Health Development versus Medical Relief: The Illusion versus the Irrelevance of Sustainability

Abstract

Development agencies want their interventions to be sustainable. The Office of Sustainable Development of the Bureau for Africa of the United States Agency for International Development defines sustainability as “the ability of host country entities (community, public and/or private) to assume responsibility for programs and/or outcomes without adversely affecting the ability to maintain or continue program objectives or outcomes”. It defines financial sustainability as “having enough reliable funding”, meaning funding “generated from a country's own resources” [1]. Exceptionally, in times of emergencies, development agencies are willing to support relief interventions that are beyond the capacity of the beneficiaries. In such circumstances, sustainability is irrelevant, as the crisis is by definition temporary and the need for relief will ebb with the crisis. In the field of health care, the issue of sustainability creates a dichotomy between medical relief and health development, because relief is unaffected by the condition of self-reliance. This dichotomy results in turf battles between the advocates of medical relief and the advocates of health development. This essay explores the causes of this dichotomy and highlights the senselessness of turf battles. All trendy development approaches point out that sustainable health care—narrowly defined as independent from international aid—is illusionary in the world's poorest countries. Public health budgets in these countries must be increased and require stronger national and international financial commitments. If public health budgets were increased, the level of health care within the capacity of the beneficiaries would be higher, and the dichotomy would dissolve to a certain extent. However, health development advocates assume that public health budgets will not be increased and base their sustainability estimations on this assumption. In doing so, they contribute to the status quo of insufficient public health budgets.