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Who will fund health systems?

Laurie Garrett in the cover story of the forthcoming Foreign Affairs talks about the issue of broader financing for health care systems. Africa’s needs are much larger than AIDS, and, as we blogged about, excessive focus on one disease may lead to under-financing of the rest of the health sector as the best talent all get drawn to work on ARV provision.

Diseases and health conditions that enjoy a temporary spotlight in rich countries garner the most attention and money.This means that advocacy,the whims of foundations,and the particular concerns of wealthy individuals and governments drive practically the entire global public health effort.Today the top three killers in most poor countries are maternal death around childbirth and pediatric respiratory and intestinal infections leading to death from pulmonary failure or uncontrolled diarrhea.

AIDS health care is not spilling over to support broader health care for the people, in part because so much of it is donor-driven service rather than locally operated and supported. Part of it is also that:

most of global HIV/AIDS-related funding goes to stand-alone programs:HIV testing sites,hospices and orphanages for people affected by AIDS, ARV-dispersal stations, HIV/AIDS education projects,and the like.

As my friend David Gartner from the Global Aids Alliance pointed out, it’s not as if this recent bump in donor money would have gone to other diseases. Most of this is new money because donors were motivated to address a specific concern. Even there, mobilization around AIDS has created ancillary benefits for other health care concerns. Because TB and malaria have been bundled under the Global Fund umbrella, a lot more money for those diseases has been offered. The Global Fund now provides 2/3 of the world’s funding to address those diseases.

Garrett raises a broader issue, that Western countries are draining all the medical talent out of developing countries actively and passively. There are recruitment programs that Western countries and companies pursue to attract nurses in particular to work in the West, but conflict and chaos in many developing countries causes many trained professionals to flee their home countries. This is a bigger problem and despite periodic offers by Western countries to send more trained doctors and nurses to Africa as a public service, keeping developing country talent at home and working on a broad spectrum of health care issues has got to be a priority for donors.

She also worries, like Alex de Waal in his recent book, that current round of altruism by Western donors may run dry, leaving Africa no more able to take care of itself.

For the day will come in every country when the charity eases oa and programs collapse, and unless workable local institutions have already been established, little will remain to show for all of the current frenzied activity.

Donors are increasingly starting to realize this, but supporting and sustaining the infrastructure and training of health care systems and professionals is perhaps as complex as creating self-sustaining governance structures, something the West and donor countries are not very good at.

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2 Responses to “Who will fund health systems?”

  1. […] At the level of advocacy, I’m impressed by this entrepreneurial model. That said, with the Global Fund still in need of an Executive Director to replace Richard Feachem, I hope all the purported good from this goodwill and optimism ultimately gets spent wisely. Laurie Garrett’s Foreign Affairs piece discusses the evidence that is emerging that donors are wasting money through too much top-heavy bureaucratic processes while some recipients countries have such graft that funds never get to the people who need it. […]

  2. […] There is an emerging debate in healthy advocacy about the wisdom of focusing funding so much on fighting a few diseases. Is AIDS money truly additional money that would not have gone for other purposes or is AIDS taking money out of child survival, maternal health and other worthy areas of expenditure? (Jeremy Shiffman of the Center for Global Development and Laurie Garrett have both made this argument in recent months as we blogged about here, here). […]