BUBAQUE, Guinea-Bissau - Joao Domingos Gomes was 19 years old when he went to war for Guinea Bissau's independence. That was in 1969. He fought alongside legendary hero Amilcar Cabral and trained as a nurse in a guerrilla hospital.

Today, aged 57, he works in Bubaque island's public hospital, which serves some 35,000 residents of the Bijagos archipelago, off the capital, Bissau.

"Our bush hospital was better," he says. "We have zero electricity. We fetch water by buckets from the well, 70 meters away. Women give birth by candlelight. Because the sterilisation machines are broken, we sterilise instruments with chemical products. We have no sheets or food for general patients."

There is, however, one bright spot in this derelict hospital: the tuberculosis ward. Freshly painted in white with blue accents, it has beds, sheets, mattresses, mosquito nets and medicines. Patients get rations of rice, porridge, sugar and cooking oil, thanks to the Global Fund to fight HIV/AIDS, Malaria and TB.

The hospital can test for HIV but does not dispense antiretroviral drugs. Domingos knows that his HIV-positive patients will be cured of TB but will return to their villages to infect others, not with TB, but with HIV.

He knows that the young woman discharged yesterday may return months later to risk dying in childbirth or her baby not surviving. The midwife has brightened up the birthing room with African cloth, but the orange and blue flower print cannot hide the rusty metal stirrups, antiquated instruments and lack of life-saving equipment.

On the other side of the country, in Gabu, near the western border with Guinea, the hospital is equally grim. The midwife washes and re-uses the surgical gloves, and wishes for a cheap aspirator that means the difference between life and death for a newborn with clogged airways. As in Bubaque, only the TB ward is an island of fresh paint and free food.

With the best intention, The Global Fund, the Bill and Melinda Gates Foundation and other donors are creating two classes of patients and health staff.

One is privileged with food and medicines and salary supplements, while the other gives birth with a bucket of water and without an aspirator and the midwife goes for months without pay.

Adrien Ware is the Global Fund's representative in Bissau. "I don't feel good about this (difference)," he says. "It does not make sense to treat TB but not treat AIDS, and it is not good to have the TB staff separated in a vertical structure."

True, sorting out the logistics and procurement system to place ARVs nationwide helps to move other drugs as well. But there is something fundamentally flawed in the approach when the TB ward is decent and the rest of the hospital, obscenely derelict.

Most African public health systems are ailing. Their sickness can be traced to the World Bank-mandated structural adjustment programmes that capped national social spending in the 1990s, coupled with apathetic governments that did not make public welfare as a priority.

Today, when the system needs to work, it doesn't. But trying to fix one part while ignoring the rest won't do. Throwing money at three diseases has limited impact when the public health systems are in distress.

This narrow approach does not work for HIV prevention, either. If you know that you and your family can die any time of malaria, cholera, pneumonia or septicemia and that the local hospital is a disaster, well, AIDS is just one more item in your unfair basket of risks.

Last year I asked the insightful Zimbabwean AIDS activist Lynde Francis what has been learned in 20 years of strategies against HIV. Francis paused, reflected and said: "We need to be more inclusive. We can't fight for AIDS alone."

The fight is not only against AIDS, TB and malaria. It is for better public health for all, regardless of the disease.

There are signs of change. Key NGOs are speaking out. The Global Fund may consider proposals to strengthen public health systems.

The United Nations Special General Assembly on AIDS (UNGASS), opening in New York on 11 June, could order some medicine for the ailing African health systems. Among these: prod African governments to keep their promise signed in Abuja of spending 15 percent of the national budget on health, persuade donors to reward countries that do, and re-focus the global health agenda to be more inclusive.

Back in Bubaque, Domingos talks to the high school director, arranging for the students to cut the one-meter high grass on the grounds.

The AIDS counsellor drops by. He feels frustrated about telling pregnant women they are HIV-positive but that nothing can be done for them and their babies in Bubaque. The capital, where they could get ARV drugs, is six hours away by boat.

Looking at the dilapidated hospital, Domingos sighs: "We didn't t fight in the bush for this."

Reuters AlertNet is not responsible for the content of external websites.