Global Health: The Challenges of Fund Allocation

Hi and welcome back to my Intro to Public Health blog. This week, we were asked to read an article about global health and development by Laurie Garret, an expert on Global Public Health who works for the Council on Foreign Relations. The article addresses the fact that in recent years health aid money to developing countries has increased tremendously. However, Garret expresses the concern that this money may not be improving health as well as it could be. The paper outlines some reasons for this, and explains how some organizations may actually be detrimental to local health. The author talks about the fact that donor money is often "stovepiped" to one very specific goal. For this reason, aid is given without building the infrastructure necessary to sustain a high-functioning health system. Also, developed countries tend to draw health care workers from the developing world. This "brain drain" is a major cause of poor health because nations are being stripped of their health work force. Another issue is that when all resources focus on one issue others are sure to cause problems. For example, the attention given to the HIV/AIDS pandemic has taken attention away from the severity of the emergence of multidrug resistant tuberculosis.

When considering the reasons for continued worsening health in the developing world, it seems that the most important is the failure to focus on infrastructure building. Although it is noble and important to focus on individual goals, it is impossible to promote health without a strong health care delivery system. The author cited an example of a country that was given vaccines, and yet could not vaccinate children due to a lack of facilities and workers. Also, it has been proven that education is one of the most effective ways to improve health in a nation. This is especially important in eliminating the tremendous gender inequities in health status.

Another significant problem is the issue of the "brain drain." In order for developing countries to support themselves, it is crucial that they have sufficient professionals. However, the numbers of physicians who train in developing nations and then emigrate is staggering. In order to promote improved health outcomes, aid organizations must both dedicate resources to creating incentives for doctors to stay in their home countries and regulate the methods which developed countries can use to draw talent away from the developing world.

The author states that there are two markers that should be considered when evaluating health: maternal survival and life expectancy. Although it is impressive to reduce AIDS transmission or increase polio vaccine coverage, if life expectancy is not increasing than health is not actually improving. Maternal mortality is a good health indicator because maternal mortality has been found to be directly correlated with the stability and quality of the health system (i.e. good hospitals, sufficient doctors, clean operating rooms). Similarly, life expectancy is crucial because it is sensitive to the rates of children (especially those under 5) who die. In countries with strong infrastructures (clean water, sanitation, proper food supply, health care access), life expectancies improve. In countries that lack these things, they flounder.

The author gave some examples of times when aid has actually damaged health. In one case, a strain of multidrug resistant tuberculosis caused devastation in a South African community. This virus emerges as a result of people not completing the antibiotic treatment regimen for TB. Since the country lacks the resources to ensure that the patient takes all doses, the distribution of antibiotics was actually detrimental. Another example occurred in Haiti. There, aid organizations funded a successful campaign to improve Haitian access to ARVs and to decrease prevalence. Although these goals were realized, Haitian health markers decreased in every other category. By creating a successful separate system of care, aid workers drew talent and resources away from the established health system and indirectly caused the country's overall health status to worsen.

That's all for this week, Bye!