Akudo Ikemba

Africa, Heal Thyself

Attempts to solve Africa’s health crises have generally looked like this: The wealthy nations allocate part of their international development budgets. The pharmaceutical companies donate drugs. The white men in doctor’s coats fly in to dispense pills and advice.

Enter the Global Fund to Fight AIDS, Tuberculosis, and Malaria, which, in the five years since its creation, has committed $7 billion to a massive effort to wipe out three of the continent’s deadliest diseases. Its policy is to put control in local hands, fast-tracking money to community organizations in the places most affected, and trusting them to put it to good use. About 60 percent of its grants go to Africa.

It’s a radical idea, says Akudo Anyanwu Ikemba, M02, who last year launched Friends of the Global Fund Africa, an organization that raises awareness and contributions for the fund from within Africa. “The concept of the West coming in to save Africa is age-old,” she says in a phone interview from her office in Lagos, Nigeria. “Africans helping themselves is not a concept that’s been tried or embraced or energized. To have real ownership and real sustainability, the effort has to be Africa-based.”

Yes, Africa does have money to give, from both indigenous and international corporations, foundations, and religious groups. Ikemba’s fundraising goal for this year is $20 million, and half of it has already been committed. It is as if Africans were just waiting to be asked to help out, Ikemba says. “People are saying, ‘Where have you been?’ ”

Her pitch to African corporations is that they have an interest in keeping their workers healthy. When she finishes her request for donations, she asks top executives for their business acumen. “They bring a strong skill set to the fight,” she says. “They bring in efficiency, they bring in strong reach.” A soft-drink distributor, for example, can use its infrastructure to deliver medicine all over a region.

Ikemba assembled a board of directors that includes leaders from Nigeria, Benin, Botswana, Burundi, Ghana, Kenya, Rwanda, Senegal, and South Africa. Just bringing so many different countries to the table is a victory. “Africans in the past didn’t really see themselves as Africans— they saw themselves as nationals,” Ikemba says. “There weren’t any links across the continent.”

Critics have faulted the Global Fund for a lack of accountability that makes it an easy target for corrupt governments, especially in Africa. Last year, tens of millions of dollars went missing from grants to Uganda, and were later revealed as looted by public officials. Ikemba is all too aware of the setbacks. She spent three and a half years with the Center for Global Health and Economic Development at Columbia University, in charge of programs in Nigeria, where she helped grassroots organizations apply to the Global Fund for grants, securing about $480 million for HIV, TB, and malaria interventions in Nigeria. One goal was to put 14,000 people on AIDS antiretroviral drugs. But a year later, no one had received treatment. Without results, the Global Fund yanked back $81 million from Nigeria.

“It was very sad, because we actually saw it coming,” Ikemba says. She doesn’t blame graft. The inexperienced grant recipients had inadequate support for managing the funds, procuring large amounts of drugs, or monitoring their progress. “Strong lessons have been learned, and I don’t think that could happen in Nigeria again.” In the long run, she believes the Global Fund’s combination of support for countries’ priorities and performance-based funding will be a winning strategy.

Ikemba has seen the African plight from both sides—as insider and outsider. She was born in Philadelphia while her Nigerian parents were studying at the University of Pennsylvania and Temple University. She grew up in Nigeria, but returned to the United States to attend Lehigh University and later Tufts University School of Medicine and the Harvard School of Public Health. She also worked for the Centers for Disease Control in Atlanta and was an associate scientist with Life Technologies, in Palo Alto, California. It would have been easier to stay in the United States, working as a physician or scientist. But with her medical degree in hand, she went back to Nigeria and set up a makeshift clinic, seeing patients in her parents’ house. The village’s other health-care provider was the local druggist, who had not finished high school.

Sub-Saharan Africa faces a shortage of 1.5 million health-care workers. Those who are there are up against three epidemics that overlap in particularly deadly ways. HIV/AIDS has led to an increase in tuberculosis, as the immunocompromised are less able to fight it, and more strains of TB have become resistant to medication.

HIV/AIDS has also compounded the problem of malaria, which is especially devastating to pregnant women and young children. “Both are diseases of poverty, and both are causes of poverty,” Ikemba says. “I just realized that to really be effective, I had to get to the policy level, the resource level, and have some impact.”

She joined the Move Back Club, a group that fights brain drain from Africa to wealthier nations. There she met her husband, Ugo Ikemba, a Nigerian who had grown up in London, but who returned to use his skills as a private equity specialist to help develop African businesses.

Combined, the diseases she fights kill about 16,000 people a day, or about six million a year, most of them in Africa. The numbers are so astoundingly high that people assume Ikemba must feel discouraged at times. “What I hear from a lot of donors is ‘It’s so daunting, it’s so big,’ ” she says. “When it’s in your face, it’s not so big.” She has lost friends and family to these epidemics, and recently found out her one-year-old son’s nanny has full-blown AIDS. “It’s in our homes, and because of that, I feel that every little step counts.”