Archive for the ‘Healthcare In China’ Category

Dr. Eric Goosby - Current United States Global AIDS Coordinator

Why is China, the world’s fastest growing economy, still receiving more than $2.5 billion a year in foreign government aid (as well as over $1b from the World Bank)?  In an article recently published by the AP out of Beijing, a correspondent argues that China shouldn’t be competing with other developing nations for the same pool of money.

BEIJING – China spent tens of billions of dollars on a dazzling 2008 Olympics. It has sent astronauts into space. It recently became the world’s second largest economy. Yet it gets more than $2.5 billion a year in foreign government aid — and taxpayers and lawmakers in donor countries are increasingly asking why.

With the global economic slowdown crimping government budgets, many countries are finding such generosity politically and economically untenable. China says it’s still a developing country in need of aid, while some critics argue that the money should go to poorer countries in Africa and elsewhere.

The current debate spotlights the challenges of addressing poverty in middle-income countries such as China, India and Brazil, where economic growth is strong but wealth is unequally spread. After the U.S., China has the world’s most billionaires, yet incomes averaged just $3,600 last year.

…China is effectively robbing the poor by competing for grants, said Dr. Jack C. Chow, who was the lead U.S. negotiator in talks that set up the Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria, a major funder of health programs.

The $1 billion China has been awarded in grants from the fund could have paid for 67 million anti-malarial bed nets, 4.5 million tuberculosis treatments, or nearly 2 million courses of AIDS therapy in poorer countries, Chow said.

“I think the milestone that China is now the second largest economy, arguably, I would say that it’s no longer a developing country with the likes of sub-Saharan Africa,” Chow said in an interview. “Having money from the Global Fund going to China really detracts and depletes that mission of helping people in the poorest of countries.” Full Article

Two points I’d like to make regarding the views expressed in this article:

1)      Unlike many other “developing” nations, China’s willingness to accept foreign aid has been a relatively new development – As the article even points out, in the 1970s, during a significantly less stable period of time in China, less than $10M per year of aid was flowing into the country.  Therefore, as the country gradually opens its doors to the outside world, it should not be a surprise to see a nation with a significant need for not only outside donations, but also expertise to address deep rooted social issues that the country has little experience dealing with (The article also fails to mention how much of $2.5B per year includes the donations to the 2008 Sichuan Earthquake recovery). China, despite how it is portrayed in the media, has over 700 million people living in the country side (approximately the population of all of Sub-Saharan Africa), many of whom do not have adequate access to healthcare or education. A separate AP correspondent article released earlier this year, in fact highlights that NGOs have flooded into the country to work on social issues and are fearful of the idea that restrictions may be placed on donations. I believe it is simply too soon to be critical of China for competing with countries that are more traditionally viewed as “developing” given that NGOs and foundations view China as a place where their efforts and dollars can go a long way

China has surprised thousands of aid groups by stepping in to regulate overseas donations for the first time, complicating efforts to get money from supporters in the United States and elsewhere. Some groups warned that losing the support could force many to shut down….China has struggled to keep up with the growth of aid groups in recent years. The Ministry of Civil Affairs says about 400,000 groups are registered and many more are not. A report published by the Chinese Academy of Social Sciences has estimated the total number could be 3 million. Full Article

2)      The critical tone of the article seems to imply that other countries need the aid more than China since the Chinese government should be able to take care of social issues on their own. However in my work with NGOs in the country, it seems to me that this may be exactly the type of situation many NGOs hope for.  During a recent meeting with the Pangaea Global AIDS Foundation which operates in Rwanda, South Africa, and China, I gathered that China programs have been dramatically more successful, largely because of the government’s involvement. While China faces wide ranging social problems from the spread of HIV/AIDS to natural disasters and poor rural education, NGOs are able to partner with a government whose technical expertise and financial war chest offer a significant advantage in addressing these issues. With a stable and supportive partner, NGOs in China are able to quickly establish programs offering strong services and training, setting in place the foundation  for what eventually becomes a self-sustaining system. As an example, with the help of NGOs, the Yunnan Province Bureau of Health, has successfully established over 20 clinics, trained hundreds of professionals and served thousands of patients in the last 5 years through a rapid scale up of a soon-to-be a self sustaining HIV/AIDS healthcare system. Many other developing nations cited in the article, while certainly not short of need, lack political stability, and therefore the infrastructure to eventually take on a self-sustaining entity. NGOs and donors have to commit significantly more money to these countries over long periods of time than to a country such as China.

To summarize, I believe the article takes too negative of a tone in suggesting that donations to China detract from donations to other countries. In the global fight against a scourge such as HIV/AIDS, it makes sense that the money goes where it is needed and where it can be put to good use. As long as donations go to building up a previously non-effective health system that saves lives, why should it matter the degree to which a country is categorized as “developing”?


