“Has there Ever Been A Greater Injustice In This world?”

1. “Has there Ever Been A Greater Injustice In This world?” Amy, Morgan, and Steve

2. “The promises are never met…” • The UN is ineffectual, difficult to navigate, and values process over results. • There is a tendency to praise the UN for increasing resources for Africa, when this amount is nowhere near what is needed. • The UN acquired $8.3B from all sources in 2005, but needed a minimum of $15B for 2006, $18B for 2007, and $22B for 2008. • Diplomacy yields concerns about “stepping on the toes” of the UN in addressing these shortfalls. • Power players set the bar low, and fail to clear even that modest hurdle. • The G8 meeting in Gleneagles in July 2005 promised to contribute $7.1B to meet Africa’s needs in 2006/2007, but only came up with $3.8B. • “Incestuous” meetings, presentations fail to produce visible results. • “We’ll never close the gap by endless contemplation of figures, as though we were in some permanent actuarial trance.” (203) • Huge amounts spent on travel, accommodations, and logistics of meetings, money that could’ve been saving lives…

3. “…all sound and fury signifying so very little…" • Organizations lack a sense of emergency • “…every minute delayed is another life lost…” (p.204) • Absence of leadership despite available human resources • “Three by Five” considered successful, WHO adopted “to hell with the obstacles, just get on with the job” attitude • “Three by Five” put 1.3 million people in treatment-a success despite falling short of its goal • Individual lives are marginalized • Perceived trade-off between treatment and prevention • “…the pandemic has come down to saving a child, to rescuing that mother’s future, to putting the highest value on individual lives.” (p.204) • Goal is to save lives, whatever it takes • “…with treatment comes hope, and with hope comes testing, and with testing comes prevention, so that what we have now, country after country, is the single minded-pursuit of keeping people alive…” (p.199)

4. “A continued swamp of economic malaise…” • Forgive the national debts • Enslaved by the debt “owed” the rest of the world • Disables progress • Focus on women and orphans • Eliminate school fees to ensure education • “We need a powerful international women’s agency more than we need any other institutional arrangement” (p.205)

5. “Phenomenal Resilience…” • “Three by Five” paving the way for universal access • Smaller organizations appear more efficient: MSF, The Clinton Foundation, etc. • DFID improved conditions and training to keep healthcare workers in Malawi • UNICEF has potential progress for children • Some debt relief…but it’s not complete

6. “An abject failure…very little has changed” • Developed nations refuse to write off debt, so that African nations pay bills instead of feeding the hungry, treating the sick, and educating the future • Barely 20% of the ill are receiving treatment • Africa lacks human capital and capacity; all the young people are dying • Funding/Aid organizations are top heavy and fractured, and there is no real central or organized leadership to streamline identification of need, deployment of resources, and follow-up on progress • UN, UNAIDS WHO, G8, Global Fund, IFF World Bank, IMF, UNICEF, ADF, MDG…and on and on… • Wealthy, developed nations do not have an urgent sense of responsibility for helping halt this pandemic • There is no true sense of corporate responsibility to halt the pandemic either (The Gates Foundation is one exception). “Corporate welfare bums.” • Women and children disproportionately affected

7. Continued… • Agricultural subsidies place Africa at an economic disadvantage. • G8 failing in its 0.7% of GNP promise. • Continued competition between treatment and prevention.

8. Recommendations/Solutions • Be real • Stop self-congratulatory pomp in the face of suffering • Replenishment Conference in 2005: Global Fund asked for $7.1B, received $3.8B • “…the large gap ‘twixt cup and lip’…” (p.195) • Better accountability standards for UN Member States • Goals set but never reached • Don’t make promises you never intend to keep • Treatment and prevention are not a trade-off, both must be given priority • There must be funding for both • Elevate the status of women and orphans through education • Assist orphans • Improve capacity • DFID in Malawi (p.202) • Reattach the human element • The purpose of all of this is to save lives • Forget the figures; get on the ground, do the job

9. Rec/Solutions Con’t • A visible “integrator” • Financial streamlining? • Better support of bottom-up efforts • Greater community health focus

10. “Searching for hope,” Our Reflections • Renewed assault on school fees by UNICEF? • Debt forgiveness? • Out of sight, out of mind • “What continues to be lacking is a sense of emergency, the fire of effective leadership, the consuming passion to cut through the cerebral doldrums and save lives, save lives, save lives.”

11. Conclusions “There should not be disciplinary action for telling the truth…” “…an unlovely pattern of Pavlovian obeisance to the United States…” • Facilitate constructive criticism… • In the absence of that, reduce the taboo of criticism between nations. • Do not ignore progress… • “Three by Five” • Goal: 3 million in treatment. • Actual: 1.5 million in treatment, opened the door for “universal access.” • Four pronged plan by UNICEF: “Unite for Children, Unite Against AIDS.” • Treatment of infected children. • Prevention of Mother-to-Child transmission. • Care of orphans. • Attention to adolescents and youth. • Think on a global scale (The UN) and act locally (communities)… • Get on the ground! • Use the UN to empower localities.

12. Questions • How do we build grassroots/community based delivery systems? • Is it possible to create an “integrator” for such a diverse range of cultures and delivery systems? • What’s the best way to reduce fragmentation? • If you contributed funds, where would you send them? • How do we spread the urgency of smaller organizations?