Fighting HIV/AIDS, malaria and other diseases (MDG 6)
The HIV/AIDS pandemic requires both emergency responses and structured responses over the very long term with a generation based vision. It is vital to act on both of these scales. To achieve this, the community of financial partners has promised, on one hand, to release the promised funds, and on the other hand to quickly adopt a truly coordinated, harmonised approach. The authorities in the countries concerned also have to take action and face the facts by including the fight against HIV/AIDS at the top of the agenda of their development strategies, ensuring the participation of all civil society bodies and forces including religious authorities, companies, patients’ associations and communities.
For nearly 20 years now France has considered the fight against AIDS a priority theme for its intervention. This priority was strengthened further in the 1999-2002 period. Just over one quarter of the Priority Solidarity Funds (27%) in the healthcare sector were dedicated to this theme (not including research programmes). In addition, some 60 full time technical assistants are active in the fight against AIDS through our cooperation programmes. The approach includes actions for prevention, detection (notably though the promotion of information centres and free, anonymous testing), transfusion security, access to medicines and antiretroviral drugs, support for partnership between associations in the north and south to facilitate the management of persons living with HIV, fighting against discrimination against victims (notably women), and finally, research.
The annual average of French engagements for AIDS alone amounts to 57.21 M€ across the board for the 2001 to 2003 period, i.e. 31% of the total financing dedicated to healthcare. In 2002 France’s contribution to the fight this pandemic changed scale, with a contribution of 50 M€ to the Global Fund to fight AIDS, Tuberculosis and Malaria. This contribution tripled to an annual 150 M€ over three years (2004 - 2006) after the Evian G8 summit. France has thus become the second financial partner, behind the United States. The multilateral channel of financing now represents the majority: 69% of planned undertakings for 2004. Since the Millennium summit in 2000, France’s contribution to the fight against HIV/AIDS in developing countries was multiplied by over 8, going from approximately 15 million Euros per year in 2000 to over 130 million in 2004.
The concentration of French aid on the fight against AIDS is carried out in parallel to aid for healthcare in general: if we consider the years 2001-2002 and 2003, 7 countries concentrated 50% of the total expenditure and 16 represented over 75% of the total.
The ESTHER initiative (Ensemble pour une solidarité thérapeutique hospitalière en réseau - Network for Therapeutic Solidarity in Hospitals) launched at the end of 2001 by the Ministry of Health supports this approach by organising partnerships between hospitals in developed countries and hospitals in developing countries. The aim is to form teams and to establish the right technical conditions for delivering adapted treatments to patients with AIDS.
Finally, the French initiative of debt reduction which started to take effect in 2001 within the framework of the Debt Reduction and Development Contracts (C2D) allows for credits to be set aside for the fight against AIDS and the first operations from this have taken place in Mozambique and Uganda.
The priority given to the fight against transmissible diseases is integrated into the much wider framework of support for healthcare systems. This system involves the strengthening and structuring of national healthcare policies. The initiatives taken are aimed at supporting reforms (institutional, hospital structures...), strategic planning, improving healthcare quality, evaluation and contracting procedures, reorganising the healthcare offer on a decentralised and district coherent basis and promoting healthcare systems based on progression from training at peripheral care units through to hospital centres. The FDA was notably applied to improving the healthcare offer at a deconcentrated and peripheral level, in coherence with the national policies defined by sector based programmes. This process was accompanied by support for the deployment of drug policies aimed at improving access and use of mainly generic drugs and encouraging research towards the development of molecules which are active against the often neglected tropical diseases. The actions carried out in this field represent 22% of the credits in the Solidarity Fund dedicated to healthcare. The development of human resources (management and training of the various healthcare professions) also represents a priority for French Cooperation. Credits applied to this question represent 10% of the Solidarity Fund healthcare budgets (this calculation does not take into account support for diploma type training, e.g. university degrees, which are recorded in the section dedicated to higher education).
Financing healthcare systems is key question with regards to ensuring the long term survival of the actions undertaken. Cooperation programmes aim to ensure the viability of these systems by taking into account local contributory capacities and seeking a difficult balance between external aid, national budgets, participation by the populations and establishing solidarity mechanisms.
Finally, strengthening of healthcare systems is accompanied by a range of targeted actions, notably in favour of mothers and children, school health, fighting against certain non transmissible pathologies and fighting against addictions.
