I spent today trying to understand South Africa’s official country response to the HIV epidemic. This entailed reading the various five-year national strategic plans to combat HIV and TB produced since 2000, along with the various documents produced by the Global Fund to Fight ADS, TB and Malaria. Tracing the shifts in style, conceptualisation and method is particularly intriguing. Perhaps the least attractive aspect of these developments is the way the Global Fund has been taken over by private sector thinking. I try hard not to be cynical – after all, there seems to be a sincere desire to address the epidemic – but the self-aggrandising, righteousness of their ‘brand’ still makes my lip curl. Take this extract from their website ‘A Smart Investment’:
In 2000, AIDS, TB and malaria appeared to be unstoppable. In many countries, AIDS devastated an entire generation, leaving countless orphans and shattered communities. Malaria killed young children and pregnant women unable to protect themselves from mosquitoes or access life-saving medicine. TB unfairly afflicted the poor, as it had for millennia.
The world fought back. As a partnership of governments, the private sector, civil society and people affected by the diseases, the Global Fund pooled the world’s resources to invest strategically in programs to end AIDS, TB and malaria as epidemics.
Note the breathless and dramatic narrative – as if AIDS, TB and malaria were the enemy, we were all involved in a war – and then the heroic Global Fund stepped in and saved the day. Indeed, the Global Fund is branded as ‘saving lives.’ But this is where the hubris comes in: they only contribute 5% to South Africa’s budget for addressing HIV and AIDS while 80% is provided by our very own government. South Africa has the largest number of people on anti-retrovirals in the world which, for all its very many failings, says more about our Department of Health, than the Global Fund.
Looked at more closely, it also seems as if the Global Fund is driving the country’s strategy. This can be tracked by the way phrases and approaches first appear in the Global Fund’s strategy documents and then make their way into South Africa’s documents (‘investing for impact’ is a prime example). At the same time the Global Fund sets country ownership as a key principle of their approach. I think not. If you want their money you do it their way and then call it your country’s strategy.