The WHO’s 3 by 5 Effort a Mess

I ran across this gem in the Kaiser Daily HIV report. Roger Bateman, of the American Enterprise Institute, and Lorraine Mooney, a demographer, have issued a devastating critique of the WHO’s 3 by 5 program, largely based on an evaluation report the WHO contracted to have done. The upshot of the report is that the plan to have 3 million people on ARV therapy by 2005 was a badly planned, politically inspired effort by the WHO to get in on the issue while donors were gearing up their support to address HIV/AIDS. Quoting the WHO evaluation report, Bate and Mooney write that:

Clearly, 3 by 5 was more of a “political declaration and an act of faith than a systematic programme of work” (60) and as such, it was “ambitious, weakly conceived … with insufficient structure against which results could be measured.” This made performance monitoring and resource planning difficult (60) but 3 by 5 also incorporated significant risks which would be borne by those it purported to help.

This is likely to be a very important set of reports that will get more play. Fortunately, it appears that neither PEPFAR nor the Global Fund were really interested in supporting the WHO on this effort and wisely stayed away. It is sort of sad, given that the WHO has 8,000 staff who are supposed to be the experts on health. Yet, given what happened with the WHO’s AIDS efforts in the 1990s and the way its program was systematically gutted (all documented in Greg Behrman’s book), it’s not surprising that it botched the effort when it tried to get back in the game in the past few years. The WHO comes out smelling really bad out of all this, but Bate and Mooney also in their conclusions go after the UN since the WHO is a specialized agency of the UN. I wonder if they just have an axe to grind with the UN.

I think this thread of the story should be something to watch. Margaret Chan, the new head of the WHO, is likely to have her hands full, and this may be the tip of the iceberg for the glow to come off of AIDS initiatives in the coming years. Now, we’re in the business of success and failure where the stakes are high. Bate and Mooney talk about the issue of drug resistance, and this could be a very serious problem if the 3 by 5 is ultimately implicated in less than stellar ARV treatment programs.

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