Global Health Chapter 4 Discussion

Question: From global health perspective, how do researchers measure the global burden of the disease and discuss the policy of increased aid funding to low-income countries (e.g: arguments, merits and constraints) with recommendations for rationing this issue.

Word limit: 500

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Chapter 4

Key Ideas

Experts disagree on whether aid improves health

Aid comes in different forms: humanitarian assistance, bilateral aid, multilateral aid

Donors’ use of conditions and tensions between aid to governments and non-governmental organizations (NGOs) are contentious

Types of Aid

International: transfer of funds from one entity or government to another across borders

Individual donations to Doctors without Borders

Humanitarian: funds to alleviate immediate human suffering

Official direct assistance: from official source to another country; grant, loan, or goods

Bilateral: one government to another

Multilateral: through an intergovernmental organization

Remittances: informal aid to relatives in another country

The US and International Aid

US government contributes 0.2% of GNP to international aid

Lower than most other industrialized nations as a percentage, but largest absolute amount

Below UN target of 0.7%

When individual citizen donations to NGOs are included, US is largest contributor

General belief in US that NGOs are better equipped to handle humanitarian issues than US government

The Aid Controversy

Some experts question whether aid helps or harms low income countries

Question relates to governmental and NGO aid

Fosters dependency, complacency, corruption?

Some countries that have historically received aid have poor infrastructure

Beneficial but used inefficiently?

Beneficial and needs to be increased?

Models of Global Aid for Public Health

Ex ante model: no prescriptions for public health; imagine making decisions prior to being born into a specific set of circumstances

Sachs model: did projects should be pooled to work synergistically

Health cannot be created in unhealthy environments

Institutional approach to policy making: emphasizes local service delivery over specific projects

Argument: Aid is Harmful

Prominence in 1960s based on work of Milton Friedman and Peter Bauer

Foreign aid strengthens governments that are already too powerful; too little investment in private organizations

Aid abdicates governments from their responsibilities if NGOs provide basic services

Official direct aid fosters dependency, corruption, and poor governance

Economies should be allowed to develop naturally

Argument: Aid is Poorly Managed

Aid is not inherently harmful but allocating it in context-appropriate ways is challenging

Can create wage disparities in local economies

Difficult to recruit top managers to low income countries with low salaries

Large number of NGOs with potentially little coordination between them

Some may not have knowledge of local culture

Argument: Aid is Misused

Models for implementation may not be appropriate for low income countries

One size fits all, structural adjustment programs

Inappropriate technology use

Funding for primary health care systems in countries without adequate infrastructure and without basic prevention efforts like sanitation

Argument: Just Send More

South Korea received large amounts of aid from the US following the Korean War and is now a strong nation economically and in terms of human capital

Some argue that other nations would have a similar outcome if only similar levels of aid were provided

Argument: We Are Making Progress

Targeted, short-term goals often are achieved

NGOs often work to promote social and policy change in addition to targeted projects

Additional challenges:

Balance services with achieving larger goals

Sustainability and local engagement

Scalability

NGOs and Aid

NGOs have different functions including:

Internal organizing or services

Lobbying or advocacy

Fundraising

Some NGOs take money from governments and must follow stipulations

Other NGOs have a policy against taking money from governments to prevent censoring of their messages