Washington, DC — An official of the Global Fund to Fight AIDS, Tuberculosis and Malaria says that African nations can effectively absorb and spend more money than has been allocated to the battle against the continent's deadliest diseases.
"The real question in the fight against aids," says Dr. Kingsley Moghalu, head of resource mobilization for the UN-initiated fund, "is 'where is the money?' That's not the only thing, but it's one of the most important elements in the fight against this disease. Everybody knows that there is treatment. Everybody knows that there is prevention. And everybody knows that there is the possibility to care for people with these diseases in a very effective manner. But the major problem in the developing world is that they have no money."
Dr. Moghalu spoke at a press conference that opened the African Women's and Children's Health Symposium being held today in Washington, DC, sponsored by the U.S. development group OIC International in collaboration with the Africa Club of the World Bank Group-IMF, the Constituency for Africa and the University of the District of Columbia. The Zambian Ambassador to the United States, Dr. Inonge Mbikusita-Lewanika, also addressed the issue of absorptive capacity. Here are some excerpts from their comments.
Dr. Moghalu: There is a problem. There are issues of absorptive capacity. But it has been elevated to the status of a myth. And now it's being used as an excuse - or to back up arguments against providing more resources. Let me tell you why this is a myth. If you look back at the history of development assistance or development financing, it is mostly government-to-government or organizations-to-government. There has not been, in the past, a systematic global financing of capacities other than that of government.
Yes, of course, a lot of the governments are small; they have weaknesses; and so you say there's not absorptive capacity. But consider that in Africa almost 50 per cent of all health care providers are outside government. You have mission hospitals, you have private sector hospitals, and then you have government hospitals. So you can see that there is rather more capacity to absorb resources in Africa than we are made to believe.
Our model at the Global Fund has proved that this is so. Fifty per cent of global fund resources has gone to governments, Forty per cent has gone to civil society - and that includes non-governmental organizations, faith-based organizations, communities of persons living with the diseases, even academicians in the countries. We recognize the need to support health systems. We like proposals that are balanced and that have health-system components as well. About 24 per cent of our funds are for human resources. And that's why we know that there is far more absorptive capacity than we have been given to believe.
What's the balance between the need for funds and the lack of absorptive capacity? The balance leans more, far more, towards the need for resources than towards the problem of absorptive capacity.
The fact that people are poor doesn't mean that there are no solutions to the problems. You can get around the problems of poverty by making use of particularities in the system that people who think within the box do not know about. And that's what the Global Fund is doing.
Ambassador Mbikusita-Lewanika: What adds to what is perceived as a lack of absorption is sometimes too much centralization of the assistance. Even the national AIDS councils in most countries now have mechanisms to monitor and to coordinate the people who are working around HIV. But they can also become like a "mini" centralized government.
I think the way forward is to trust other people. Sometimes we trust people in capital cities more than people in rural areas. We assume that if it takes a long time to get there and there's no telephone, no computer, therefore you can't give your money there. There are many good ideas in the remote rural areas that are very effective.
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The capital cities have been over-supported in relation to the capacities of rural areas, where the money can really be used, if we trust the people. Pastors, faith- based groups are in the villages. Government services may stop at the level of the district, but faith-based groups reach all the way into the homes. Women's groups, youth groups, even the children can be supported to act.
I lived in a rural area for eleven years. I saw the astonishing capabilities of people who live in rural villages. If more money were delegated to the people who can use it at the local level, it can be absorbed effectively in no time.
We need to recognize that sometimes we waste a lot of time in the processes and systems and structures: who's going to be the chair, the vice-chair, the secretary, what department will administer? People are dying, and the people can use the money yesterday. So we hope we get more funding out to those who can use it immediately.
