Thank you very much, indeed.
It's great you're mentioning Botswana as an example, so let me take that and answer your question through that.
Botswana is one of the countries where I worked and advised hospitals before the Global Fund was created. In the years 2000 and 2001, Botswana had the highest HIV prevalence in the world, you will recall. Close to 40% of young adults were infected with HIV. It was an absolutely devastating situation. I was in some of the hospitals where we introduced the first antiretroviral treatment schemes, which were so urgent. At that time it wasn't even clear whether, under the conditions, they could be implemented. That was a year or two before the Global Fund was created.
Now Botswana has, indeed, made tremendous progress on HIV. It was one of the countries where the life expectancy had gone down to 35 years on average. As you mentioned quite rightly, it has now gone up again to 54 years among females. That's a tremendous achievement.
With the investment over the years, they have really scaled up their health systems. The hospitals are in a much better place now, and Botswana is a relatively wealthy country. It's an upper middle-income country. They no longer depend on Global Fund funding. We are not financing their treatment anymore. We have over the years, but they are now at a point where their health system can support that itself. I think that's a great achievement.
We do want to see that, over time, countries can graduate out of this international support, if possible. We see significant economic growth in many African countries. Botswana is just the leading example, I would say.
We've always believed in investments in the health systems while we invest in these three diseases. It was never a situation where we just delivered the drugs and then told them to take care of it. That does not work. Unless you have a workforce that is trained, unless you have hospitals with laboratories and outpatient and in-patient services, you cannot do that.
Let's talk about the prevention of mother to child transmissions, something that is very dear to Canada because of the Muskoka initiative. That requires good antenatal services for women, which they can attend, where they get tested, and where they receive overall antenatal care. If they prove to be HIV positive, they also receive treatment so their babies will be born without HIV.
That was an investment in the health systems, particularly in maternal and child health. That has really been going on. Billions have gone into these health systems through Gavi, through Global Fund, and through other initiatives.
There has been so much talk about Ebola, of course, over the last year. It was a very dramatic situation, and there was a lot of criticism that the international response was late. I do take that criticism, but we should also not forget many countries like Mali, Senegal, Nigeria, and others were able to prevent any outbreak. They had early cases, and the health systems were strong enough to prevent any further spread.
Now, we are grateful that Liberia, Sierra Leone, and Guinea also seem to be turning the corner. That is because there has also been significant investment in the health systems of these countries. Otherwise they would not have been able to cope.
There are good studies now that also show that investment in AIDS, tuberculosis, and malaria helped those countries to also address the challenges presented by new diseases, or other particular health challenges.