Monday, November 03, 2008

Weaning Africa off health aid

There are often complaints that the richer countries of the North -- particularly some of them -- do not devote a sufficient percentage of their GDP to international aid. The thought is basically that a small sacrifice, say a few dollars or Euros from each citizen, could save the lives of many people in poorer nations. There is something right about this, but also something quite wrong.

To increase in international aid -- especially health aid -- shouldn't be considered something good in itself. International health aid can be valuable in cases of catastrophic health emergencies, but over the long haul, countries should not become more dependent on external funders to provide a decent level of health care for their own citizens. It is not just the indignity of dependence on others as such; it is also the instability and unreliability that goes hand in hand with such dependence, as the levels and priorities of international health aid are subject to the political and economic fortunes of the developed world. And they generally come with strings attached, hidden agendas and unnegotiated preconditions. The ultimate goal should be to reduce the need for such disempowering dependence to the greatest extent possible.

A recent article in the Bulletin of the World Health Organization, by Joses Mithuri Kirigia and Alimata J Diarra-Nama, give some good general ideas about how to wean Africa off of international health aid. Reducing inefficiencies, changing priorities in public expenditures, expanding the tax base, increasing involvement of private sectors, and fighting corruption: attempting to do all this will raise many practical and ethical problems, but at least it holds the promise of minimizing a dependence too long regarded as 'natural' and 'inevitable.'

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