Public health infrastructure

Dear Colleagues

Public health infrastructure maybe better than it was a century ago ... but in most or the Global South, the state of the public health infrastructure is appalling.

Why is this? Health has been a priority for international support from donors for decades ... but has it really been able to do much good.

It is possible to argued that health is the perfect scam. Everyone is easily convinced that disbursing money for health is a good thing. In this situation fund raising is relatively easy, and programs get approved.

But what exactly is the money going to be used for? In my own personal experience as an acting aid coordinator for an African country, 16 different countries were offering bilateral assistance for the health sector. The problem was that every single one wanted to use the money available to study the sector, and not one was willing to help fund what other studies (and very good studies at that) showed was most needed ... help with buying drugs, help with increasing operating expenditure disbursements, help with training more nurses, etc. In order to get a small amount of the things we needed, we had to have studies that nobody needed and did nothing but consume available funds.

My impression is that the problem that I describe ... which was 15 years ago ... is as bad as ever.

Another issue is that the general expectation of support from the health budget of government is unrealistic given the terrible state of most countries' public finances. Donors have helped in some cases with program funding for health, for example, for AIDS, for immunization, for bednets, etc. And while this has helped to get some of the needed items into the country, the underlying failed health infrastructure remains a problem.

The top down planning favored by WHO, the World Bank and others in the international donor community encourages the program approach, and makes coherent health activities at the community level a distant dream.

Tr-Ac-Net is committed to the idea that development performance will be improved substantially as soon as performance is looked at from a community perspective. From this perspective much of the international community's support seems to be badly allocated and essentially almost useless. This is a serious observation ... over and over again, I have been asked why is it that nobody will help with what we need, but we can get all sorts of resources for things that we don't need.

One of the areas that is needed ... improved public health infrastructure ... meaning funds for staff and for medication that is needed to treat people with illness ... and funds to help make communities healthier through better prevention.

One step at a time ... one community at a time will work.

Sincerely

Peter Burgess