While the article highlights some of the disturbing problems that have faced the region for decades, it draws distorted and inaccurate conclusions about the progress being made today in improving the health of hundreds of millions of Africans.

The article draws well-deserved attention to the tremendous challenge developing nations are facing as they increase spending on health after decades of neglect and underinvestment. In less than a decade, the world has seen an unprecedented level of resources invested in health in the developing world.

Yet, despite these increases both in domestic health spending by developing countries themselves and in international development assistance for health, the resources now at work are still nowhere near the levels necessary to provide adequate health services for all who need it in developing countries.

When there is not enough money to do everything, tasks must be prioritized. During the Millennium debates in 2000, the world — rich and poor countries alike — agreed to focus their attention on areas that together constitute the overwhelming part of the great burden of diseases weighing on developing countries, hampering economic and social development and perpetuating poverty.

Those areas are child health (including immunization), maternal health, and AIDS, TB and malaria. In most poor countries — in Africa in particular — these health problems and pandemics constitute as much as 80 percent of illness and deaths.

The Global Fund was created as a consequence of these global priorities. They also guided the strategies of the newly established Bill and Melinda Gates Foundation and international investments through the GAVI Alliance, which provides support for vaccination programs in least-developed countries.

The increased investment in these diseases and services has highlighted both the areas that remain underfinanced and the strain and imbalances such disease-focused financing is putting on the countries’ under-developed health systems. The most glaring area of neglect is in the field of maternal health, and a concerted international campaign Is underway to increase funding and tear down obstacles to help women during pregnancy, childbirth and early motherhood.

We are now entering the “second phase” of this endeavor to improve health in developing countries, where a greater focus is sustainable, long-term solutions. A number of international initiatives are working to better harmonize development assistance of organizations focusing on disease-specific programs with others who are focusing on strengthening the underlying health systems needed to deliver sustainable health services to all.

In addition, organizations like GAVI and the Global Fund are adapting and developing their funding policies to enable the most flexible possible use of grant funding so countries can better plan how they best strengthen their health systems.

While the new resources for health have exposed weaknesses, the LA Times article’s underlying argument that focusing on specific diseases was a mistake and that the resources by the Gates Foundation, the Global Fund and GAVI have made no significant progress — and in some cases made things worse — is fundamentally wrong and misleading.

The LA Times is wrong when it claims that “key measures of societal health have stalled at appalling levels or worsened” in African countries receiving assistance through either the Gates Foundation directly, the Global Fund or GAVI. The progress we have achieved goes far beyond “pockets of success” as stated in the article.

The statement that “maternal and child mortality and life expectancy show no statistical relationship -- for better or worse -- to Global Fund grants or to overall Gates Foundation spending in Africa” is meaningless, given the substantial delay in the collection of reliable health statistics in these countries. That statement certainly runs contrary to a growing body of evidence.

Since its creation in 2002, the Global Fund has grown to provide nearly a quarter of all international resources to fight AIDS and more than two-thirds of international resources to fight TB and malaria. Five years after the first three Global Fund grants were signed, we can only now begin to measure the impact on the ground. What we see is tremendously positive.

Malaria investments are a case in point. The latest reliable statistics on child mortality in African countries are at least two years old. Yet recent surveys show that child mortality can fall as much as 70% in one year once villages reach a 60% or higher coverage of bed nets combined with use of effective malaria drugs, in areas where malaria is by far the largest killer of children.

Yet, it is only in 2006 and 2007 that we have seen a tremendous roll-out of bed nets in Africa, 46 million of which were paid for by the Global Fund alone. In large parts of East, Southern and West Africa, bed net coverage has increased from less than 10% to more than 60% in just the past 18 months. The positive effect on child mortality will be substantial, but it is still too early to measure it.

Programs supported by the Global Fund have provided ARV treatment for 1.4 million people so far and effective DOTS TB treatment for 3.3 million people. The Global Fund estimates that more than 2 million people who otherwise would have been dead are alive today thanks to AIDS, TB and malaria programs it supports. This number grows by 100,000 people every month. These people free up hospital beds and consultation time, they take care of children who otherwise would have become orphans, and they earn a living for themselves and their families.

The positive health, social and economic effect of these gains is obvious, and there is no evidence that these gains have come at the expense of an increase in mortality from other diseases.

Over the coming years, we will increasingly be able to measure the impact the disease-focused programs are making on the overall disease-burden of developing countries. Once such reliable, independent data becomes available, we can begin to adjust our funding streams to better assist countries in developing strategies that improve health outcomes across the board.

The LA Times makes another erroneous assumption: that somehow, the Gates Foundation, the Global Fund, GAVI and a few other international institutions determine how countries in Africa should spend their money.

However, both GAVI and the Global Fund are based on the principle that countries make their own decisions on how they should spend their resources. The Global Fund sets no conditions for how its grants should be spent apart from demanding that measurable targets are set for prevention activities, treatment, care and training.

The purpose of Global Fund resources is to provide countries with a way to fill gaps in their own health budgets. The Global Fund’s grants come in addition to domestic investments in health, and these grants enable countries to free up their domestic health spending and other international assistance to cover other areas. The Global Fund is moving towards financing whole national plans to prevent countries from having to split their health spending up into individual programs.

Imbalances will occur when making so much money available for certain health areas, especially during the first few years when such funding becomes available, and the LA Times is right in pointing this out. However, increasingly, technical and development assistance partners in African countries are working to help them prioritize based on health needs — not based on what money is available.

The LA Times article points to two other challenging problems in scaling up health services: the imbalance of staff salaries and hunger among patients. Both these problems are intractable because their causes and solutions go far beyond the field of health and are ultimately linked to overall economic development.

One point needs to be made for each of these issues, however: supporting the salaries of some health staff may be preferable to supporting no health staff and may have assisted in retaining some health personnel who otherwise may have left the country. In countries with HIV infection rates of 10 — 40%, such as Lesotho, Malawi and Swaziland, where AIDS by far dominates the health sector response, paying such salary increases may be the only way to retain a minimum of staff.

In every case, the salary supports come as a consequence of decisions made by the country — not by the Global Fund. The Global Fund makes no recommendations in this or any other technical matter relating to the structuring of the programs we support.

Contrary to the impression created in the LA Times article, nutritional assistance is needed only in a minority of cases; it is not a dominant factor in the roll-out of ARV therapy throughout Africa.

Again, where countries deem it necessary, the Global Fund’s grants are used for limited nutritional support. Countries themselves, however, struggle with where to set the limit for how far health budgets can compensate for the general conditions of poverty.

The substantial new investments in AIDS, TB, malaria and immunization over the past decade have led to a turn-around in the view of health in the developing world. Already, there is hope (supported by evidence) that these diseases can be controlled in the course of the coming decade. In doing so, developing countries will be relieved of a tremendous economic and social burden and can use the improvements to focus on other health problems.

In the mean time, we must do our utmost to ensure that investments in specific diseases also help strengthen the overall health services, and we must intensify investments in neglected areas, such as maternal, primary and preventative health. The Global Fund is constantly working to improve its policies and practices to assist countries’ needs. The debate about health systems strengthening, as it is reported in the LA Times, is welcome and plays a useful role in this effort.