Corporate America Partnering with Africa: Strengthening Local Capacity and Improving Health Care on
Remarks by Pat Christen, President, IDI, Ltd. (IDIL); President, HopeLab
Africa America Institute, “Africa Thursday," March 17, 2005
Madame President, Honorable Ambassadors, Representatives and friends and colleagues of the Africa America Institute.
Thank you for inviting me here today to help describe the creation of the Infectious Diseases Institute. I’m eager to discuss with you how the United States and the global community can effectively build sustainable infrastructure for providing care and treatment for people with HIV/AIDS in sub-Saharan Africa.
I am President of Infectious Diseases Institute, Ltd. or IDIL. The IDIL is the non-governmental organization responsible for supporting the clinical, training, laboratory and research programs of the Infectious Diseases Institute. In 2001, I was the Executive Director of the San Francisco AIDS Foundation and President of its international affiliate, Pangaea Global AIDS Foundation, when Pfizer approached us to manage and administer an $11 million construction and program grant for the creation of the IDI.
As Robert Mallett has discussed, the Infectious Diseases Institute was the vision of a group of Ugandan and North American physicians called the Academic Alliance for AIDS Care and Prevention in Africa. Dr. Nelson Sewankambo and his colleagues at Makerere University, some of the most respected infectious diseases researchers in the world, had a vision of an institution that would be both a training center for doctors, nurses and other health care professionals in the treatment of HIV/AIDS and a model for the treatment and prevention of AIDS in resource-constrained settings. It was our job Pangaea to support Dr. Sewankambo and his colleagues in the realization of their vision and to ensure that the financial resources provided by Pfizer were utilized in a manner wholly consistent with the program vision and managed in accordance with solid accounting practices to ensure the highest level of program effectiveness and fiscal accountability.
In addition to providing oversight of the “bricks and mortar” construction of the IDI facility, my colleagues at Pangaea in both Kampala and San Francisco worked closely with Dr. Sewankambo and his colleagues to build necessary financial, legal, administrative, managerial, and governance structures for the IDI. We are all justifiably pleased with the fact that this state-of-the-art 25,000 square foot facility, the first new construction of its kind on the Makerere campus in 35 years, was completed on time and on budget – a remarkable achievement on any continent. Now that the facility is complete, we continue to work closely with Dr. Sewankambo and University officials to finalize sustainable and innovative governance, management, and administrative systems for the IDI. We expect that this process will be complete and that the facility and operations – essentially all assets of the IDI -- will be turned over to the College of Health Sciences at Makerere University by July of this year.
I’d like to tell you a little more about the steps that have been taken over the course of this remarkable project to ensure that it will thrive and grow as a local, Ugandan-controlled institution. From the beginning, the IDI has been seen first and foremost as a Ugandan entity and fiscal, administrative support and program implementation has been geared to nurturing sustainable local capacity. The building was designed by a local architect who took into account local conditions and materials. Local Ugandan staff have been recruited and trained to fill the institute’s medical and administrative positions. The clinical training program models have been designed for achieving high standards of care appropriate for sub-Saharan Africa, rather than simply superimposing U.S. models. From the beginning, it has been a given that the faculty and clinical staff at Makerere will be operating the IDI and so they are the ones who have set the standards, overseen the training of doctors, nurses and staff, and ensured that the highest possible standard of care is followed.
The same focus on local control can be seen during the administrative transition process, including the governance and the management of IDIL itself. The assets of the IDIL will be transferred in their entirety to the University via a share transfer mechanism. This will allow Dr. Sewankambo and his University colleagues the ability to operate the IDI in a manner consistent with University policies and procedures, but with greatly enhanced governance and management flexibility. Use of the NGO IDIL model at the University will allow for both high accountability and flexibility. I believe it is to the University’s great credit that they are pursuing this affiliated NGO option within the University setting and hope to use it as a model of operations for future innovative endeavors affiliated with the University.
So what are the lessons that we can take away from this project?
