The aid groups "are doing more damage than good; I want the world to hear it", said Salman Rawaf, a professor at Imperial College London and an adviser to the World Health Organisation.
"They're very generous," Rawaf said. "But they should move away from disease-specific funding into health-system strengthening."
Many officials share Rawaf's views: they say spending billions of dollars to fight ailments such as HIV/Aids, malaria and polio rather than supporting basic health services has left nations unprepared for epidemics such as Ebola. Critics say that more resources should go to general health infrastructure such as training for doctors and nurses, ensuring supply of medicines, or developing a system to detect outbreaks.
The Gates foundation and other aid groups say that although they do focus largely on specific diseases, some money does go to broader programmes and, ultimately, any investment in health helps to shore up basic systems.
"It's a false choice," said Chris Elias of the Gates foundation's global development programme. "What do you need to manage HIV treatment? Continuity of care. That's what you need for diabetes as well. HIV can be the scaffolding upon which you build a broader health system."
A primary concern is the salary gap between NGOs and state clinics.
In Guinea, where the Ebola epidemic started a year ago, a physician employed by the government earned $300 to $400 (between R3500 and R4600) a month, said Mohamed Lamine Yansané, a policy adviser at the country's health ministry. The same doctor could get as much as $2000 working for a foreign-backed NGO, he said.
Since 2002, the Geneva-based Global Fund to Fight Aids, Tuberculosis and Malaria has distributed more than $25-billion to slow the spread of HIV/Aids, TB and malaria and says it has saved more than 6.5million lives. Gavi, the biggest funder of vaccines for poor nations, has supported vaccinations for half a billion children, saving about six million lives.
And the Gates foundation has disbursed $31.6-billion since its inception in 2000.
In Liberia, foreign assistance for health increased almost twentyfold in the decade after 2002, to $110-million in 2012, according to the WHO. That year, 43% of the aid went towards combating malaria, HIV/Aids and TB, versus 2% in 2002. Yet the country had only eight hospital beds for every 10000 people in 2012, versus 29 in the US and UK.
In one Liberian county, just half the population had access to general health services, and only a third had a health clinic within an hour's walk, according to a Harvard University study published this year. By contrast, everyone in the county could get malaria treatment.
Another Harvard study, of Global Fund grants, found little co-ordination between the group and officials from national health programmes, leading to duplication, inefficiency, and excessive spending on educational seminars. Some physicians would attend multiple training sessions to boost their income through daily allowances, which in turn cut the time they spent with patients.
Alan Brooks, a Gavi director, said the group tried to support health priorities set by countries receiving aid, and that its efforts were run by local healthcare workers who also dealt with patients with a range of diseases.
The Global Fund says that although the bulk of its funding does focus on specific diseases, it hasn't skimped on general health.
About 10% of the $25-billion the group had disbursed since 2002 had gone towards strengthening health systems, said Christoph Benn, the fund's external relations director. And spending on HIV/Aids, malaria and TB indirectly bolstered public health by freeing up capacity, he said.
Benn acknowledged that services for noncommunicable ailments such as cancer and heart disease had received less attention.
David Evans, director of the WHO's health systems department, said: "You get treatment if you're a woman with malaria or if you're a woman with HIV, but if you've got cervical cancer or cardiovascular disease, you're not covered."
The distorting effect of foreign aid on health systems had worsened as donors had grown more focused on outcomes, Evans said.
Politicians in wealthy countries were more interested in supporting groups that produced measurable results - such as the number of lives saved by vaccinations - than in less-quantifiable goals such as building health infrastructure, said Nils Daulaire, the Obama administration's representative on the WHO board from 2010 until February this year.
"You'd get more for your money if you supported a broad range of health system-strengthening activities," said Daulaire. "That's a much more difficult message."
- Bloomberg.
Culled from The Times Live ZA.
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