Reply: Serious shortcomings in the global handling of Ebola

Sida's claim that the Global Fund's and GAVI's efforts would be “well integrated in the recipient countries 'health systems where the starting point is the countries' own needs and priorities” lacks strong support. These and other major donors have built up special systems for HIV / AIDS support, which are separate from the countries' own systems. The donors have not done enough to increase the effectiveness of aid or reduce the burden of aid on the recipient countries, Björn Ekman writes in a reply.

Anders Molin, Sida's expert on health assistance, thinks that Sida's health support is good. It is possible, but that was not the topic of my post. He also writes that what I am saying about global health assistance, which was the subject, is sweeping, nuanced and incorrect. Handling such a large topic in such a limited space as a debate page easily leads to what can be perceived as sweeping formulations. From what I wrote that was incorrect, I do not understand Anders Molin's reply, but I will try to specify what I presented here by referring the interested reader to some sources.

My post was based on the ongoing Ebola disaster in West Africa and which by chance writes the newspaper The Guardians health reports the next day how health assistance in recent years has been directed at other parts of Africa and other continents, ie an example of how the allocation of global health assistance has been too one-sidedly focused on individual diseases in certain countries at the expense of others. Anders Molin agrees with me on this, which is uplifting.

With regard to the global system of health assistance, one can take advantage of what Bezanson and Isenman from Center for Global Development (hereinafter CGD; a think tank that is considered very competent and credible in the field) writes in a report from 2012. Among other things, the authors note that many of the global health initiatives lack a strategic direction and do not take national needs and resources into account to a sufficient extent. In a recently published report from Institute for Health Metrics and Evaluation ; a group of researchers who, among other things, analyze global health aid), it appears that the allocation of aid does not reflect the needs of the recipient countries.

There is also not much support for Anders Molin's claim that the support provided by the Global Fund and by GAVI would be "well integrated into the recipient countries 'health systems where the starting point is the countries' own needs and priorities." In a report from CGD Looking at this, it appears that these and other major donors have set up special systems for HIV / AIDS support, which are separate from the countries' own systems.

More generally, you can also take part in the evaluations that are made about the "quality" of development assistance, ie. how it meets needs and achieves results. IN CGD's latest report if this means that donors have not done enough to increase aid effectiveness or reduce the burden of aid on recipient countries. One reason is the high administrative costs (read, a lot of bureaucracy), a branch where Sweden ends up particularly far down the list. That conclusion is also in line with what has been found regarding the actual implementation of The Paris Declaration. There are also signs that it has been particularly difficult in the health sector to achieve better national ownership, something that is thus reflected in my conversation with a representative from the Ministry of Health in a recipient country.

This is of course only a small part of a much larger discussion, but from the above one can conclude that health care has been too ineffective, misdirected and probably also counterproductive, no matter how sweeping, nuanced and incorrect it may sound in the ears of a health care expert. . And I also mean that bilateral aid is probably the weakest link in this thin chain.

Anders Molin concludes his reply by saying that we will wait for the Ebola crisis in West Africa to end and then see what we can learn from it. For those of us who cannot wait that long, it may be interesting to take part in that discussion right now, e.g. here: or here. Contrary to Anders Molin's more than legally generous assessment that "Ebola shows that the world still has the capacity to respond (albeit slowly) to acute disasters.", The current epidemic has shown serious and fundamental shortcomings in the global health system, a system of which we are all, in one way or another, a part.

Björn Ekman
Researcher in health economics at Lund University


Previous posts in the reply shift:

"Reply: Nuanced criticism of health care”(Anders Molin 30 Oct, 2014)
"The Ebola epidemic is a sign of failed health care”(Björn Ekman 28 Oct, 2014)

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