Reply: Nuanced criticism of health care

At the same time as the outside world's health investments have made it difficult for the recipient countries to plan and manage their own healthcare, the resources have saved millions of lives. This is what Anders Molin, Sida's expert on health assistance, writes in a reply to Björn Ekman.

Björn Ekman writes in one article on Bistå about the Ebola epidemic and global and Swedish development assistance in the area of ​​health. His conclusion is that the Ebola epidemic is a sign of the failure of health care.

There are several interesting points in Björn Ekman's analysis and he describes in a good way some very problematic aspects of global health assistance. It is therefore a pity that he does it in a sweeping, nuanced and sometimes even wrong way.

There is a lot that could be discussed, but I would like to highlight two aspects in particular.

Over the past ten years, two large multilateral organizations have been built up that channel large resources to low- and middle-income countries. The Global Fund against HIV / AIDS, Tuberculosis and Malaria (GFATM) and the Global Vaccine Alliance (GAVI) fund vaccines. These organizations have been very successful in saving lives in their respective areas, and have received large grants from Sweden. The work of the organizations has not been entirely unproblematic. However, the problem has not been that they, as Björn Ekman writes, "have been inefficient bureaucratic conglomerates without overall control or strategic direction". On the contrary, they have been effective organizations, but with the weakness that they channeled large resources to the recipient countries only for certain defined diseases and activities, without sufficiently adapting the support to the countries' own national health plans and priorities. On the one hand, the resources have created opportunities for the treatment of HIV-positive people, tuberculosis patients, and vaccination of children, which has saved several million lives. On the other hand, the efforts have made it difficult for the countries' health ministries to plan and direct their activities. Sweden, together with other donors, has been aware of this dilemma and worked within the respective organisation's board to ensure that the support via the Global Fund and GAVI is to a greater extent adapted to the countries' own priorities and national health plans. Today, the support channeled through these multilateral organizations is well integrated into the recipient countries 'health systems, where the starting point is the countries' own needs and priorities.

The Swedish bilateral health assistance managed by Sida is currently focused on mainly eight countries (Democratic Republic of the Congo, Somalia, South Sudan, Uganda, Zambia, Zimbabwe, Bangladesh and Myanmar). The guiding principle of the assistance is to contribute to a broad strengthening of national health systems with a focus on women's and children's health and sexual and reproductive health and rights (SRHR). In support of the construction of health systems, we try, where possible, to channel funds to health ministries precisely to help strengthen institutions and national ownership. This support is often supplemented by less project support to civil society organizations. An example is Bangladesh, where the majority of Sweden's aid, in collaboration with several other donors, is channeled directly to the Ministry of Health and where we also have support for organizations that work with safe abortions. In several of our partner countries where it is difficult to work through the state, we use other channels such as the UN system or civil society.

Finally about Ebola. It is extremely important that the international community, once the ongoing epidemic is combated, makes a proper analysis of what needs to be done to prevent a similar epidemic in the future. I myself believe that that analysis will lead to two overall conclusions. Partly that the international preparedness for similar epidemics must be significantly much better in the future, both at national and international level- Partly that a serious discussion is needed on how international support can be improved and expanded so that the world's poorest countries can have a sustainable socio-economic development that is much faster than is currently the case. Then the countries themselves can develop institutions that can handle this type of crisis better. What Ebola shows is that the world nevertheless has the capacity to respond (albeit slowly) to acute disasters. The chronic catastrophe in which the world's poorest live, on the other hand, must receive more attention than what we see today. Health aid is part of this, but it is the broad fight against poverty that is most important.

Anders Molin,

Sida's expert on health assistance

This is a debate article. The author is responsible for analysis and opinions in the text.

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