Global Health Ideas

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The Challenge of Global Health – A Development Aid Catch-22

The THD Blog would like to welcome our first guest contributor, Dweep Chanana. Dweep will be posting with us from time to time and we are fortunate to have his commentary. Dweep is currently working in philanthropy consulting, and focuses on sustainable enterprise and non-profit management. He has an MBA in International Organizations from the University of Geneva, Switzerland, and previously worked in telecom engineering. I highly recommend Dweep’s excellent blog, The Discomfort Zone.

Dweep’s post below is a brief summary of Laurie Garrett’s recent critique of global health funding priorities and her call for a dramatic shift to health systems investment. I would also like to note several related items:

  • Foreign Affairs, has published a roundtable debate of this article with Paul Farmer, Jeffrey Sachs, and others (link).
  • The ODI think thank blog has their own take on this issue.
  • Two rare pieces of news aligned with this call for infrastructure investment is worth noting. “The health minister of Karnataka, India has finalised an $800 million project to revamp its healthcare infrastructure and train health professionals at the grassroots – a scheme that is expected to benefit over 45 million people.” (Link). Also the GAVI Alliance has announced they will commit $500 million over 3 years to train health workers (LA Times).

by Dweep Chanana – Guest Contributor
The Challenge of Global Health – A Development Aid Catch-22

The venerable Foreign Policy has an excellent critique of the challenges of international development assistance directed at public health (The Challenge of Global Health), that documents the massive amounts being spent on public health by rich governments, philanthropists, and international NGOs, and the challenges that brings.

In this sector, money is clearly not a problem. International health-related aid doubled between 2002-2004, and will double again by 2007. By these estimates, it will soon account for over 10% of many African country GDP’s. Yet, this massive aid has not improved things, and brought many challenges. Two stand out.

The first, and perhaps, biggest challenge is a serious lack of qualified health workers in poor countries, that makes already poor health systems completely dysfunctional. The problem exists largely because qualified health workers in poor countries are often hired by western nations, themselves short of nurses and doctors. For instance, Botswana, an early test of international HIV/AIDS treatment programs, was “by 2005, losing 60 percent of its newly trained health-care workers annually to emigration,” and had to depend on Peace Corps workers to distribute ARV medication.

The second major problem is a manifestation of the aid curse, common to all development assistance. The proliferation of HIV/AIDS programs has been matched by a complete disregard for overall healthcare and an attendant failure to provide for maternal health, malaria, TB, dysentery, or vaccination programs. Of the billions being spent on HIV/AIDS programs, none goes towards training local health workers, or towards supporting a private healthcare industry. Worse, international NGOs and organizations, flush with funds poach the best local talent away from public health systems. As a result, even as HIV/AIDS infection and mortality rates have gone down, overall life expectancy and other health indicators have continued to deteriorate over much of Africa.

Some supporters of foreign aid maintain that the problem with aid is not that it doesn’t work, but that there isn’t enough of it. This article explains what happens when significant aid is indeed made available. As it also illustrates, that is hardly the solution:

In the current framework, such as it is, improving global health means putting nations on the dole — a $20 billion annual charity program. But that must change. Donors and those working on the ground must figure out how to build not only effective local health infrastructures but also local industries, franchises, and other profit centers that can sustain and thrive from increased health-related spending. For the day will come in every country when the charity eases off and programs collapse, and unless workable local institutions have already been established, little will remain to show for all of the current frenzied activity.

The answers are not simple. If anything, the expanded aid has aggravated the underlying problems – weak public health systems that function within a distorted international system, and a market-oriented healthcare industry that does nothing for diseases that have no lucrative market.

A significant amount of money is indeed addressing the second problem, with new initiatives seeking cures to neglected and tropical diseases. However, the bulk of the money – directed at HIV/AIDS programs and infrastructure – is not being very helpful. As Garrett points out:

The health world is fast approaching a fork in the road. The years ahead could witness spectacular improvements in the health of billions of people, driven by a grand public and private effort comparable to the Marshall Plan — or they could see poor societies pushed into even deeper trouble, in yet another tale of well-intended foreign meddling gone awry.


Written by Guest Contributor

February 6, 2007 at 3:43 pm

Posted in Global Health

2 Responses

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  1. global warming is becoming such a obvious problem that someone somewhere other than Al Gore needs to step up to help drive the bus!

    global warming

    August 19, 2007 at 7:54 am

  2. […] by Guest Contributor on June 19th, 2007 Contribution by Dweep Chanana Two interesting articles point to the future direction in the pharmaceutical […]

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