Where is your $10 going?

Since the earthquake in Haiti over a month ago, donations have poured into charitable organizations, NGO’s, and UN organizations like UNICEF.  With the help of modern technology, making donations both large and small can be done simply, through the Internet or even by sending a text message. Many of the organizations responding focus specifically on health (such as Doctors Without Borders or Partners in Health), sending medical supplies and medical professionals to help deal with thousands of seriously-injured Haitians, in a country whose health system was in shambles long before this natural disaster.  While much attention has been placed on financing the relief effort for this particular disaster, little media attention and little funding has been given to health-sector support.  A tragedy of this magnitude did indeed merit the outpour of international financial support that we have seen in the past month, but I can’t help but wonder: What’s going to happen to Haiti when everyone moves on to the next disaster?  How will Haiti’s health system deal with the hundreds of thousands of people who have been affected by this earthquake?

In the past twenty years, development assistance for health (DAH) has expanded substantially.  DAH encompasses both public and private health sector assistance to the developing world.  By definition, it typically only includes expenditures that are directed to disease-specific support and general health-sector support, and does not encompass programs that support other development programs, such as education or sanitation- although these programs can dramatically affect population health.  The total amount of global DAH quadrupled from $5.6 in 1990 to $21.8 in 2001.  A large portion of these funds was directed toward vertical, disease-specific programs, such as the Global Fund.  There has also been a dramatic increase in the percent of total development assistance coming from NGO’s operating in the developing world.  While both disease-specific programs and NGO’s can positively influence population health, most of the power for their health interventions is in the hands of foreigners, not in the hands of the country receiving assistance.  Powerful bilateral or multilateral organizations, along with NGO’s can further cripple weak governments, rather than helping them to create their own health programs.

A very small portion of global DAH goes toward general health sector support.  In 2007, only $0.9 billion of the total $14.5 billion of DAH (for which research was available) went toward health sector support.  This suggests that while publicly and privately funded programs may be successful in the short-term, they will not be sustainable without the continued presence of aid organizations.  This presence can’t be guaranteed, however, with the volatility of the world economy.  If more development assistance isn’t geared toward health sector support and empowering countries to take control of their own health programs, true improvements in health with be difficult to sustain.  More attention and more funds need to be directed toward health sector support in developing countries so that they may have the systems in place to eventually help lessen their dependence on foreign aid and foreign programs.  Perhaps if Haiti had been given more development assistance for its health system, some of the chaos that ensued following the earthquake could have been avoided.  Now, in the wake of this disaster, foreign governments, UN organizations, and NGO’s need to begin looking toward the future health of Haitians and therefore the future of Haiti’s healthcare system.

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