LILONGWE, Malawi – Foreign aid, despite its necessity, will never replace country-led approaches to solving public health issues. The funding potential from international donors for global health programs may be many times greater than a developing country’s public health resources. However, long-term success is largely determined by the strength of governance in countries that have traditionally relied on health aid from international donors.
This was one of the major themes of a recent progress report from the consortium Uniting to Combat NTDs, a broadly supported organization which is endorsed by major international donors such as USAID and The Bill & Melinda Gates Foundation.
It is a regular mantra among development organizations that country-led approaches to economic, social and health issues are superior in quality and sustainability to donor-run global health programs. USAID even states on its website that its goal is to no longer be needed; presumably this would involve empowering developing nations to fully fund their own programs and social safety nets.
However, producing country-led solutions to public health issues is often an elusive goal. International donors might supply large quantities of medical supplies, which simply end up collecting dust in a warehouse because the aid recipient lacks the resources to distribute them.
Such was the case in Malawi in 2008, when Square Mkwanda, an administrative employee for the Ministry of Health, was trying to utilize millions of dollars worth of vaccines meant to treat Neglected Tropical Diseases or NTDs. Mkwanda and the Minister of Health of Malawi initially managed to distribute the vaccines to only eight of 26 districts.
By the following year, they were distributing the drugs to all 26 districts without relying on international aid. This was an ideal case of an aid recipient producing strong leadership to solve a public health issue without relying too much on relatively unstable international funding. Recently, Mkwanda was able to announce that the distribution program had effectively halted the transmission of lymphatic filariasis in Malawi, commonly known as elephantiasis.
Treating NTDs, in particular, presents an opportunity for developing countries to practice good governance. NTDs are very common, and efforts to eradicate them are among the most well-funded by international donors. Thus, the places hardest hit by NTDs have the opportunity to use that funding to create their own public and global health programs as they slowly, but surely, develop the ability to finance and administer them.
According to the report by Uniting to Combat NTDs, there is cause to be optimistic, as “countries are demonstrating strong political ownership and leadership, in variable financial, political and environmental circumstances, to ensure their NTD programs are successful in meeting 2020 targets.”
The report also discusses creative ways that affected countries might begin financing and administrating their own programs. These methods include decentralizing program management, coordinating with education systems to deliver vaccines and drugs to school-age children and funding programs through airline ticket levies.
In addition to Malawi’s success story, the report also describes how Bangladesh, the Philippines, and India are all funding most or all of their NTD programs. These successes were in part motivated by the Addis Ababa NTD Commitment in December 2014. This summit of developing nations in Ethiopia’s capital served as an acknowledgment that treating NTDs should be high on domestic development agendas and a commitment to increase domestic investment in public health programs which treat them.
Signatories of the commitment have developed their programs in unique ways that reveal the flexibility and durability of country-led approaches. Brazil, for example, has rolled its treatment of NTDs into its national poverty reduction program, which includes other indicators such as sanitation and education.
The program allows individual municipalities to administer treatment of NTDs in whatever way is most effective for their geographic idiosyncrasies, making for a more efficient distribution system. Brazil, which is more of a middle-income country, is even helping fund the public health programs of other developing nations.
Interventions such as these are essential steps toward creating global health programs which can outlast aid. If countries such as Malawi can continue to strengthen their ability to effectively utilize and distribute medical resources, they can hopefully eliminate their dependency on donors in the long run and strengthen resource management. Mkwanda noted that his distribution program helped the Ministry of Health increase its budget discipline and effective distribution of other health resources as well.
This observation supports a statement by Kesetebirhan Admasu, Ethiopia’s Minister of Health, the one who initiated the Addis Ababa NTD Commitment. He noted that NTDs are confounded with other development and governance issues, saying that “NTDs are not only a health agenda but a development agenda too, for which the poor pay the highest price.”