The discipline of global health follows the mission of improving health and instilling equity in health for all individuals on a worldwide scale through the adequate implementation of good health practices and engagement, as well as deriving equitable solutions from proper research and promoting these results to increase knowledge. Perhaps one of the most common practices to help alleviate the health stressors in developing countries is foreign aid. Foreign aid in global health and similar development projects have only increased at an unprecedented rate in the early 2000s - making it a relatively new form of distributing necessary aid to countries that lack stable health systems. However, the main concern that arises about foreign aid is its credibility of improved financial assistance for its intended beneficiaries. Are there guiding principles that effectively ensure the delivery of foreign aid to some of the world’s poorest settings? How does foreign aid work in countries that severely need assistance in their standard of care and improvement of health outcomes? What are other factors that should be implemented alongside foreign aid so that a long-lasting health difference can be instilled throughout developing countries?
Let’s begin with the definition of foreign aid. Foreign aid is defined as humanitarian or financial assistance given to developing countries to assist them in improving health outcomes, emergency preparedness, and disaster relief in rural neighborhoods. Many public discussions support the principle of foreign aid and its ability to help fill the gap or supply the missing resources in developing countries. Jeffrey Sachs, an economist at Columbia University, is an avid supporter of foreign aid, emphasizing in his book The End of Poverty: Economic Possibilities for Our Time (2005) that the contribution of “$135 to $195 billion in foreign aid could help end extreme poverty, which would only amount to 0.54% of the rich world’s gross national product - less than the 0.7% target proposed by the UN Millenium Project” (Sachs, 2005). Families living in developing countries experience the consequences of poverty traps, in which Sachs describes that they “are unable to reach the first rung of the development ladder because they spend all of their income on basic survival and therefore, unable to begin saving and investing in productivity enhancements, education, health care needs, and other preconditions of escaping poverty” (Sachs, 2005). Besides poverty traps hindering the financial liberation of poor families in developing countries, geography is also another factor. According to Sachs, developing countries that struggle with a large disease burden due to its tropical climate, or high transportation costs due to the terrain in rural areas, encounter barriers to economic growth. Sach’s points out that with the adequate application of foreign aid for the multitude of developing countries that endure poverty traps and high burdens of geographical factors, individuals living in these countries are more susceptible to overcome these economic stagnation difficulties. Of course, with high optimism comes greater criticism, however, Sachs points out that “foreign aid can help reduce poverty, only if it is overhauled into an efficient, transparent, and accountable system that effectively channels resources to the people who need them most” (Sachs, 2005). On the opposite side of the spectrum, William Easterly, a former World Bank economist and currently working at NYU, completely rebukes the optimism presented by Jeffrey Sachs. He continually challenges the legitimacy of foreign aid and if it is a truly effective tool that improves the health and well-being for the individuals left behind by development.
Although foreign aid has relatively been a helpful tool for developing countries, foreign aid in itself alone still presents limitations. With the rapid evolution of the world, the solutions presented by foreign aid alone are not a sustainable one-size-fits-all approach. There should be other tools working alongside the distribution of foreign aid if we really want to help uplift the voices of the individuals of developing countries and help dissolve the issues within their current health systems. Easterly provides a counterargument for Sachs’ stance on foreign aid, highlighting in many of his writings that the history of foreign aid is a failure of grand schemes of developed countries. In his 2006 book, The White Man’s Burden: Why the West’s Efforts to Aid the Rest Have Done So Much Ill and So Little Good, Easterly examines the failure of foreign aid promoting economic growth by utilizing cross-sectional statistics to analyze foreign aid delivery programs. He argues that “not only has aid failed to promote growth, but it has bred dependency and corruption in poor countries” (Easterly, 2006). He uses the example of corruption in the country of Cameroon, in which the president, Paul Biya, siphons off at least 41% of foreign aid that Cameroon receives. Easterly also argues that the “underlying problem with aid is that its initiatives are hatched by “planners” in the United States and Western Europe - aid officials seeking to impose top-down solutions to poverty and other problems of development, but such blanket cures will not trigger economic growth and social developments” (Easterly, 2006). It is quite apparent that foreign aid is often intercepted by dictators and predatory elites before fully reaching its intended beneficiaries. Easterly reveals that the focus of foreign aid must shift from its overall sum to how it can spur growth. He adamantly suggests that foreign aid should instead bypass governments and flow directly to private sectors to reach its target and fulfill its mission.
Although foreign aid has been a great tool, it does have its limitations, which have been attributed to consequences of corruption and leaving individuals living in the midst of poverty without any assistance. Many approaches to address the implications of foreign aid are the accompaniment approach, foreign aid reform, and deep reflection to erase the injustices in the realm of global health. The accompaniment approach is defined as supporting developing countries and its public and private partners until they have the viable capacity to improve livelihoods in the long run. With the concept of patience, flexibility, and commitment to engaging in the mission to help the poor and their allies to build effective health systems that will trigger economic development and proper health care delivery. The accompaniment approach is broken down into eight core principles:
1) Favor institutions that the poor identify as representing their interests - Listening and taking into account what the individuals have endured first hand with the successes and failures of foreign aid projects in the past. They have a wider knowledge and suitable approach of which development opportunities will likely contribute to delivering aid effectively and acting in their best interests.
