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Commentary

Dr. Santa Comes to Town
Jon Entine, Campaign for Fighting Diseases, 3-26-07

Entine argues that the enormous flood of funds flowing to health projects in poor nations is largely misspent by NGOs that are focused on pleasing their donors rather than building long lasting health care infrastructure.

It is the curse of good intentions. Each day, 50,000 people, mostly women and children—18 million people a year—die from poverty-related causes such as dysentery and malnutrition. Although the statistics are devastating, the prognosis should be heartening. The explosion in philanthropy spearheaded by the mind-boggling $60 billion that has begun flowing out of the Bill and Melinda Gates Foundation for healthcare has buoyed hopes in the developing world.

But here's the rub: while billions pour into high-profile drug-focused programs targeting malaria and Aids—in the US, 43% of foreign health assistance funds HIV efforts—less glamorous but more widespread problems such as maternal care and the public health infrastructure are overlooked.

As Laurie Garrett notes in January/February's Foreign Affairs, "there is a grave danger that the current age of generosity could not only fall short of expectations but actually make things worse on the ground."

The major culprit is well-meaning NGOs that have seen their financial pipelines swell to overflowing. What's the problem? James Pfeiffer, now at the University of Washington and previously an NGO administrator in Mozambique, has written eloquently about the "flood of NGOs" which has "fragmented the health system" by creating model projects focused on popular drugs that help a tiny fraction but which bleed resources from the basic day-to-day needs of the vast majority.

James Pfeiffer, currently at University of Washington School of Public Health and Community Medicine, wrote eloquently when an anthropology professor at Case Western Reserve University in Cleveland about the "flood of NGOs" that he believes has "fragmented the health system" by creating model projects focused on popular drugs that help a tiny fraction of the impoverished, and bleed resources from the basic day-to-day needs of the vast majority.

"It's a 'Santa Comes to Town' health system," agrees George Jagoe, who spent two years in Mozambique as part of the Clinton Foundation HIV/AIDS Initiative. "In their eagerness to 'nail the numbers' promised to their donors or provide "first world care" in rural districts, foreign NGOs import short-term healthcare workers, over-invest in narrow disease-specific programs, and demotivate local workers who don't get any of the funds."



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