On April 14, the Senate Foreign Affairs Committee held a hearing on the FY2012 budget for African Affairs at the State Department and United States Agency for International Development (USAID).
Ambassador Eric Goosby, MD, U.S. Global AIDS Coordinator, Department of State, echoed his testimony before the House Appropriations Subcommittee on State, Foreign Operations, and Related Programs (see The Source, 4/1/11), and also discussed USAID’s efforts to prevent the spread of HIV/AIDS and provide for patients’ treatment and care. Ambassador Goosby said, “Antiretroviral treatment saves lives, but it is a significant component of our overall costs. In July, we reported on treatment costs, based on groundbreaking studies of PEPFAR-supported treatment sites across 12 countries. This data, indicating an estimated mean cost to PEPFAR of $436 for each patient supported, provides a baseline for efforts to identify treatment efficiencies. South Africa has the world’s largest number of people living with HIV, and the world’s largest treatment program. The South African Government identified the need for additional funding that would help to fill urgent short-term gaps in drug availability and drive changes in procurement policies, while greater South African investments could be marshaled. I personally joined our country team in working with the Ministry of Health, and we concluded there was a need for an additional one-time $120 million dollar investment over two years. With this money, PEPFAR was able to buy drugs at 50 percent of their previous prices in South Africa. This investment, along with substantial work by the Government, led to an historic change in South Africa’s policies that enabled the Government to do what we had done, and purchase medicines at 50 percent of its previous costs. This allowed the country to save an estimated $600 million dollars over the next two years alone. In short, the PEPFAR investment had a remarkable multiplier effect. It will immediately allow hundreds of thousands to receive lifesaving treatment that they would not otherwise have received, preventing the vertical transmission of HIV to thousands of additional infants, and keeping their mothers alive and their families intact, while remaining a South African government investment.”
He added, “Other compelling examples drawn from the treatment program area reflect the work of the Supply Chain Management System [SCMS], which PEPFAR created and manages through USAID. Antiretroviral drugs purchased through that mechanism are now over 98 percent generic – an amazing achievement that saved us over $380 million dollars in 2010 alone. Our progress toward reliance on generics was described in a recent paper in the Journal of the American Medical Association. And through our supply chain strengthening efforts, we’re increasingly moving those drugs and other commodities in more cost-effective ways. SCMS estimates we’ve saved almost $40 million dollars to date just by using sea rather than air freight, for example. Through SCMS, we’ve also set up three state-of-the art regional distribution centers in Ghana, Kenya, and South Africa, helping to make us more efficient in moving products. All of these commodity savings lead directly to being able to serve more people and save more lives.”
With regard to prevention, Ambassador Goosby said, “In HIV prevention, smart investments are equally essential, and this year brought much encouraging news. UNAIDS reported significant declines in new HIV infections in over 30 countries, including 22 in Africa – a remarkable turnaround from the trends of a few years ago. In the past, we’ve used the phrase ‘combination treatment’ to suggest the need to rely on several antiretroviral drugs, not just one. Now we also talk about ‘combination prevention’ to demonstrate the importance of relying on multiple prevention tools for a given population – including biomedical, behavioral, and structural approaches. It is essential for each country to know its epidemic, and PEPFAR is seeing the payoff from heavy investments in high-impact prevention activities tailored to the needs of specific countries. Evidence on the epidemiology of HIV within each country helps answer questions such as need for relative emphasis on youth or older population groups to find the right mix of programs that promote, for example, delay of sexual debut and partner reduction. Country epidemiology also helps us identify and focus on most-at-risk populations, where comprehensive prevention efforts play a critical role in halting the advance of the epidemic, including among men who have sex with men, sex workers, migrant workers, and those who inject drugs. We have also strengthened efforts to rigorously evaluate the impact of prevention activities, in order to target investments to save more lives.”
USAID Deputy Assistant Administrator for Africa Raja Jandhyalanoted that the FY2012 budget for Africa is “$7.797 billion, representing a 10 percent ($732.7 million) increase over the FY2010 enacted total.” Of that amount, $5.4 billion would fund the Global Health Initiative (GHI), one of President Obama’s “three major initiatives.”
In outlining some of USAID’s priorities, Ms. Jandhyala discussed the Global Health Initiative (GHI): “Through the Global Health Initiative, the United States in partnership with local governments and donors will accelerate progress toward ambitious health goals, which will improve the lives of millions. Funding is targeted to the highest priorities – from infectious diseases to maternal and child health – while helping developing countries build their capacity to help their own people. In order to maximize the sustainable health impact of every U.S. dollar invested in global health, GHI will expand basic health services and strengthen national health systems to significantly improve public health, especially that of women, children, and other vulnerable populations with effective, efficient country-led plans. Our health programs not only show America at her best, but also deliver results. In 2000 malaria killed nearly a million people in sub-Saharan Africa. The cost to the continent was $30 billion a year in lost productivity. By 2009, that number had dropped nearly 20 percent. In all eight African countries where both baseline and follow-up nationwide surveys have been conducted by the President’s Malaria Initiative [PMI], there has been reported substantial reductions in all-cause child mortality, and growing evidence suggests that malaria prevention and control measures have been a major factor in these reductions. In FY 2012, PMI will continue to strengthen the capacity of local partners to deliver highly effective malaria prevention and treatment measures. And we will expand malaria control into two critical countries, the Democratic Republic of Congo and Nigeria, which have a combined population of 200 million and where 50 percent of the African malaria burden lies. But despite these successes urgent challenges remain. This year, more than 350,000 women will die in pregnancy or childbirth and 8 million children will die of preventable diseases before their fifth birthday; approximately half of these deaths will occur in Africa.”
Ms. Jandhyala continued, “GHI provides a platform to increase the efficiency of our investments in global health. Rather than supporting separate lines of health delivery – focused on diseases – GHI focuses on improving service delivery in an integrated way – particularly for women. Doing so generates efficiencies, allowing far more comprehensive treatment during fewer patient interactions. But the real success will be measured in lives saved – today and in the future. Accelerated progress depends on our ability to develop, identify, adapt, and deliver the game changers. We cannot be satisfied with marginal improvements for those who are already served. That is why under GHI, we will make substantial investments in better ways to treat diarrhea and pneumonia in children to save lives and prioritize vaccines, like rotavirus or pneumococcus, which are now available, to more effectively prevent disease so children don’t have to be treated later. For FY2012, we have prioritized funding in four areas that have maximum impact on the health of women and children: HIV/AIDS, maternal and child health, malaria, and family planning. We are concentrating our financial, technical, and human resources on these areas to achieve dramatic, meaningful results for the American people and the developing world. Bipartisan Congressional support and the generosity of the American people have long defined U.S. Government global health work. We look forward to continued cooperation and consultation with Congress as we work together to implement this important initiative.”
Johnnie Carson, assistant secretary for African Affairs, State Department, and Patrick Fine, vice president for Compact Implementation, Millennium Challenge Corporation, also testified.