Top 3 debates in international aid and global health
by Victor Roy on January 12, 2009
Where do you stand? Below I lay out a few of the key debates (feel free to post important debates that I missed in the comments section!) that are currently playing out in global health when it comes to international aid. Can we play an active role in bridging these "divides"?
Debate #1: Horizontal or Vertical health programs? We've covered this debate on Article 25 before, but to re-cap - "vertical" public health programs have traditionally focused on specific disease priorities, such as HIV/AIDS, TB, malaria. Critics claim that such a focus has neglected broader primary care (or "horizontal") infrastructure, often making it harder for a health system to cope with the myriad of other diseases (diarrhea, respiratory tract infections, etc) that afflict poor populations. However, procuring funding and creating strategies for fighting disease often requires vertical approaches, which are far more tangible and deemed "focused". Check out the prior post for more context on this discussion.
Debate #2: Prevention versus Treatment. This debate has raged in the context of HIV/AIDS for years, as NGOs and experts have vied for funding their respective projects and programs. Advocates of prevention assert that the rate of new infections far outpaces the rate of treatment, and that a treatment focused strategy will never allow the global community to end the AIDS pandemic. On the other hand, some argue that without adequate resources for treatment, millions of people will die in the short-term, and it's hard to see how a prevention strategy can work without people feeling safe in knowing that they can get treatment (if they found out they were indeed infected).
Debate #3: Paternalism and Measuring Effectiveness. This last debate isn't a "one versus the other" type of discussion, as the others have often been. But the ways in which aid is delivered and measured are still sources of controversy in global health circles. Critics like Laurie Garrett point out that aid often "dis-empowers" local / national actors in developing countries, while "experts" in NYC and DC offices decide the fate of poor populations around the world without enough collaboration. Others raise the deep concern that aid is not effectively measured, so it's hard to know the impact the $$ is having. However, an increased emphasis on evaluation/surveys/monitoring may reinforce paternalism by forcing developing nations to "report to their donors" in ways that might harm cooperation. At the same time, producing effective results (and knowing about them) is an important step towards progress and further collaboration. My question: how can we partner with developing countries and communities to effectively deliver and measure the effectiveness of aid? Some experts are already trying to answer this important question.
Another interesting debate that I won't cover here, but is worth discussing more: public versus private?
Jacob Kneeman says on January 14, 2009 at 10:15pm:
The Diagonal Approach: Partners In Health has demonstrated a successful vertical strategy, using the funds to treat HIV/AIDS, malaria, and even MDRTB. However, PIH has employed resources in a horizontal way, building the overall infrastructure of Haiti and implementing a solid primary care delivery system. Thus, both vertical and horizontal health programs are required. The diagonal approach takes advantage of the most beneficial aspects of the vertical and horizontal strategies: consolidation of the large donations (vertical) to specific causes allows public health advocates to coordinate with native officials to strengthen the overall health infrastructure (horizontal). Prevention and Treatment are Case-dependent: Surveillance and epidemiology should determine whether public health organizations focus more on the treatment or prevention of a specific disease. For instance, if the majority of the poor, which in most cases comprises the largest number of citizens, suffers from a virulent disease, effective methods of treatment are valuable. If the death rate is high, treatments are more valuable than prevention because they can uphold families and economic systems together for an extended (albeit temporary) period of time before death. Similarly, if the disease affects populations throughout a country, more effort should be placed on treatment rather than prevention. However, prevention is also required because effective methods abate incidence and prevalence rates. It is important to measure the amount of treatment and prevention applicability in terms of epidemiological statistics. Surveys that expose a disease's incidence rate signals that strategies for prevention are economical. Paternalism and Measuring Effectiveness: Paternalism can be enhanced through systems of scientific accountability. For example, the United States can use its influence to set up accountability contracts, or agreements, with countries receiving aid. One accountability factor could be epidemiological improvement, measuring basic infrastructural needs - birth, maternal death, HIV/AIDS, flu, and rates of other basic health ailments. If the government agrees to a coordinated system of accountability, where the United States remains largely aloof during the actual policy administration, governments have an incentive to follow through. The United States, providing a time range, can follow up by conducting epidemiological surveys to assess the improvement since date of the first donation. This way foreign systems of government can operate according to what they believe is best as well as obtain a sense of beneficial relations with the United States. In the case that improvements have not been made, the United States then withdraws the aid. If the government is perceived as corrupt, this accountability system could come in handy if foreign governments desire aid from the United States and other large benefactors.shelly says on January 22, 2009 at 9:56pm:
Prevention versus Treatment. This is not a question of what came first the chicken or the egg. I think both issues need equal amount of attention. And simple things like Circumcision can do wonders for prevention.antriya says on February 23, 2010 at 11:11am:
However, prevention is also required because effective methods abate incidence and prevalence rates. It is important to measure the amount of treatment and prevention applicability in terms of epidemiological statistics.Ooty says on July 14, 2010 at 5:55am:
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