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The first suspected HIV/AIDS cases in China can be traced back to Yunnan Province in the 1980s.  Located in south central China, Yunnan is the province with the greatest number of suspected HIV/AIDS patients in the country. The disease has spread predominately through intravenous drug use, encouraged by its proximity to the “Golden Triangle” – the border region between Vietnam, Laos and Myanmar that accounts for much of the world’s heroin production. In addition, as with other regions in China, low awareness of healthcare issues among the rural population and the limited use of contraceptives even among commercial sex workers, has created a ripe environment for the spread of the disease.

Yunnan Ministers, in their effort to combat HIV/AIDS, have actually welcomed international nonprofit groups and have received support from Australia, the United States and various European Nations. In 2005, former President Clinton visited Yunnan healthcare facilities (documented by Dan Rather on 60 Minutes) where he made headlines by publicly embracing HIV/AIDS patients. Following this visit, China’s attitude toward HIV/AIDS improved, as both premier Wen Jiabao and president Hu Jingtao have made concerted public efforts to discourage social stigma against patients with HIV/AIDS.

The Clinton Foundation’s efforts in Yunnan over the last 5 years have helped to establish healthcare and educational settings that address HIV/AIDS. This includes formal clinical training and support centers, lab testing centers,  education centers and the development of medication procurement strategies.  While the Clinton Foundation is currently winding down its programs in Yunnan, foreign donors will continue to provide critical resources for this hot zone going forward.

From a technical and strategic support perspective, the Clinton Foundation’s 2011 focus will shift to Xingjiang, a remote province in western China who’s capacity to address this epidemic continues to be terribly limited.

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To try and summarize the work that I’m doing in China, I will write a few brief entries that highlight the public health issues Clinton Foundation hopes to address:

The Clinton Foundation was established in China in 2004. Since then, their efforts have primarily been directed at improving access to education and treatment for HIV/AIDS and to a lesser degree, Tuberculosis patients and families. Like many developing nations with fragmented and less sophisticated healthcare systems, China has recognized HIV / AIDS as an increasingly troublesome issue , especially in several high prevalence regions that have been afflicted with epidemics. The Clinton Foundation attempts to provide technical, financial and clinical support to both national and regional officials and healthcare providers. My specific tasks will include drafting proposals for programs, developing financial control models for the foundation operations, and helping to craft an annual review of all foundation programs in the country.

Current foundation programs are focused on three areas of China: Yunnan Province (and other Southern Provinces), Xinjiang Province, and Henan Province. These regions represent around 80% of the nation’s total estimated ~800K people living with HIV. While this translates to a relatively low national incidence rate for the disease, according to the CDC, the overall number of patients actually places China as the 14th most heavily burdened country in the world. And given the country’s total population, a continued upswing of the epidemic is of great concern for the government. In addition, incidence rates in these relatively less populated, rural provinces are still considered high by any country’s standards.

China’s greatest struggle right now continues to be educating key at-risk populations and overcoming a cultural reluctance to discuss such socially taboo topics. While many major cities in China have strong social programs in place to address infectious diseases (significantly improved after the SARs outbreaks of the early 2000s), rural provinces continue to lag behind the rest of China in their offering of healthcare education and clinical access programs.  According to Bernhard Schwartländer, coordinator of UNAIDS in China,

“China is a whole continent. It’s 1.3 billion people. The big question is always, ‘How do we make sure these good, sensible policies and ideas are really implemented throughout the whole country?'” It is not enough to have good policies in Beijing; the work has to happen in the provinces and the communities where 60% of the nation actually lives. Unless you understand how you can translate the policies into the realities of where the people are living, you will not succeed.  There’s an opportunity here to make sure 50 million people don’t become infected.” Full Article

In later posts, I will discuss regional causes for the spread of HIV in Yunnan, Xinjiang, and Hunan, and the differences and similarities across each region.

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My Office

Clinton FoundationGlobal Fund, UNAIDS Originally uploaded by sxz321

My Office is located on the 8th floor of a diplomatic compound which also hosts the offices of New Zealand, Bahamas, and Togo. Larger nations tend to have their own separate embassy compounds, and at least 15 are located within a 3 block radius of my building. The neighborhood feels somewhat like a UN convention with all sorts of countries and languages represented from across the world.

The Clinton Foundation office shares a floor with the Global Fund and UNAIDs – the sporting equivalent of Lebron James, Dwayne Wade and Chris Bosh teaming up in Miami, except to fight HIV/AIDS and TB. We have a relatively western office set up (i.e. glass walls, panoramic views of the city, European furniture, etc). There are only 4 people in my office on a regular basis including myself and my country director. Other members of the CHAI team are scattered across the country and across Asia.  Also, it turns out that while English is the business language in the office, pretty much everyone prefers to speak Mandarin. My Mandarin is about as proficient as a 4 year old’s so this environment should provide me an excellent opportunity for me to improve my use of the language.

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