This election season has made victims of us all. To hear it from Republicans, Medicare subscribers are targets of raids. Sit with Democrats long enough and privileged women become casualties of war. In reality these people are hardly victims, and America’s election machine distracts from the needs of the truly poor and oppressed. Today, malaria will massacre thousands of poor African children. For millions more, their only protection is a drug, a bed net, or a protective spray provided by the U.S. government.
Our $8.6 billion global health budget may not be a big factor in the election, but make no mistake: this line item is the difference between life and death for countless people around the world. When the campaign dust settles and our leaders get down to balancing budgets, they must take care to preserve healthcare programs that work.
Chief among them is the President’s Malaria Initiative (PMI), one of the most effective government initiatives in recent history. According to U.S. government data, all-cause, under-five mortality rates have declined by 16-50 percent in 11 PMI target countries in which surveys have been conducted. Since malaria is a leading killer of African children, and malaria control was the only recent major public health program in many PMI countries, much of the difference can be attributed to its work. Of course, PMI wasn’t alone in making these advances. Over the past five years, the World Bank found a 12 percent drop in mortality rates for children under-five across all Sub-Saharan Africa — but PMI deserves much of the credit.
Yet, PMI is facing across-the-board budget cuts while less effective programs, such as the Global Fund to Fight AIDS, TB and Malaria, are on track for double-digit gains. It’s not inconceivable that President Obama would eliminate the PMI if he’s reelected, promoting the reallocation of funds as “investment in health systems strengthening.” After all, this is one of George W. Bush’s signature programs, and we know how President Obama feels about his predecessor’s legacy.
The fact is the U.S. government sets the standard for malaria control. PMI stands among few aid programs that conduct drug quality surveillance to weed out counterfeit and substandard medicines before they cause harm. It is also an unflinching proponent of insecticide spraying — which is how we eradicated malaria in the U.S.
These methods are tough to employ. Health systems are weak or non-existent throughout much of sub-Saharan Africa. It’s much easier to distribute insecticide-treated bed nets — which nearly all donors do — and assume people use them. Or simply wire money to health ministers and hope they spend it wisely.
Though even with rigorous monitoring, there is always a risk that donor funds will be diverted. So the mark of a truly effective agency is a zero-tolerance policy on corruption. Here again, PMI is a cut above the rest.
In 2008, more than $642,000 worth of U.S. taxpayer-funded antimalarial medicines were plundered on the Angolan Health Ministry’s watch. So PMI stopped using the Angolan government’s warehouse to store drugs, immediately moving to distribute through private channels.
This may seem like a sensible response, but other agencies are not so diligent.
The Global Fund professes to fight corruption, and it certainly doesn’t condone it, but it has refused to abandon government distributors, even those found guilty of gross negligence and theft. From documents I’ve seen, at least 12 Central Medical Stores in African nations have engaged in corrupt activities with donor-funded drugs — and the vast majority of them were purchased by the Global Fund. In total, about $100 million worth of HIV and malaria drugs have gone missing.
When some of these facts came to light last year, the Swedish and German governments froze contributions to the Global Fund. The organization came under scrutiny and several donors pulled back. The Global Fund has since replaced its chief executive and restructured its aid model to improve accountability. Yet in some critical ways, it is still business as usual.
For example, the Global Fund works with the United Nations Development Program to manage its programs in some of the world’s poorest countries. Under international law, U.N. agencies do not have to open their books to independent auditors — and the U.N. Development Program takes full advantage of this. Investigations into the diversion of aid funding are often stonewalled by this agency.
If our political leaders truly want to protect the poorest and most vulnerable, they should keep aid flowing through PMI. Cutting its budget will have an immediate impact on childhood mortality rates in Africa. Rerouting those funds to agencies beyond the reach of the U.S. Congress will only make them prey to corruption.
Roger Bate, a resident scholar at the American Enterprise Institute, is co-author of the paper, “Prioritizing Malaria Control in a Time of Foreign Aid Austerity.”
