President and princess on plenary podium

"There is so much more we could do with resources", said Ugandan President Yoweri Museveni, addressing the first plenary session at the XV International AIDS Conference on "Access to resources: commitment and accountability".

Summarising Uganda's achievements in combating HIV/AIDS, President Museveni stressed the reduction in prevalence of HIV there has been the result of a broad-based national effort backed by firm political commitment, including his own involvement.

Uganda, one of the first countries in sub-Saharan Africa to experience and take action against HIV/AIDS, is a rare success in a region ravaged by the epidemic. While the rate of new infections continues to increase in most of sub-Saharan Africa, Uganda has succeeded in lowering very high infection rates.

Since 1993, HIV infections in pregnant women - a key indicator of the progress of the epidemic - have more than halved in some areas, and infection rates among men seeking treatment for sexually transmitted infections have dropped by over a third. Uganda is the first African country to have reversed the spread of the disease, giving hope that the tide can at last be turned.

The political commitment President Museveni identifies has meant the involvement of a wide range of partners, including religious and traditional leaders, community groups, NGOs and many other sectors of society. Key was the forging of a consensus on the need to contain the spread of HIV, and to provide care and support for those affected.

The president used political rallies and public broadcast messages, especially by radio, to educate the Ugandan people.

President Museveni added that through additional funding from the Global Fund and the US President's Emergency Plan For AIDS Relief, supplies and infrastructure are in place to begin treating HIV-positive people with antiretroviral drugs.

Jean-Francois Rischard, vice-president of the World Bank, made an address on the subject "Global problem-solving in the 21st Century: desperate times deserve innovative approaches". He discussed the urgent need for new global problem-solving approaches; the clock is ticking inexorably towards "high noon" - also the title of his book - before time runs out to resolve the world's 20 most urgent problems, ranging from global warming and water shortages to communicable diseases such as HIV/AIDS.

These problems are all interlinked, Mr Rischard said, and there is an urgent need to discuss appropriate responses.

He dismisses the idea of global governance, citing the European Union, which has been trying to become a regional government for the last 50 years. Instead, he proposes "Global Issues Networks", comprising government experts in the relevant fields, international civil society organisations and businesses. Different networks deal with each of the 20 big issues. He suggests that such networks are a real possibility for better and faster global problem-solving. They would be able, he argues, to reach a rough consensus towards the necessary action.

A striking example of effective collective action was the "Montreal Protocol" on ozone-depleting substances, which had seen a rapid reduction in the production of ozone-depleting gases. But this is the exception, Mr Rischard warns. For networks to work, he said, India and China must participate, since these nations represent about one-third of the world's population.

Critical review of funding mechanisms was discussed by HRH Princess Mabel of Orange-Nassau, currently with the Open Society Institute (OSI). The challenges, she said, are to increase available funding for HIV/AIDS in low- and middle-income countries, to improve donor co-operation in support of national plans and frameworks, to develop comprehensive programmes and to make necessary policy changes.

Princess Mabel argued that these objectives can achieved by involving civil society and other stakeholders in program design and implementation, and by streamlining and harmonising donor procedures. Comprehensive programmes should prioritise needs and not be based on ideology. They should also address controversial aspects of HIV/AIDS, and look at tackling structural, political and legal barriers. Underlying health structures should be strengthened, she added.

The "three ones" principles also received endorsement from Princess Mabel, who sees them as a means to achieve the most effective and efficient use of resources, and to ensure rapid action and results-based management. As she explained, the principles are:

    * One agreed HIV/AIDS action framework that provides the basis for co-ordinating the work of all partners.
    * One national AIDS co-ordinating authority with a broad-based multi-sectoral mandate
    * One agreed country-level monitoring and evaluation system.

Princess Mabel went on to mention the new funding initiative from the US: the President's Emergency Plan for AIDS Relief (PEPFAR), which favours a bilateral approach. Canada, France, Germany, Italy, Japan and the UK have also increased their funding, and the increasing contributions of Ireland, the Netherlands, Norway and Sweden are impressive, she said.

She continued by praising the Global Fund for being participatory, and addressing the problems it is experiencing. But, she said, it is at a critical juncture, and will need at least $3.5 billion in 2005, of which only $880 million has been pledged so far. She noted that French President Jacques Chirac and others have suggested that the Fund's needs should be provided on the following basis: one-third from the US, one-third from the EU, and one-third from other countries and private sources. While recipients need to use AIDS funds effectively, international donors must also increase the impact of their efforts, she said.

"The business response to HIV/AIDS" was presented by Tsetsele Fantan, project leader of the African Comprehensive HIV/AIDS Partnership. Since the XIV International AIDS Conference in Barcelona, international focus has increasingly shifted towards addressing HIV as part of a continuum between the workplace and the community. Indeed, a growing number of national business coalitions and industry associations are supporting national responses, and the Global Business Coalition on HIV/AIDS has doubled its membership since 2002.

Speaking about the Debswana mining workplace programme, Ms Fantan added that HIV/AIDS is a business issue requiring effective leadership, adequate resources and a commitment to manage its impact. The programme extends productive lives through the provision of antiretroviral therapy. Debswana encourages voluntary counselling and testing, and employees and spouses who test HIV positive receive treatment. In 2003, Debswana agreed to introduce the government's antiretroviral scheme at their mine hospitals.

A company should not operate in isolation, said Ms Fantan; it is important to engage other stakeholders from the business area and community. She continued by saying that effective monitoring of impacts requires good information management, and this will help inform better decisions.

Ms Debswana concluded by stressing how, in developing countries, sustainable access to healthcare can be provided through public-private partnerships, where the government delivers the minimum standard of care, the private sector brings skills and core competencies and the donors bring funding and other resources. The public and private sectors are complementary, she insisted, and effective public-private partnership is about structured co-operation and collaboration.

Given the examples presented , it appears that such partnership, combined with innovative approaches to funding, can help increase access to essential services based on structures already in place.

Ishdeep Kohli-CNS

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