Global Health Ideas

Finding global health solutions through innovation and technology

The End of the Era of Generosity? Global Health Amid Economic Crisis

If you only read one thing this week, the below article deserves your attention. I have excerpted only bits and pieces, the full piece is worth reading. Co-authored by Laurie Garrett, this is a much better, more cohesive and articulate encapsulation of the current economic crisis than what I wrote last week (if I only had 1/4 of the writing ability of Garrett!).

The End of the Era of Generosity? Global Health Amid Economic Crisis
Kammerle Schneider email and Laurie Garrett
Philosophy, Ethics, and Humanities in Medicine, Jan 2009
Global Health Program, Council on Foreign Relations

For too long, the international community has responded to global health and development challenges with emergency solutions that often reflect the donor’s priorities, rather than funding durable health systems that can withstand crises…The global health community must now objectively evaluate how we can most effectively respond to the crises of 2008 and take advantage of this moment of extraordinary attention for global health and translate it into long term, sustainable health improvements for all. Over the past eight years global health has taken center stage in an era of historic generosity as the wealthy world has committed substantial resources to tackle poverty and disease in developing countries…there has been a massive swell in the number of nonprofit organizations (NGOs), faith based groups, and private actors contributing to this boon.

Past is prelude
The emergence of HIV/AIDS fundamentally transformed the way in which the world engaged global health. It shook world leaders…It awoke the average citizen to gross disparities… The fight against HIV/AIDS rallied tremendous financial support for global health, while at the same time, moving investments in health from infrastructure: clinics, roads, sanitation, and personnel, to funding disease specific initiatives with emergency, short term targets, and often unsustainable results.

International institutions and governments heavily reliant on steady inflow of foreign donor funding are now frantically trying to resolve how to continue the operations of their health programs… Undoubtedly, the economic crisis will crimp humanitarian aid, and international efforts to fight disease and alleviate poverty.

The special challenge of HIV
Increased focus on the urgent management of specific diseases has weakened the ability of health systems to respond to crises
. To respond to the AIDS epidemic, the share of global health aid devoted to HIV/AIDS more than doubled between 2000 and 2004 – reflecting the global response to an important need, yet, the share devoted to primary care dropped by almost half during the same time period...In many of the countries hardest hit by the pandemic, a large portion of their funding for AIDS medications come from outside donors. For example, in Mozambique, 98 percent of all funding for the country’s HIV/AIDS programs comes from outside donors…the nation’s extraordinary dependence on external support begs questions about the efforts’ sustainability, and country ownership and control… As we enter an economic downturn, the sustainability of emergency initiatives, such as PEPFAR, that are 100 percent dependent on a never ending supply of donor dollars, are called into question.

Moral hazard amid complexity
Instead of making things simpler and more efficient on the ground, in many cases, the rapid increase in funding and number of global health players has made the mechanisms for delivering aid even more complex. At the developing country level, hundreds of foreign entities are competing for the attention of local governments, civil society interest, and the desperately short supply of trained healthcare workers…

A moral path forward
Given the scale of the world’s healthcare workers deficit, no progress can be made in the creation of universal primary care systems if models continue to be doctor-based.
Even if the world committed today to the most massive medical training exercise in history, the deficit would not be overcome for more than two generations. Only a substantial commitment to building genuinely viable health infrastructures centered on community based workforces, coupled with local profit incentive systems, and global scale supply and inventory management…The crises of 2008 have brought together committed government officials, UN agency leaders, NGOs, faith-based groups, and corporate actors to collectively think about new ways to break out of patterns of charitable giving and move towards real sustainable investments in health…A number of promising initiatives are beginning to emerge. In this time of financial catastrophe, the onus sits squarely on the shoulders of global health advocates living in the wealthy nations: push your governments and philanthropic institutions to not only maintain their technical and financial commitments to the poor nations of the world, but actually increase the scale of investment to reflect the rising costs of doing good in a troubled world. It is conceivable that 2008 will mark the beginning of the end of the Era of Generosity. But it is equally probable that the economic crisis will usher in a bold new era of investment in the public goods of poor and emerging market nations worldwide. Successful navigation of these turbulent waters will require a shift from the morality of “charity,” to that of “change”…

Advertisements

Written by Aman

March 16, 2009 at 8:30 pm

%d bloggers like this: