Utah Valley Global Health Group

A blog about global health for those living in Utah Valley and their friends.

International Development by James Fuller

Posted by benjamincrookston on August 11, 2008

Governments, like any steward, are certainly most effective and responsible when they are accountable to their constituencies. Unfortunately for the millions suffering throughout the world, no one is held accountable for failures in global health, but many are willing to take credit for success. I don’t mean to cast stones at the sinners; I simply believe it is important to recognize the inherent flaws in the international system in order to avoid them.
Bilateral and multilateral donors spent over $11 billion in 2005 on health and population projects. A large portion of that comes from American taxpayers. Therein lies the problem. Donors often respond to the wishes and needs of taxpayers, instead of to the wishes and needs of the sick. Can we count on donors to always act in a humanitarian way? The answer becomes clear when we apply the same question to a Congressman or bureaucrat.
The truth is, donors often act in their own self-interest. Aid is too often used as a foreign policy tool instead of a health tool. At present, aid does not provide a voice to the voiceless; when a USAID funded clinic in Kenya is not appropriately staffed or equipped, USAID is not held accountable to Kenyans. USAID is accountable to the American people, and if the taxpayers are indifferent then so too will be USAID.
Though aid is only a fraction of our government’s budget, it must become a more important policy issue. An increase in the quantity of money will not be nearly as valuable as an increase in the quantity of it. Donors must become more transparent, Information on aid projects must become easily accessible to taxpayers, and most importantly, taxpayers need to care! Election time is wonderful for showing what Americans want from their government. Unfortunately, most of those desires are entirely based on material self-interest. Donors will not become more responsive to the health needs of the world, until we the people are ourselves responsive.


3 Responses to “International Development by James Fuller”

  1. chads said

    I’m currently reading “The Trouble with Africa: Why Foreign Aid Isn’t Working”; Calerisi makes some of the same points you are.

  2. Dave said

    This is also the issue stressed by William Easterly in his books, the difference between “planners” and “searchers.” I agree with the need to increase accountability and transparency as they will facilitate greater competition and therefore higher quality and efficiency, but I don’t think taxpayers in the U.S. is where the change is needed, the needed innovation is empowering the Kenyan receiving the service to be able to “vote” for quality service and care. We need to mimic the feedback mechanisms of the market and incorporate them into the public sphere. We need to change the current system of organizations appealing to the US government for money and being awarded by how well they can maneuver through the bureaucracy or how well they align to US political interests towards a system in which the feedback of Kenyans is used to award the best organizations, the feedback of the end user needs to drive the money.

  3. chads said

    interesting perspective, Dave. I’ve never really thought about it like that, but it makes sense. I’m just not sure that all public health services can or should be subject to the market. I guess I’m thinking of clean water and vaccines. Any thoughts?

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