The article “The Challenges of Global Health,” published in Foreign Affairs, discusses the changes in development over the last century and the current state of global health. Over the 20th century, aid has seen an increase in spending for health related programs. Increased spending on global health initiatives began with the HIV/AIDS epidemic, which revealed disparities in access to treatment for victims of low socioeconomic status. Healthcare professionals were appalled and caused an outcry, spearheading a, “larger global public health agenda.” Other recent incidences, such as the Avian Flu, have also increased funding for global epidemiological surveillance. Furthermore, spending by wealthy nations has lead them to pressure developing nations do their share by allocating more of their national budget toward healthcare. The aid world is finally begging to realize that poor health impedes productivity and developmental growth.
Enormous sums of money are now given annually by private and government donators, each amount designated for a specific, narrow goal. This increase in donations has spurred an explosion of well-meaning NGOs dedicated to solving the world’s problems. But, lack of coordination amongst these do-gooders may be doing more harm than good. The main problem facing health development is no longer lack of resources, but rather lack of coordination.
Aid is ultimately failing because it is inefficient. As money becomes tied up in bureaucracies and corruption, funds don’t end up supporting their intended purpose. Inefficiency is also due to “stove-piping” funds by narrowing their focus to one specific disease or program. Stove-piping reflects the priorities of donors, which is subject to their opinions, whims, and ideals. Improving efficiency can also be achieved by spending less on specific diseases prevention and more on improving the total health of the population, a more comprehensive approach.
Donors and NGOs can even hinder the progress of global health with their well intended projects. Spending by outside organizations and NGOs in developing nations can destabilize a nation’s economy by causing inflation and driving up costs of health higher than what people can afford. This can only be avoided by the economic participation of local people. The article reaffirms this point stating, “If locals cannot profit, country will never be able to ween off its dependence of aid.” The donor system is also causing a “healthcare brain drain”--trained healthcare workers in developing nations are being lost to better funded projects or are practicing in wealthier nations where they can earn a better living. In some cases, medical professionals are even being recruited by the very organizations who are trying to help. Ultimately, successful global health development will incorporate exit strategies and transfer control to local leadership.
Two rates that can be used as markers of healthcare development: reduced maternal mortality and increased life expectancy, trends that show an overall improvement in the health of populations. It is more beneficial to focus on these factors rather than improvement of mortality rates by specific diseases. Death rates from specific diseases will will only show narrow progress, because diseases can be controlled independently of the nation’s general health, as in the case of HIV. Furthermore, life expectancy also incorporates death by preventable diseases, thus broadening the focus of aid efforts. Diseases and causes of death are interconnected, demanding a comprehensive approach that addresses them all simultaneously. Integrated efforts that deal with many variables at once through interconnected, community based interventions will be more effective than tackling each problem individually. The article discusses the importance of maternal mortality and life expectancy, claiming “If mothers thrive, it means the health-care system is working, and the opposite is true,” and “life expectancy is a good surrogate for child survival and essential public health services”
The efforts of donors and NGOs are also unintentionally worsening the state of certain illnesses, such as AIDS and Multi Drug Resistant Tuberculosis (MDRTB). Many developing nations don’t have sufficient healthcare infrastructure in place and are not equipped to effectively battle AIDS and other infectious disease. Having multiple donor groups is resulting in uneven distribution of aid and incoordination between efforts. This has lead to many bad effects, such as the failed recognition of connection between AIDS, malaria and MDRTB. Ultimately, lack of coordination amongst donors results in repetition of interventions. The state of global health can be improved through dialogue and coordination between organizations and donors who are focusing on the same goals. Coordination needs to be lead by a visionary leader, something which global health is currently lacking.
Hi Anna,
ReplyDeleteGood Post.
Lack of coordination amongst different NGOs and agencies does seem to be a major problem in international health. To me the most valid reason from the article as to why we are not seeing greater improvements in global public health is because of the wrong focus. As you mentioned, donors and organizations are focused on particular "popular" diseases and instead of building infrastructure that can be used for basic services to help everyone, money is being used to focus only on a select few diseases. Now of course treating HIV/AIDS is important, but by focusing only on HIV/AIDS it seems we missing the forest through the trees.
You are right about the two indicators of maternal mortality and life expectancy being considered the most important.
In terms of worsening disease as a result of current practices, the article discusses how anti-retroviral drugs are provided to prevent the spread of transmission of HIV from pregnant women to the fetus, but money is not available to create basic infrastructure for obgyn care, 24/7 safe birthing, or child immunizations. So while the transmission of HIV may be prevented, the rates of maternal death, child mortality, and vaccine preventable infectious diseases remain high.
Another example is the increase in pandemic Influenza. In order to handle influenza countries need public health infrastructure as well as trained primary care workers, veterinarians, scientists, and public health workers. One might think that the same infrastructure built to handle HIV could also be used to deal with influenza, however, this has not been the case. There are many reasons for this including that donor agencies have not tried to integrated these programs, lack of funding from government for health care programming, as well as lack of resources in for training, insufficient funding from local government to pay health care workers which take more lucrative jobs from donor funded NGOs or other countries.