Trading ideology for dialogue: an opportunity to fix international aid for health?

Abstract

1Although the amount of development aid spent on health has increased since that time, the logic behind aid administration remains controversial. Both the professional and lay press report that, despite some successes, development aid for health has not realised its goals, often because of inadequate or harmful policies. 2 In this article, we track the evolution of the policies of the major bilateral and multilateral aid donors since the 1960s. We argue that those policies, instead of reflecting needs of the recipient countries, have evolved in response to donors’ ideologies. Aid policies emerge from a monologue of donors, rather than a dialogue including recipients, despite window-dressing to mask this reality. This lack of dialogue underscores most of the failures of international health and suggests the urgent need for a restructured aid process, in which policies and projects are not merely guided, but actually designed, by recipients. Major trends in policy Why do donors have such a heavy influence on health policies in developing countries? Donors’ contributions account for perhaps 3% of total health expenditure in developing countries, but influence policy and steer the spending of the remaining 97%. 3 Clearly, other aspects of politics and international relations are used to wield influence over health policy, not just this small financial contribution. The table summarises the major health policy movements of multilateral donors in the past four decades. 4,5