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.'

Health and Human Rights: new online journal

The journal Health and Human Rights has been around since 1994, and it started out under the editorship of Jonathan Mann. Paul Farmer has took over the reins in 2007, and now it has gone online and open access. The inaugural edition of the journal in this new format has a host of interesting looking articles, but my eye was caught by the piece entitled 'Notes on the rights of a poor woman in a poor country' by Tarek Meguid, Deputy Head of the Department ofObstetrics and Gynecology at Bwaila Hospital and Kamuzu Central Hospital in Lilongwe, Malawi. What is striking about the article is its graphic -- and moving -- description of a vast gap between the human right to health (often in the form of access to basic medical supplies) and what actually happens in health care centers in low-income countries like Malawi. The disjunction between rights and reality can be regarded as a source of inspiration and idealism, in so far as one recognizes the existence of the gap and is committed to narrowing it. But as Dr. Meguid's article illustrates, the commitment and idealism of health care workers in many parts of the world are subject to alarming challenges on every work shift. When the situation on ground is that dire, and the prospects for change seem dim, can the human right to health continue to function as an ideal, rather than a haunting spectre, a biting reminder of failure or source of profound shame?