Victims of generosity

Has Bill Gates poured $8.5 billion into programs that are doing just as much harm as good? LA Times questions whether the money Gates has devoted to global health causes is well-spent.

Critics say that Gates is funding much-needed vaccines and AIDS pills, but diverting attention from the true killers: poverty, ignorance, hunger, and poor hygiene. Patients may receive free AIDS pills from the Global Fund to Fight Aids, Tuberculosis, and Malaria, but the patients vomit them up because they are starving. Mothers may owe their lives to the pills, but their infants are dying in filthy hospitals for lack of a $35 oxygen tube.

LA Times poses three concerns. First, the Global Fund has diverted staff from basic health care, replacing well-trained clinicians with inferior staff. In Rwanda, for instance, the Global Fund pays its nurses $175 to $200 a month, while other nurses earn $50 to $100 a month. A Lesotho government official said the problem could be solved by taking a fraction of Global Fund's funding to fund pay raises for other government health pay professionals.

Second, the focus on a few high-profile diseases has diverted attention from nutrition and transportation. The clinics are there, but some patients have to walk nine hours to reach them. One nurse told Times that four out of her five patients ate fewer than three meals a day, and most of them were dying of hunger as well as AIDS.

Finally, programs actually tell caregivers to ignore the possibility of other diseases. During vaccination drives, program directors tell caregivers that addressing other health concerns slows the vaccination lines.

Global Fund director Michel Kazatchkine said the Global Fund "cannot resolve all the problems of all the people." The Global Fund has given 1% of its funds to helping local health systems, but it adds that its task is treating AIDS, TB, and malaria, not propping up local health systems. To take over would weaken African countries that need to learn to support themselves.