Health initiatives ‘backfiring’ in poor countries

GLOBAL health initiatives aimed at fighting major threats such as AIDS and malaria are showing signs of backfiring in the countries that most need their help, it was claimed yesterday.

Two reports from the World Health Organisation (WHO) and a team of US researchers point to serious shortcomings in the health programmes.

The WHO said, although global health initiatives (GHIs) had benefited millions, there was evidence they held back the health systems of poor countries.

Services not targeted by GHIs were sometimes left behind and aid from outside could lead to countries reducing their own health spending.

GHIs had both exposed and, on occasions, contributed to weaknesses in the governance of health systems in poorer countries, said the authors. Reliance on GHI supply structures to obtain drugs and medical equipment could compromise a country’s opportunities to develop its own.

Global health initiatives had also had an adverse effect on health service workforces.

In some cases, GHI projects had poached healthcare staff from the public sector. In others, they had been linked to an increased imbalance between workforces in urban and rural areas.

Dr Carissa Etienne, assistant director-general of the WHO, said: “The financial crisis poses some fundamental questions about the way the international community uses its resources. And the response is, while we clearly need more funds for health, we also need to identify opportunities to deliver better results and value for money. Building stronger health systems and promoting greater synergies between health systems and individual health programmes are key to making this happen.”

The WHO findings were published in The Lancet medical journal, which also carried a critical report on global health funding from researchers in the US.

The paper showed funding for health in developing countries had quadrupled over the past 20 years from $5.6 billion in 1990 to $21.8bn in 2007. Private donors were gradually displacing governments and agencies such as the World Bank and UN as major contributors of global health funding. In 2007 they made up 30% of the total. Study leader Professor Christopher Murray, from the University of Washington in Seattle, said: “With no-one tracking this massive growth in spending, it’s no wonder that some countries receive far more than their neighbours for no immediately apparent reason.”