(Not) Trying to Kick the Dependence

When I was 12, in a moment of unnecessary arrogance, I confronted my uncle—the hardest-working doctor I have ever met—with the following challenge: don’t you think it’s a little bit perverse that your livelihood depends on there being sick people in the world? He paused for a moment, before stating: “I would gladly be out of a job if it meant there were no more sick people in the world.” I felt sufficiently put in my place, even comforted by my uncle’s sentiments. It seems, though, that these are not shared by health providers throughout the world. In fact, as Cohen et al. point out in “The New Colonialists,” many aid organizations actually rely on the dysfunction of the countries they are claiming to help. Their institutional survival “depends on it.”

In the medical world, drug dependence refers to a person who needs a drug to function normally; stopping the drug abruptly leads to withdrawal symptoms. As the shared terminology suggests, it seems that a similar dynamic exists between aid organizations and many developing countries, and that the dependence goes both ways; as Cohen et al. argue, “these new colonialists need weak states as much as weak states need them” (77). With all the money flowing into the burgeoning NGO/aid/development industry—a key question to be asked is: are these organizations working toward solving public health crises, or are they working simply to ensure their own preservation as institutions, vying for contracts to keep themselves in business? Unlike states, whose mandate (at least in theory) is to work toward the health and happiness of its citizens, what stake does or should an NGO have in the long-term health of citizens of a developing country?

As Cohen et al. point out, these organizations often do things that local governments can’t or won’t do; but at the same time, their work is caught up in the priorities and values of donors, which may not be the same as what developing countries actually need. As Garrett describes in “The Challenge of Global Health,” funding comes with strings attached, with unhelpful restrictions put on its use. Furthermore, the very nature of the funding world is such that donors focus on new initiatives which bring quick results. These results are based on targets they themselves set, rather than priorities set by the countries in question. This places undue pressure on the recipients to achieve these narrow targets, “discourag [ing] investment in health systems.”

While NGOs are often providing crucial health services, the obvious consequence of all of this is that mutual dependence fails to properly empower developing countries. They don’t develop the local infrastructure to survive effectively without these “new colonialists.” Rather than filling in the gaps, NGOs are not doing anything toward weaning the developing countries from their dependence on them. Instead, they are working toward staying permanently, allowing corrupt governments to continue evading the responsibility of keeping their citizens healthy.


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