Addis Ababa, 23 September 2005 - Experts at ECA have warned that health systems and financing could be at risk unless a different approach is taken to tackling the "big three" killers - HIV/AIDS, tuberculosis and malaria.

AIDS has become the leading cause of premature death in sub-Saharan Africa, while malaria claims the lives of a million people annually, 75% of whom are young children. Tuberculosis, once defeated, is resurging in a more virulent form. Besides the incalculable human suffering, the epidemics have reversed decades of development progress and slowed economic growth by 1.3 percent.

The Millennium Declaration has recognized the devastating impact of these diseases on development, characterizing them squarely as a development crisis, rather than just a health problem.

There is no doubt that HIV/AIDS, tuberculosis and malaria are difficult to control because of drug resistance, weak health systems, conflict and post conflict settings, and the biological capacity for change of these diseases which requires constant revision of control strategies.

But there have been quiet successes. Integrated malaria control was successful in the Zambian copperbelt and impregnated bed nets at district level trials in Tanzania have substantially reduced child mortality and reduced anaemia in pregnant women and children.

This demonstrates that, with the right policies, considerable headway can be made in alleviating the catastrophic effects of disease. Long term successes with other devastating epidemics have been achieved over the past three decades in Africa. A group of debilitating, disabling diseases has been controlled, eliminated or eradicated such as guinea worm, onchoceriasis (river blindness), leprosy, and to some extent poliomyelitis.

In countries such as Liberia, Sierra Leone and parts of the Democratic Republic of Congo, post conflict health systems have rapidly embraced onchoceriasis control. In Sudan, ceasefires were organized to eradicate guinea worm and immunize against polio.

In addition to improving the general wellbeing of the population, it is estimated that guinea worm eradication has produced is calculated to produce an economic return of 29%. And according to the World Bank, onchoceriasis control in West Africa has been the most effective investment in any development sector.

Since 1974, the total cost of controlling these diseases in sub-Saharan Africa has been estimated at US $3-4 billion, excluding the value of drug donations. Yet, the Global Fund for HIV/AIDS, tuberculosis and malaria - set up in 2001 - has already received pledges of around $3 billion, but by the end of 2004, only $700 million had been disbursed.

It seems that policymakers sometimes ignore the scientific and operational evidence of successful interventions against the "other diseases". With rates of immunizable diseases still high, water-related illnesses on the rise and poor housing conditions, ill health will remain prevalent across Africa. Targeting mainly HIV/AIDS, TB, and malaria will not lead to the best overall improvement in health.

There is a danger that the emphasis being placed on these three diseases may overshadow other fundamental health needs. This doesn't mean that these deadly diseases are not formidable threats to Africa, but sufficient attention must also be given to the "basics" that prop up an efficient and effective public health policy.

So it is not just funding that is required to combat HIV/AIDS, tuberculosis and malaria. Tackling these epidemics also requires a proactive, pro-poor approach aimed at reducing transmission. This is a public health development prerequisite that has successfully controlled diseases in the past.