LONDON, March 10 /PRNewswire/ -- Tanzania, 2007. A male patient is admitted to a hospital with pneumonia and possibly HIV. Due to staffing problems and improper handling, the patient is not seen for a week. Upon finally being seen, he is found to be HIV negative. Because he does not have HIV he has to pay for all expenses, totaling more than his monthly earnings. If he were HIV positive, the entire stay, all medication, and all tests would be free.

This experience demonstrates the growing crisis in health and healthcare in developing countries. Basic health services are seriously underfunded and doctors are abandoning their home countries. While donor money pours in, it usually focuses on single diseases like AIDS, while the death rate remains higher for common conditions like malnutrition, diarrhea and respiratory tract infections.

This story, which appeared in the British Medical Journal, March 2008, highlights one of the most important challenges for developing countries: the allocation of donor money in healthcare. The campaign "15by2015" asks donor organisations to allocate a part of their disease-specific funding towards sustainable comprehensive primary healthcare delivered by multidisciplinary teams, accessible and affordable for all.

Quality healthcare for all

The eight millennium development goals,, form a blueprint agreed upon by all the countries worldwide and the leading development organisations to make unprecedented efforts to meet the needs of the world's poorest, by the target date of 2015. Improvement of health and healthcare are leading priorities.

With the campaign "15by2015" we want to make all influencing stakeholders aware of an adequate strategy to improve healthcare. Quality healthcare, accessible and affordable, is a right for all; but how to attain it is not always that clear.

The present situation of healthcare aid

The good news is that financial support to improve healthcare in developing countries increased by about 26% between 1997 and 2002 (from US$6.4 billion to US$8.1 billion). However, the vast majority of this aid is allocated to disease-specific projects ("vertical programmes") rather than to broad-based investments ("horizontal programmes") as primary healthcare services. In some countries for example, the money spent by donor organizations for treating one disease (HIV/AIDS) is higher than the total budget of the ministry of health.

Salaries of healthcare providers working for donor-funded vertical programs are often 2-4 times that of equally trained government workers in primary healthcare. This induces an internal brain-drain where local healthcare workers move from their work in health centres and hospitals to the better paid projects of donor organization.

Why "15by2015"?

To improve the health status of individuals worldwide, a different strategy of money-spending in health care systems must be adopted. Barbara Starfield, distinguished professor at the Johns Hopkins University, Baltimore USA, states: "Solving global health problems needs global solutions in the form of coordinated and population-oriented services: primary healthcare for all and not fragmented disease-oriented approaches."

Today, the World Organization of Family Doctors (Wonca,, in collaboration with Global Health through Education Training and Service (GHETS,, with the Network Towards Unity for Health (, the European Forum for Primary Care (EFPC,, Health Alliance International (HAI, and Doctors for Global Health (DGH, initiated the campaign "15by2015" to strengthen primary healthcare worldwide. They ask all donor organizations to allocate 15% of their vertical budgets towards the development of horizontal primary healthcare systems, which cut across diseases in a systematic way.

We can do it!

There are indications that disease-oriented organizations want to go this direction: the Global Fund to fight AIDS, Tuberculosis and Malaria ( has called for investment to strengthen health systems and to address social determinants of health by supporting poverty reduction strategies. Dr. David Egilman of Brown University states, "We are not calling for less money for HIV. We are asking for more effective spending and more resources for all health problems."

Community-oriented primary healthcare is also a cost-effective way to strengthen the quality of both preventing and treating all illnesses and empowering individuals and communities. One source reported that in 42 countries accounting for about 90% of child deaths worldwide, 63% of these deaths could have been prevented if good primary healthcare had been available. Primary health care teams, based in the community, consisting of family physicians, mid-level health care workers, nurses, nutritionists, social workers, health promoters, can really make a difference.

