International health and aid policies: urgent cure needed!

Blog Post by Jean-Pierre Unger, physician, professor of public health, Institute of Tropical Medicine, Antwerp, Belgium

Red carpets were put away. The MDG midnight mass ended over renewed, solemn commitments. But the by now near failure of the MDGs in health can be read as the chronicle of a death foretold, a failure especially manifest in a region, where international aid is most active – in Sub-Saharan Africa. 10 million are victims of communicable diseases vulnerable to simple drugs such as malaria, tuberculosis, AIDS, diarrhoea. These victims die because they lack access to quality, affordable health care.

Although appalling, these figures are not news. What is new is the now demonstrated culpability of international health policies in this situation. For over a decade now, our team and many collaborators worldwide have gathered evidence on the grave consequences of a series of international health policies. These policies have promoted excessive reliance on disease-specific programmes and commercialised care delivery and financing, while restricting access to family medicine and hospital care.

This research has now been collated into a new book published by Cambridge University Press, International Health and Aid Policies: The Need for Alternatives which by chance is being released while the Summit of the MDGs is being closed in New York. International aid to date (2009) amounts to more than 120 disease control programmes implemented in many capital towns, regions and districts of developing countries. This worldwide, pervasive bureaucracy is one of the largest, if not the largest, ever created. It consumes the bulk of the aid funds and has negative effects, including the underutilisation of health professional skills in excessively standardised disease control programmes.

Our researches also show that the model of health care delivery promoted by the aid policies has rarely been evidenced-based. For instance Costa Rica, which has a politically independent public health care system, scores close to the USA on its epidemiology and demographic indicators and access to health care while spending nine times less on health per capita. This experience and other national case studies pose the question why the American model, not the Costa Rican one, is used as a universal policy yardstick. International Health and Aid Policies offers strategies to health professionals to develop socially motivated, publicly oriented health services, regardless of where they are posted and the government’s policy. These perspectives aim to bridge the gaps between public health and medicine. 

It is the view of many authors in this collection that the MDGs in health won’t be achieved unless one new MDG is added: access to family and community medicine (possibly implemented by nurses and clinical officers where there is no doctor) and to general hospital care. These can be measured with the number of new cases (sickness episodes) per year per inhabitant accessing first line services and the admission rate, respectively. Without this, disease specific programs will remain fishing for scanty candidates for their activities in dried up ponds. The book concludes that it is urgent and essential to develop a not for profit health sector, with a publicly oriented and  social mission. This the authors argue  would permit to coordinate health activities of organizations such as MoH, municipalities, regions, provinces, NGOs, mutual aid associations, social security health services, denominational hospitals, etc. Such an organizational framework, supported with the needed financial and technical support, could overcome the incredible segmentation of health services in LMIC and integrate disease control interventions in bio-psychosocial, patient-centre care – in short humanized health care such as that most of the people in the world would desire, as healthcare remains a fundamental human right denied.

 JP Unger, P De Paepe, K Sen, W Soors. International Health and Aid Policies, Cambridge University Press, 2010. Paperback 9780521174268.

*these views are of the author only and not of the Institute of Tropical Medicine

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