Wednesday, June 1, 2011

The Fallacy of Donors' Driven Health Agenda

In Tanzania, like many other low income countries, funds for healthcare activities are largely derived from donors. It can be PEPFAR, USAID, or The Gates. We can not tax our way through providing comprehensive health insurance for everybody in the model of UK's NHS for obvious reasons. And we can not generate funds from Social Insurance Schemes due to largely high levels of unemployment. So, we rely on donors, who in turn get to set the agenda and the priorities on how to spend the money.

This is what we get-- Acute Respiratory Infections only get 3% of funding despite contributing to 25% of disease burden. Shigellosis (some stomach infection) kills 1 million a year, mostly children but receives relatively no fundings. On the other hand HIV despite of its deservingly fame, contribute only 5% of disease burden but it collects 32% of total funds. There is absolutely no infrastructures for cardiovascular and other non communicable diseases, but collectively there is no emphasis to earmark funds onto these categories (because they do not cross borders). This is what happen when a country loose grip of its own agenda.

What is rather surprising is law makers in Kenya have gotten creative and proposes airline levy (like UNTAID is doing) to increase funds for HIV. This is mind boggling, because they could use that money to build up their non-communicable disease infrastructure since they get so much HIV money from other sources.

We can not improve the health outcomes of our people, if we can not even address the problems that requires our undivided attention. Spending our time and efforts in HIV, TB, and Malaria just because thats what the donors want is a ticking time bomb.


Anonymous said...

Thank you for this piece.
I wasnt aware of this problem before . Thank you for sharing .
Off point, is it just me or the likely biggest health challenge we are like to face is diabetes and other diatery complications ?
I mean , with the increased middle class families in Dar, it seems the society is sleep walking into this .

Thuwein said...

You are very right, and thanks for sharing your 2 cents. There is already an epidemic of Diabetes in our society and as of now, we do not have enough resources to control it. I'm sure there are policy position in place, but they are quite unimplementable.

Our policy makers, pushed by donors are focusing on disease control measures rather than investing in a holistic health systems. If we can spend energy in building a top-up health system, with health extension workers in rural areas, and a classy emergency medicine component kwenye hospitali za rufaa (to begin with). We might have a chance to prevent premature fatalities and have a healthy nation.