The Ebola epidemic is a sign of failed health care

The parallel, bureaucratic structures that have emerged in international health assistance mean that the support of the outside world can be directly detrimental to the recipient countries' conditions for development. No more fragmented efforts are needed to deal with the Ebola epidemic, efforts based on knowledge and needs are needed. That is the opinion of Björn Ekman, a researcher at Lund University

The worst Ebola epidemic in history is currently raging in West Africa and the effects of it are being felt in more and more places outside Africa. The epidemic is a humanitarian and economic disaster of appalling proportions. But, from a larger perspective, it is also a serious sign of the failure of the rich countries' health aid, including what has been provided by Sweden for several decades via the aid authority Sida. And there are other equally serious but less obvious signs of failure.

Like other development aid, health aid rolled on at a leisurely pace for a long time. In the early 2000s, something happened when the world seemed to wake up and realize that an entire generation, especially in sub-Saharan Africa, was on the verge of being wiped out by disease. In particular, it was the HIV / AIDS epidemic that was the subject of a multiplication of health assistance as it was considered, with some justification, to be the really big threat. To mobilize and channel the increased resource resources, around the middle of the 2000s, a large number of so-called global health initiatives have been taken in the form of funds, alliances, partnerships and countless other new constellations. All of these were added in parallel with the already existing UN agencies, such as the WHO, UNICEF and the World Bank, and to the approximately twenty bilateral aid agencies, all of which provided various types of health assistance. The result has been a system of inefficient bureaucratic conglomerates without overall governance or strategic direction. The global aid apparatus is not only guilty of a major waste of aid money, but is also a directly harmful system that has allowed poor recipient countries to see their own institutional and other conditions for development overthrown.

"Development aid has meant that we cannot prioritize, plan or control our own development." So says a senior manager in the planning department at a ministry of health in one of Sida's largest recipient countries. He could have sat in any ministry in any other recipient country, the picture is pretty much the same. When I recently asked what would happen to a similar epidemic that in West Africa would hit his country, he just rolls his eyes and says that it could only end in one way, in total disaster: "We have no conditions to deal with such a situation." And donors have not contributed in an effective and sustainable way to building in the recipient countries a preparedness for, or rather an ability to prevent, outbreaks of serious infectious diseases. On the contrary. Uganda was one of the few countries that managed to reverse the spread of HIV / AIDS at an early stage. Today, after receiving many millions of dollars in health care, not least in the field of HIV / AIDS, the prevalence of HIV is increasing again. It can not be seen in many other ways than as a serious failure for aid, which is what essentially determines the development of the health sectors of Uganda and many other countries.

All health care provided in the last, say, 15 years has not been wasted. Vaccinations for children are, without discussion, a completely necessary type of intervention. There are also other examples of what could be considered "health assistance" that have contributed to improved health for many people. But, to an excessive extent, health care has been ineffective, misdirected and misconceived. Above all, it has failed to help build effective health care systems that can prevent the spread of infection, improve public health and deliver basic health care to those in need. Much of the health support, especially bilateral, is handled by individuals and organizations who lack the right skills and whose driving forces are more political than appropriate.

It is time for the support given to low- and middle-income countries to become significantly more needs- and evidence-based. Instead of fragmented efforts against individual diseases, health assistance must draw on the knowledge and experience that exists about how sustainable and fair health care systems can be developed. This requires a new structure that is more country- and local-based than today's "Geneva-based" architecture. Such a structure would probably mean fewer but more competent actors than the current plethora of inefficient bureaucracies.

Björn Ekman
Researcher in health economics at Lund University

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