First, I think it is clear that for a healthcare infrastructure and training project to be successful and to have lasting value for the people for which it is intended, it is essential that it be closely tied to the visions and aspirations of the people of the region. Dr. Sewankambo and his colleagues live daily with the dire shortage of trained healthcare personnel in Uganda and envisioned a regional training center where best practices in the provision of care and treatment of HIV/AIDS and other infectious diseases could be disseminated to a growing group of local doctors and nurses.
Second, Pfizer’s willingness to provide adequate and flexible private sector funding throughout this project has been essential. Leveraged use of these private resources not only allowed for the construction of the IDI itself but also allowed for the creation of world-class training, research, lab and clinic capability supported by solid fiscal and management systems. High quality programs cannot exist and will not be sustained in the absence of good management and fiscal mechanisms to support them. I believe this is at the center of concerns related to absorptive capacity. We know this well. Yet too often, public and private sector funders are reluctant to support these necessary project management and administrative costs. Too often, these costs are viewed – inaccurately and naively – as superfluous “overhead”. Nothing could be further from the truth. It is absolutely essential that we be willing to pay for project management and solid administrative systems – just as we’re willing to pay for drugs and physicians. All are necessary components to a successful, sustainable effort.
Pfizer’s recognition of the need for this up-front management, administrative and fiscal support and sustained human and financial resources in service of this effort is extremely rare among funders and is to be applauded. It should also be noted that this leveraged use of private resources is now paving the way for a much larger infusion of dollars from PEPFAR and Global Fund to pay for drugs and treatment. Here in the IDI we have built absorptive capacity that can make effective use of these public dollars. Because the groundwork has been laid with flexible private sector involvement, funding streams like PEPFAR can be utilized to produce an immediate return on investment, which in this case translates directly into increased numbers of people on ARVs and related AIDS care.
Finally, project management skills are critically important to ensure that dreams and vision get turned into meaningful program reality on the ground. Skillful project management does not grab headlines. But it does mean patients have up-to-date files, pharmacies have supplies, water runs, rooms are clean, money is accounted for, tests are administered, computers function - no detail large or small is overlooked to provide top quality programs in a reliable manner.
So what does this one project matter in the grand scheme of things? Despite the increased numbers of people with HIV/AIDS receiving needed ARVs, the challenge of taking the next giant step and getting millions of people on treatment globally is a daunting prospect. And we can’t fool ourselves into thinking there are shortcuts or easy fixes. Creating unrealistic expectations helps no one. We need to replicate more symbiotic partnerships like the IDI on the local, regional, and national levels to provide the locally controlled, robust infrastructure that will sustain treatment and care efforts over the long term.
According to UNAIDS, over 3 million people died of AIDS in 2004 and another 3 million died of malaria and tuberculosis. President Bush has asked Congress to authorize a total of $3.2 billion for the global war against HIV/AIDS in 2005, including $2.9 billion for PEPFAR and $300 million for the Global Fund. Senators Santorum and Durbin are introducing a bipartisan amendment this week to raise the United States’ contribution to the Global Fund for Treatment of AIDS, Tuberculosis and Malaria to $800 million, which would bring total AIDS expenditures, if appropriated by Congress, to $3.7 billion. Funding our international AIDS programs to this level is the very least that we should do to meet the challenge posed by the AIDS pandemic.
By comparison, our country’s commitment to the war in Iraq will total approximately $200 billion by the end of 2005. Our total funding in the global war against HIV/AIDS over the last 3 years in less than 5% of what we will have spent just on the war in Iraq. We can’t forget that like the war on terrorism, the war on HIV/AIDS must be fought over the long term. The rationale cited for U.S. engagement in both involve a belief in an ethical imperative, a desire to avoid societal destabilization and millions of unnecessary deaths, protection of national security interests, and an assessment that the U.S. is uniquely situated to take a leadership role. Given the long-term consequences of the AIDS pandemic, it is important that we are mindful of both of these threats to global stability and make resource allocations accordingly.
As former Secretary of State Colin Powell remarked: “There in no war causing more death and destruction, there is no war on the face of the earth right now that is more serious, that is more grave, than the war we see here in sub-Saharan Africa against HIV/AIDS.”
Thank you for the privilege of speaking with you today. I look forward to your questions.