Will Effective Health Delivery Platforms be Built in Low‐Income Countries?

Abstract

Recent estimates indicate that building effective health delivery platforms in lowincome countries would cost more than these countries could afford. Low-income countries must rely on international assistance, and therefore global health policies are crucial in determining the future of such delivery platforms. The first decade of the twenty-first century was marked by a substantial increase in development assistance for health (DAH) and by donors committing to align such assistance with the priorities of countries needing assistance. However, most of the additional DAH was allocated to infectious disease control, arguably serving the interests of the countries giving the assistance. Nevertheless, some low-income countries with strong health sector development programs, such as Ethiopia, have been able to take advantage of the international community’s willingness to control infectious disease to build stronger and more effective health delivery platforms. Organizations created for global infectious disease control, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, acknowledge the importance of strong health delivery platforms, although they remain hesitant about their own role in supporting those platforms. Given that the international community will probably always prioritize infectious disease control, the “diagonal approach” - using disease control priorities to drive the building of effective health delivery platforms - should be explored. There are other lessons to be learned from the first decade of the “global health revolution.” These include the importance of casting premature and avoidable deaths as human rights violations, and of accepting dependence on international assistance as a problem to be managed with appropriate mechanisms rather than a problem to be avoided.