures, the G8 announced their intention to launch a new global partnership on agriculture by the time of the UN General Assembly meeting in September. The global partnership would coordinate the international response and ensure a comprehensive strategy to tackle food security in the medium and long term. The partnership would strengthen and build on existing international institutions and facilitate coordinated financial and technical support around country-led processes and local leadership. As part of the partnership, the G8 intends to create a global network of high-level experts on food and agriculture to provide science-based analysis on global needs and future risks.

The G8 called for open and efficient agricultural and food markets and for the removal of export restrictions on food, signaling their support for a process at the WTO that is working to put in place a set of guidelines and agreements on global trade restrictions such as export bans that prolong and aggravate rising food prices or hinder humanitarian purchases of food commodities.

The G8 provided a comprehensive outline of their intended mid-to long term response to food and agriculture, which included reversing the decline in aid and investment to the agriculture sector, fully implementing the Comprehensive Africa Agricultural Development Programme (CAADP), achieving a 6.2% annual growth rate in agriculture productivity, supporting research and development, improving infrastructure and food security early warning systems, helping countries adapt to climate change, and ensuring compatibility between policies on sustainable bio-fuel production and food security.

The G8 tasked their Experts Group to monitor the implementation of their Hokkaido commitments and continue to work with the UN-World Bank High Level Task Force on the Global Food Crisis.

TRADE AND INVESTMENT

Reiteration of previous commitments

The G8 acknowledged the impressive growth rates achieved by African countries in recent years and reiterated their support for measures that will lead to increased trade and private investment. Some of these measures include: strengthening the financial sector, improvements in domestic revenue generation, development of road and power networks, boosting agriculture productivity, supporting good governance. It also underscored the importance of the Doha Development Agenda negotiations, particularly the upcoming ministerial meeting on July 21, and committed to work urgently towards the completion of the negotiations. However, the G8 statements on trade did not reiterate the important 2005 commitment to “make trade work for Africa”. The G8 reiterated but did not add to its 2005 commitment to provide $4 billion in trade related assistance in line with the WTO Hong Kong Ministerial conference. The G8 also signaled their full commitment to implement duty-free and quota-free market access for products originating from Least Developed Countries.

GOVERNANCE AND THE FIGHT AGAINST CORRUPTION

Reiteration of previous commitments on UNCAC and OECD Convention; support for anti-corruption measures, including StAR Initiative and Africa Peer Review Mechanism

The G8 called for ratification of the UN Convention Against Corruption (UNCAC) by all countries and for the development of a review system to ensure compliance (Germany, Italy and Japan have still not taken action on the Convention). The G8 underscored their support for asset recovery efforts, namely the Stolen Asset Recovery (StAR) Initiative at the World Bank and called for more technical assistance to help developing countries implement the Convention and undertake asset recovery efforts. The G8 endorsed an annual accountability report that will detail actions each G8 country is taking to implement previous anti-corruption commitments.

DEBT SUSTAINABILITY

Committed to deepen aid dialogue with development partners

G8 leaders expressed their desire to deepen aid dialogues with emerging donors, especially around the issue of debt sustainability. The G8 highlighted the importance of borrowers and lenders pursuing sustainable lending practices so that the gains made from G8 debt cancellation are not wiped away.

PEACE AND SECURITY

No new commitments

The G8 reiterated their commitment to promoting peace on the continent by enhancing Africa’s peacekeeping capabilities through support of the Africa Peace Security Architecture and Africa Standby Force. Support will include training and equipment, sustainable and flexible funding for peace operations, and peace building support for humanitarian, reconciliation, stabilization, recovery and reconstruction efforts.

ZIMBABWE

Pledged to impose further measures (financial and other) against those responsible for the violence; recommended a UN envoy to support mediation efforts

In a separate statement, the G8 condemned the recent election in Zimbabwe and said they would not accept the legitimacy of a government that does not reflect the will of the Zimbabwean people. The G8 pledged to take financial and other measures against individuals responsible for the violence and also called for the appointment of a special envoy of the UN Secretary-General to report on the situation and support regional efforts to mediate between the opposition and the government.

More information:
All 2008 G8 Summit documents are available here.

