This week, the cameras are following President Bush on his first visit to Africa in five years. It's a trip that may prompt some cynicism and sneers among critical observers. When lame duck presidents reach their final year of service, they traditionally embark on public relations campaigns designed to solidify their legacies. President Bush, like others before him, has set out to identify his presidency with humanitarian aid.
But to the surprise of many, his trip is not merely part of a tightly choreographed final year in office which includes racking up mileage on Air Force One. A fact that most Americans will not realize is that his administration has invested more in African public health and economic development programs than any other.
Bush's week-long agenda takes him to Benin, Tanzania, Ghana, Liberia and Rwanda, where I live and work. So far, he has see the profound effect of his commitment on this part of the world. Just seven years ago, not a single person here had been treated for AIDS with US taxpayer dollars; today, the number well exceeds one million. A few years ago, the battle against malaria appeared abandoned; in just two years, increased funding has put the disease back on the political map. Since 2003, the president's programs -- such as PEPFAR (the Presidential Emergency Plan for AIDS Relief) -- have dedicated nearly $19 billion to African aid programs addressing health care improvement, economic development and prosperity building. Global AIDS spending in 1996 was approximately $300 million; this year it will come close to $10 billion with nearly half coming from the US.
In Rwanda, administration and donor support have altered the landscape, helping government build the critical foundations of a public health system. Just five years ago, there were merely four sites in the entire country where a person could be tested for HIV. Today, there are well over one hundred.
The Bush administration has demonstrated that seemingly intractable public health challenges can be met with adequate resources. The next step is to learn from that experience and build on current momentum.
While Bush spending is largely positive, its emphasis on treating diseases rather than their underlying causes is short-sighted. While AIDS remains a killer, there are other areas of health and development which deserve increased attention; addressing these will also help fight AIDS. Over the years I've seen AIDS programs where patients took drugs costing hundreds annually that were ineffective because they were starving. Funds targeting agricultural productivity, business loans, and infrastructure improvement would go a long way in health care.
It's likewise not unusual to come across health centers with superb AIDS testing and treatment, but little ability to handle equally life-threatening infections and accidents. Neglected Tropical Diseases -- including horrors such as intestinal worms (which afflict a billion world-wide yet cost a mere 50 cents to treat) -- remain grossly neglected in spite of the fact that treating them makes treating AIDS easier. Strengthening these programs will improve global public health, but family planning, maternal health, and child health have suffered terribly under this administration due to ideologically-driven policies; PEPFAR is the funding source for controversial abstinence education programs.
One initiative supported by the administration -- though not at high enough levels -- is the Global Fund to Fight AIDS, Tuberculosis and Malaria. Unlike Bush administration direct funding, which flows through a costly and circuitous stream of recipients and sub-recipients, the Global Fund directly supports governments in addressing disease. While the Global Fund and the administration present themselves as partners, their different approaches reveal a critical split on development ideology. By reinforcing government programs, the Global Fund lowers implementation costs, and taxpayer dollars are often better leveraged than by administration initiatives. For its part, the administration has helped a wider group of implementers (particularly non-governmental organizations) put drugs to use on the front lines. The president and his successors should study the pros and cons of each program.
It's important that our tax dollars in global health be viewed as investments which will pay dividends for decades to come. The president has called on Congress to reauthorize a $30 billion, five-year extension of his AIDS program, which would treat 2.5 million people, prevent 12 million new infections and provide care for 12 million more. This is necessary to save lives, and it advances the Bush legacy in a meaningful, productive way that will help the region become self sufficient and begin to eradicate poverty, which must be the real target of the president's and our fight. Activists are seeking an additional $20 billion to enable the program to adopt a more comprehensive approach. The president should seriously consider their request as his African journey comes to its conclusion at the end of the week.
Enormous challenges remain, but our presidential candidates will do well to build upon the administration's legacy in Africa. U.S. dollars can be leveraged more effectively and measures more holistic in approach can turn recipients and their nations into productive, globally integrated economies which will ultimately be able to manage their disease burdens without international support. The success of the Bush years should not leave government feeling complacent or settled on approach. Rather, this should be viewed as the time when Africa landed back on the policy map as a place where well-managed programs in committed nations could truly yield missions accomplished -- and lives saved -- by the millions.