2) Fund public institutions to do their jobs - The funding of traditional NGOs commonly drain the sectors of natural resources and skilled personnel within the developing country, leading to further corruption. To combat the likelihood of corruption, it is important to prioritize systems of accountability and transparency within development opportunities.
3) Make the job market a benchmark of success - Contributing to the growth of local job creation will bolster individuals into achieving basic well-being and the opportunity to pursue their own dreams of professional development. Local job creation simultaneously benefits individuals and the stimulation of local economies, creating a more robust approach within their health system.
4) Buy and hire locally - Buying local goods/products from local farmers can contribute to further job creation, development of local markets, and even increase entrepreneurship among individuals.
5) Co-invest with governments to build strong civil services - The accompaniment approach will promote the modernization of pre-existing human resource systems, which inevitably goes hand in hand with the health workforce to produce strong civil services within the country.
6) Work with governments to provide cash to the poorest - The theory of poverty traps, introduced by Sachs earlier in the reading, have left many families to fend for themselves as they try to navigate out of poverty. Direct cash transfers can be a useful tool in reducing the hardships of poverty, boost demands for local goods (enhancing the fourth principle), and empower locals, thus creating more equity.
7) Support regulations of international non-state service providers - The involvement of NGOs, or non-governmental organizations, often lack proper coordination and regulation, resulting in higher risks of being duplicative, inequitable, and unaccountable to the beneficiaries they are meant to serve. Instead, the involvement of the government of recipient countries of foreign aid would be better and generate meaningful, long-lasting solutions.
8) Apply evidence-based standards of care that offer the best outcomes - Implementation research and other methods in poor settings will only procure health care results with budgets and funding streams, as well as raising the standard of health care in resource- poor settings to a higher level.
With these eight core principles of the accompaniment approach in global health, how is it practiced in an effective manner? We can look at the efforts made by the American Red Cross, and how these efforts ultimately strengthened the largest public-sector hospital in Port-au-Prince after suffering from an earthquake in 2010. The American Red Cross pledged to spend $3.8 million on a salary support program. The General Hospital in Port-au-Prince lacked modern book-keeping and computing systems to keep track of employee work hours, and this unprecedented issue was solved by the American Red Cross’s efforts in the installation of new and upgrading of current computer systems to benefit the hospital workers as they treat victims of the earthquake. The relentless efforts made by the American Red Cross shows the importance of solving root problems through long-term assistance guided by the core principles of the accompaniment approach. It also shows how the benefits of the accompaniment approach are very worthwhile because it creates a stronger health system to provide better care in a specific approach that best suits the locals without overwhelming them. The application of foreign aid and the accompaniment approach have pioneered the way for other projects, including the coordination and partnership of non-state health providers and local ministries of health, international health groups purchasing local goods instead of following the norm of importing goods, and the prioritization of increased job creation.
Foreign aid and the accompaniment hold the basic frameworks needed to implement an adequate and proper health system in developing countries, but there are some things we can do as individuals to promote a long-lasting change in developing countries and create better health outcomes for the individuals trapped in poverty. Dr. Steve Gloyd, a family practice physician, UW faculty member and professor, and Director of the Global Health MPH Program at UW, has presented a powerful presentation on what the general public can do to advocate for global health justice. In my Global Health 201 seminar, I have learned valuable information on ways to address global health injustices, and I urge others to follow these steps to create advocacy for proper deliverance of aid to developing countries. According to Dr. Gloyd, foreign health workers in low-and-middle-income countries apply humility when developing and using skills - have a sensitive mindset to inequalities and resentments that might occur from the locals. This ties back into the first core principle of the accompaniment approach, understanding that the locals in the developing country know which approach is best to produce the health outcomes they want (there is no one-size-fits-all approach when implementing a health system in developing countries as each country has different needs and different solutions must be implemented to reach these needs). Personal steps we can all take are changing the narrative about foreign aid such as advocating for fairness, equity, and redistribution to local governments and ministries of health within the country, and support groups that work towards equity and challenge the status quo of foreign aid and predatory capitalism. Perhaps one of the most vital steps we can take is to challenge ourselves to align our work as advocates of global health with our own values. This step can lead to a plethora of benefits, including fighting for the change in the current state of foreign aid and calling out inequalities with its distribution, as well as adding on the principles of the accompaniment approach along with the renovated approach of foreign aid - all of which lead to the perfect recipe in creating and sustaining a health system that fits the needs of developing countries.
Work Cited:
Sachs, J. (2005). The End of Poverty: Economic Possibilities for Our Time. Penguin Books, an imprint of Penguin Random House LLC.
Easterly, W. (2006). The White Man’s Burden: Why the West’s Efforts to Aid the Rest Have Done So Much Ill and So Little Good. Oxford University Press.
Farmer, Paul, et al. Reimagining Global Health: An Introduction. 1st ed., University of California Press, 2013. JSTOR, http://www.jstor.org/stable/10.1525/j.ctt46n4b2. Accessed 20 Nov. 2023.
Gloyd, S. (2023). Lecture 3: Global Health Justice Presentations [PowerPoint Slides]. University of Washington Multidisciplinary Perspectives In Global Health
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