But eight years after the Global Fund’s inception, the fight against these infectious diseases, and delivering essential health services more generally, is being severely hampered by weak health systems and a critical shortage of health professionals. With this in mind, we’re asking the G8 to deliver a strategy for improving overall health conditions while continuing to vigorously fight infectious diseases. Here are ONE’s three top-line health asks:

1. Develop a time-bound action plan for delivering $100 billion for health: At the 2007 G8 Summit in Heiligendamm, Germany, non-US G8 members promised to provide $30 billion for AIDS, TB, malaria and health systems in order to match the United States’ $30 billion, five-year AIDS, TB and malaria program. That program, known as PEPFAR, will now be authorized at $50 billion over five years. Non-US G8 donors should build on the original spirit of the Heiligendamm commitment by providing a $50 billion match over the same five-year period, and improving the quality of these investments over the same time frame.

By the end of the Japanese G8 presidency, the G8 should provide a donor-by-donor timetable for delivering on this health commitment.

2. Set a numeric target for filling Africa’s critical shortage of health workers: G8 leaders should agree to funding an increase of at least 1.5 million additional health workers in Africa by 2015, with an interim target of at least 600,000 additional health workers by 2012.

According to the WHO, meeting major health-related MDGs, such as universal access to treatment for HIV/AIDS, is “very unlikely” unless countries reach a minimum threshold of 2.3 doctors, nurses, and midwives per 1,000 population. In Sub Saharan Africa, this ratio translates to roughly 1.5 million additional health workers, including more than 800,000 doctors, nurses, and midwives.

3. Coordinate new and existing donor resources for health systems and health workers around national health sector plans. The G8 should agree to support the development of, and effective coordination of aid around, national health sector strategies. Assistance should be immediately scale-up in countries that already have rigorous national plans and a process should be developed to ensure all poor countries have the resources to complete donor-ready health sector investment plans.

-Ben Hubbard

A couple days ago, Dr. Clemons wrote a comment on the post, saying that he thinks the mainstream media misinterpreted the results of his study.

Dr. Clemons’ comment on my post :

“I wrote the study in question and I think the BBC piece just got it wrong. I explain why here:
http://blogs.cgdev.org/globaldevelopment/2008/01/media_reports_on_african_brain_1.php

Also- a useful summary of his research from the CGD site:

“Conventional wisdom says that, because low-income countries need skilled professionals to develop, their migration to better-paying countries is unequivocally bad… So the recent surge in the international mass migration of highly skilled workers has many worrying: will the loss of skilled professionals stymie development?

In this new working paper, CGD research fellow Michael Clemens uses new data on African health worker migration to test whether decreases in emigration raise the number of domestic health professionals, increase the mass availability of basic primary care, or improve a range of public health outcomes.

The results suggest that Africa’s generally low staffing levels and poor public health conditions are the result of factors entirely unrelated to international movements of health professionals, and that the option to emigrate has positively affected Africans’ decisions to enter the health field.

Bottom line: impeding the migration of skilled health professionals, by sending and receiving countries, does little to improve health systems or heath outcomes in Africa.”

I whole heartily thank Dr. Clemons for leaving his comment on the 14th, and hope he may accept my invitation to post on the ONE Blog in the future? We’d love to have your insights.

-Virginia Simmons

The study was done by the the Center for Global Development in Washington and looked at census records collected between 1999 and 2001. A recent BBC News piece details some of the core findings:

Several countries, including Mozambique and Angola, have more doctors in one single foreign country than at home.

And for every doctor in Liberia, there are two working abroad….

The report suggested the loss of doctors often went hand-in-hand with civil strife, political instability and economic stagnation.

The piece displays this chart, documenting the % of doctors in the following countries that move abroad:

The charity ActionAid said the brain drain was “a huge threat” to Africa.

“One of the best way to keep healthcare professionals in the countries that need them is to pay them properly – but currently health systems in many African countries are woefully underfunded,” said Nick Corby, policy officer at the charity.

“The UK government could do Africa a real service by upping aid levels for health systems, ensuring that desperately needed doctors and nurses stay where the need is greatest.”

Read the full BBC News piece here.

-Virginia Simmons