Visit for more information and to sign a petition in support of the "15by2015" campaign. Also, see our editorial in the 8th of March 2008 edition of the British Medical Journal at

Examples of the distortion of healthcare due to vertical programs

A 50-year-old male patient was admitted to a hospital in Tanzania which has a donor-supported VCT (Voluntary Counseling and Testing for HIV) and CTC (Care and Treatment Clinic) that receives a lot of external funding (PEPFAR: President's Emergency Plan for AIDS Relief). At the time of admittance, the HIV status of the patient was unknown. Because of the symptoms it was presumed that he was HIV positive and he was admitted to the hospital where all HIV positive patients are registered and followed up for care and treatment. Due to a lack of doctors the patient was not seen for a whole week. When he was finally seen by a doctor the patient had improved and his HIV test turned out to be negative. Because he was HIV negative the patient had to pay for everything, all the tests, medication and a week's stay in the hospital. The cost of a week's stay in the hospital, without seeing a doctor, was more than this farmer makes in a month. These services are free to HIV-positive patients while HIV-negative patients must pay to receive the same treatment.

In the same region HIV-positive patients can get free food from the World Food Program (WFP), while other people, like malnourished children or elderly, when HIV-negative don't get any support.

A health worker went to a family in Uganda for a home visit. On the table in the main room of the 2-room house a pot full of pills was seen. The mother was asked what this medication was for. The mother stated it was medication they received from several different programs that were running in the region. The father was in an AIDS program, the mother in a TB program and 2 of the young children were in a malaria program. All the programs had their own rules and regulations that were very unclear to the family. Therefore they had put all medicine in the big pot and instead of everyone taking the pills according to the program they were in, they would take pills from the pot at random when one of them felt ill. In his pot at least US$300 worth of medicines were being spoiled..

If a comprehensive primary healthcare team was present, the family could have received the needed guidance to cope with the different treatments. Well-financed, vertical programs, funded by international donors, need skilled local health personnel and "divert" them away from the poor but needy local (primary) health care system. In Ethiopia, for example, to implement the Global Fund proposal, local medical staff was hired on consultancy contracts at triple the salary available in the public sector.

As a result, most of the medical doctors and other skilled health personnel moved from the governmental primary health care in the rural areas to the big Global Fund. Therefore the health sector became vertically organized, with staff moving from one section to the next, jeopardizing access to overall health services and raising deep concerns regarding equity. This type of internal "brain drain" has devastating consequences, undermining critical primary health care services.

Further information: The Americas Julia Dettinger Development and Program Director, GHETS United States of America Phone: +1-508-226-5091 ext 15 Fax: +1-508-448-8346 Europe Prof. Jan De Maeseneer CEO The Network/ TUFH Belgium Phone: +32-9-332-3542 Mobile: +32-478-544-188 Fax: +32-9-332-4967 Africa Prof. Khaya Mfenyana Walter Sisulu University South Africa Phone: +27-47-50-2728 Mobile: +27-8332-44259 Fax: +27-47-5022235 Asia Prof. Alfred Loh CEO Wonca Singapore Phone: +65-6311-2529 (9.30am - 12.30pm) +65-6224-2886 (2.30pm - 5.30pm) Mobile: +65-9633-8151 Fax: +65-6324-2029 Australia Dr. Ian Cameron CEO NSW Rural Doctors Network Phone: +61-2-49248000 Mobile: +61-2-49248010 Fax: +61-419-252460 Rest of the World Dr. Maaike Flinkenflogel Ghent University Belgium Phone: +32-9-332-6082 Fax: +32-9-332-4967

Further information: The Americas: Julia Dettinger, Development and Program Director, GHETS, United States of America,, Phone: +1-508-226-5091 ext 15, Fax: +1-508-448-8346; Europe: Prof. Jan De Maeseneer, CEO The Network/ TUFH, Belgium,, Phone: +32-9-332-3542, Mobile: +32-478-544-188, Fax: +32-9-332-4967; Africa: Prof. Khaya Mfenyana, Walter Sisulu University, South Africa,, Phone: +27-47-50-2728, Mobile: +27-8332-44259, Fax: +27-47-5022235; Asia: Prof. Alfred Loh, CEO Wonca, Singapore,, Phone: +65-6311-2529 (9.30am - 12.30pm) +65-6224-2886 (2.30pm - 5.30pm), Mobile: +65-9633-8151, Fax: +65-6324-2029; Australia: Dr. Ian Cameron, CEO NSW Rural Doctors Network,, Phone: +61-2-49248000, Mobile: +61-2-49248010, Fax: +61-419-252460; Rest of the World: Dr. Maaike Flinkenflogel, Ghent University, Belgium,, Phone: +32-9-332-6082, Fax: +32-9-332-4967