Offline: The panjandrums of global health

Abstract

She was angry and upset. She directs the policy, planning, and financing division of an African Ministry of Health. She never represents her country on official panels at the United Nations. She doesn't write papers for medical journals. And she isn't consulted by the giant panjandrums of global health. Nobody asks her for her views. Nobody is interested in her experience. But what she knows, and what others should know too, is important. The indifference of all of us—The Lancet too—to those who actually “do” global health in countries raises questions about just what our efforts really achieve. How can global health succeed if it doesn't listen to those on the front lines of policy making in countries we profess to care about? Her task in her ministry was to work with “partners” to strengthen her country's health system. (It is worth emphasising that the word “donor” is now unacceptable in global health, although the replacement word “partner” has become a dishonest way to cover up the enormous power imbalance between what are still, like it or not, “donors” and “recipients”.) Specifically, she has to persuade those who lead Global Health Initiatives to pool their windows of spending on health systems. Her guide is the 2005 Paris Declaration on Aid Effectiveness: country ownership, alignment, and harmonisation. Countries should be able to set their own strategies for poverty reduction; donors must align behind these objectives and use local systems to do so; and donors should coordinate and simplify their procedures to avoid duplication. The 2012 Busan Principles for Effective Development Cooperation were supposed to provide a new and better vision for the relationship between development partners. They should have helped strengthen the ability of this African policy director to negotiate with reluctant “partners”. Instead, Busan said that “development depends on the participation of all actors, and recognises the diversity and complementarity of their functions”. Busan lacked the clarity of Paris. It fudged the responsibility of donors. It was a step backwards, not forwards, for development cooperation. The panjandrums of global healthRichard Horton's Comment (July 13, p 112)1 suggests that recent international commitments on development cooperation have done more harm than good for health-care in Africa. I disagree. But his conclusion that our “global health panjandrums” need better feedback from beneficiaries on the ground is sound. We now have a window of opportunity to get things right. Full-Text PDF