In the medical research sector France’s offer is based in priority on i) the fight against HIV/AIDS by mobilising the main research bodies and stimulating more transversal disciplines such as the social sciences which should be taking a greater place in operational research; ii) the fight against infectious and parasite borne diseases, mainly concerning malaria; iii) the fight against emerging diseases: viral hemorrhagic fevers (Ebola) and SARS. Research initiatives on AIDS have also been undertaken in partnership with scientific teams in Southern hemisphere countries via the intermediary of the National AIDS Research Agency (ANRS). In addition, within the framework of the "Global HIV vaccine enterprise" initiative, supported by the G8 since 2004, France and six European countries (Germany, Spain, Great Britain, Italy, Sweden and Holland) undertook, on 19th October 2004, to strengthen the collaboration between their research bodies to accelerate the development of a vaccine against HIV/AIDS.
Modernised technical assistance for healthcare structures: the technical assistance system contributes towards achieving French cooperation objectives. After a major decrease in personnel numbers in the early 1990s some 220 new positions were opened at the end of 2002. The mission entrusted to these technical assistants has evolved significantly with the virtual disappearance of so-called ‘substitution’ positions, replaced by the activities of consulting, expertise and project management. This technical assistance is comprised of 45% of doctors from the public health service, 24% hospital doctors, 9% pharmacists and biologists, 6% nurses, 5% establishment directors and 3% engineers. This technical assistance contributes to the analysis and studies into the modernisation of the healthcare systems and also contributes towards training high level decision makers and local managers.
Greater regional coverage: with the objective of regionalisation of healthcare policies, French cooperation had doubled its numbers of regional social-healthcare consultants. Ten regional consultants are currently deployed as follows: two in West Africa, two in Central Africa, one in the Horn of Africa, one in southern Africa, one in the Indian Ocean area, one in South East Asia, one in the Caribbean and one in the Middle East. Each social-healthcare consultant covers five to eight countries. These regional consultants, in addition to the technical support to embassies and technical assistants in their zone, strengthen the regional coherence of French Cooperation actions for which they play a role of coordination in direct contact with multilateral organisations and other financial partners.
Development of operational networks: Cooperation also includes strengthening partnerships. The creation of federating thematic networks is one of the Department’s priorities in ensuring that the coordinated mobilisation of French expertise provides a quality technological monitoring system, optimal coordination of the French offer via improved time lapses prior to the deployment of healthcare professionals in response to the demands expressed. Currently five networks are in place: hospital management (Federation of French Hospitals), support for healthcare mutual funds (RAMUS); medicines (REMED), maternal healthcare, cancer studies.
Improved cooperation with international organisations: complement of obligatory and voluntary contributions to the standard budget of the specialised UN agencies (representing an amount of approximately 45.7 M€), France has significantly strengthened its relations with the multilateral agencies with regards to certain programmes. This collaboration is effective in the field (notably through the French system for technical assistance which frequently provides assistance to programmes established by these organisations) or by means of conventions signed between the head offices of these institutions and the French public authorities. This was the case with the WHO (convention which was renewed in 2003), notably with regards to the financing of programmes aimed at reducing the impact of transmissible diseases:
· convention to "fight against malaria" (1.46 M€ over 3 years) · convention for fighting against African Trypaniosomasis (1.22 M€); · opening of a WHO office in Lyon for controlling transmissible diseases (ongoing financing plus initial payments amounting to 2.05 M€ between 2002 and 2004); · support for regional WHO organisations including two technical assistance being placed at the disposal of the WHO/OPS in the Americas; · financing from the International Union for the fight against tuberculosis and respiratory diseases (to the amount of 2.2 M€); · participation with the World Bank in the programme against onchocerciasis (engagement to contribute 7.012 M€ to the APOC programme (African Programme for Onchocerciasis control) by 2007, including 5.18 M€ already paid or pending payment).
In addition to support for the World Fund against AIDS, Tuberculosis and Malaria, as mentioned previously, France has strengthened its cooperation with UNAIDS since 2000 by means of subsidies (1.4 M€ in 2001, 1.8 M€ in 2002). A tripartite convention UNAIDS/ Rio de Janeiro School or Public Health/ MAE, has enabled an international network of experts to be established on the theme of financing access to health care for persons with AIDS (the principle for this structure was established during the International Conference in Barcelona in 2002).
Finally, France envisages, along with the United Kingdom, to launch a pilot project of an international financial facility aimed at providing funds for the GAVI immunisation initiative.