Meeting the Survival Needs of the World's Least Healthy People

Abstract

NTERNATIONAL HEALTH ASSISTANCE IS PROVIDED IN AN INeffective way that does not enhance the capability for human functioning. 1 Most funding is driven by emotional,high-visibilityevents,includinglarge-scalenatural disasters such as the Asian tsunami; diseases that capture the public’s imagination such as the human immunodeficiency virus and AIDS; or diseases with the potential for rapid global transmission such as hemorrhagic fever, severe acute respiratory syndrome, or pandemic influenza. These funding streams skew priorities and divert resources from building stable local systems to meet everyday health needs. A relatively small number of wealthy donors currently wield considerable influence in setting the global health agenda. Although well intentioned, rich countries and philanthropistsoftensetprioritiesthatdonotreflectlocalneeds and preferences. Sometimes donors exert control over the useoffundsthatdiscourageslocalleadersfromtakingownership over programs. Conditions attached to funding can evenbedetrimentaltothepublic’shealth,suchasthePresident’sEmergencyPlanforAIDSReliefrequirementthat33% of prevention funds must be spent on chastity and fidelity, whereas no funding can be used for clean needle programs. 2 Similarly, for years, development banks have encouraged or required poor countries to cap internal spending on health as a condition of loans or debt relief. 3 Donor countries often fund politically popular projects, ratherthanwhatismostlikelytoimproveglobalhealth,leading some experts to conclude, “... funding is skewed towards what people in the West want to deliver.” 4 International health assistance, moreover, is fragmented and uncoordinated. Nongovernmental organizations and relief agencies often establish programs that compete with each other and, still worse, compete with local government and businesses. Rather than integrating policies and programs within local hospitals, clinics, and health agencies, they set upstate-of-the-artfacilitiesthatovershadowanddetractfrom governmentandprivateefforts.Foreignphilanthropistscan offer salaries and amenities that are far more generous than those that can be offered locally. As a result, local innovation and entrepreneurship are stifled; talented individuals in business, health care, and community development migrate to foreign-run programs; and the local health industry cannot profit or easily survive. 5 In addition, massive infusion of humanitarian assistance into very poor countries can lead to reliance and dependency. If charity is the main vehicle for health improvement, local government and businesses lose the desire and ability to solve problems on their own. When the infusion of foreign cash, clinics, medicines, and aid workers ends, the least healthy will be no better and perhaps worse off, unless they gain the capacity to meet their own basic health needs.