AID WITHIN GLOBAL RELATIONSHIP ARE THINGS GETTING BETTER OR WORSE

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AID WITHIN GLOBAL RELATIONSHIPARE THINGS
GETTING BETTER OR WORSE?

• MUSTAFA KHOGALI
• 25/6/02

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1. BACKGROUND

• A. What is Health?
• What is Development?
• What is Health Development?
• B. We are all interdependent in health
  including other creatures.

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• Health is a state of EQUILIBRIUM
• between humans and the physical,
• biological and social environment,
• compatible with full functional
  activity

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Classifications of Nations

• Per Capital GNP
• World Bank
• 1. Low income
• 2. Lower middle income
• 3. Upper middle income
• 4. High income
• UNICEF according to infant and early child
  mortality rates.

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Agencies Involved in the International Health

• (MULTILATERAL) government sponsored agencies.
• (BILATERAL) government agencies in a single
  country , e.g. USAID.
• (NGO) private voluntary organizations (20).

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Government Sponsored Agencies(MULTILATERAL)

• UN Organizations
• WHO
• UNICEF UN fund for children.
• UNDP - UN Development Program.
• FAO - Food and Agriculture Program.
• UNFPA - UN Fund for Population Activities.
• UNHCR - UN High Commission for Refugees
• WB - World Bank

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• B. Bilateral
• USAID US Agency for International Development.
• SIDA Swedish International Authority.
• CIDA Canadian International Development Agency
• C. NGOs
• ICRC International Com
• Red Cross
• Red Crescent

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WHO 1999

• FOUR CHALLENGES TO WORLD HEALTH
• Decrease mortality and morbidity among poor.
• Investment in Res Dev for diseases of poor.
• Countering threats from economic crisis,
  unhealthy environment, and risky behaviors.
• Development of effective and efficient H systems
  that improve H status and reduce H inequities,
  and enhance responsibilities.

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World Bank HNP sector strategy

• Three goals in
• Improving Health - outcomes for the poor.
• Increasing efficiency of Health care.
• Facilitating sustainable Health finances.

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W.B. Commitment vs Challenges in Health

• Millennium development goals.
• Poverty reduction strategies
• Global public private partnership
• Sustainable development and cross sectional
  approaches.

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Poverty

• Definition of Poverty
• A range of factors housing, commodility price
  and degree of inequality in society
• Wealth and Poverty
• Are they determinants of health?

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Equity

• Fairness and justice???
• Is it offering equal goods, resources and
  opportunities to all individuals?
• Equity in Health Care
• Equal shares of HC regardless of need? OR
• Distributing HC equally
  healthy
• Can equity be EFFICIENT?

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DEVELOPMENT

• What is Development (D) ?
• Goal of D a state of global WELL
  BEING
• Indicators measures of economic
  growth GNP and per capital income measure of
  health

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Are Things Getting Better or Worse?

• ENV Vs Socioeconomic Perspective?
• What can we do to make things better?
• Changing views about development?
• poverty---- Is it the invention of civilization?
• OR IS Wealth------ the motive force of
  civilization?

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• 1960s D was synonymous with GROWTH?
• Growth-promoting policy was the order.
• The TRICKLEDOWN EFFECT
• 1970s third world D was stunted
• ILO basic needs approach
• WHO PHC approach

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• 1980s A decade lost for development (UN
  1990)
• Austerity measures of WB Packages.
• Growth supercede Equity
• 1990s EQUITY (Renewed call)
• GLOBALIZATION

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Globalization

• All countries are INTERDEPENDENT.
• It is not new
• Colonialism
• Internationalization of capital
• Multinational corporation
• STRUCTURAL ADJUSTMENT

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Privatization a global trend??!

• 80s 90s shift in role of state in D
• ????? Public sector accused, inefficient and
  performing poorly.

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Sectorial Reform

• In context of structural adjustment
• Sector Reform Central Part
  of Agenda of International Inst.

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• REFORM
• Improving management
• improving efficiency
• increasing competition
• containing cost
• W.B in essence promote
  private sector

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AID AND HEALTH SECTOR (1)

• 1. AID is a two way process
• For Donors Recipients
• Donors (Multilateral / Bilateral / NGOs)

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AID AND HEALTH SECTOR (2)

• With resources
• a. Conditions
• b. Demands

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Features of AID Process (3)

• Paradox Awareness of Role Health
  sector in Development.
• Calls for privatization
• And shift of role of state
• Provider to regulator

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• Problems (4)
• Provide capital costs but not
  recurrent costs
• Commercial interests of donor countries
• (Goods to be ordered from donor country)
• 3. Nature of AID Project itself.
• 4. Projects have a limited life.

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Question of Sustainability

• The ability of a system to produce outputs that
  are sufficiently well valued by beneficiaries and
  stakeholders, so that enough inputs are provided
  to continue performance leading to long term
  benefits and impact.

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Privatization within the Health Sector

• 1. Privatization An important part
  of political agenda
• 2. Private sector the way to provide
  care.
• 3 . International agencies have espoused
  
• privatization.

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• Q Is it that creation of a market
  environment within health services, will improve
  equity, efficiency, and quality of services?

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• Is there a case against the public sector?
• 2. Is the public sector inefficient?
• 3. What is the market environment for?

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Privatization

• Does a market environment
• Enhance democracy and community participation?
• Increase efficiency?
• Improve the services on offer?

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Conclusion

• Provide a guide for the study of health policy as
  related to AID.
• In 70s and 80s- debates were dominated by PHC
  Approach
• Today the BUZZWORD is HEALTH SECTOR REFORM.

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• Has the struggle for health for all by year 2000
  been dropped?
• Health sector reform is an open-ended concepts,
  which will drop equity?
• Is this what we aim at?
• To provide primitive HC instead of Primary Health
  Care for the Poor.