We Have Changed

An editorial in the August 7th New England Journal of Medicine talks about "push" and "pull" factors in improving health care in the developing world. The editorial (The President's Emergency Plan for AIDS Relief- Is the Emergency Over?) is a look at the past and future of PEPFAR (the President's Emergency Plan for AIDS Relief), which has provided much of the funding for HIV/AIDS care in sub-Saharan Africa. Despite my misgivings about every other aspect of the Bush administration, and despite some limitations of the original program in terms of prevention, it has been a remarkable success, saving thousands of lives. Fortunately, Congress has reauthorized the program this July. The work of CIDRZ portrayed in our documentary film could not have happened without this funding. CIDRZ has been able to translate this money into an effective network of health providers for HIV care. The question now is whether such a network can be broadened to other areas of health care. As the editorial notes:
"In a sense, then, the key choice for PEPFAR at this crossroads is between a "pull" strategy and a "push" strategy: Will a continued singular focus on HIV "pull" other components of national health care systems forward, so that they become more responsive to other health threats and can catalyze the necessary changes in social norms and policy? Or will a "push" strategy that is focused primarily on strengthening health care systems and tackling fundamental issues that define societal vulnerabilities to disease be more effective in achieving both HIV-specific and broader health and social goals?"