The readings we have been doing this week, as well as the policy memo, discusses how non governmental agencies should allocate resources, something I find to be one of the most critical issues of public health. As we have read in the articles, in the past twenty or so years the number of money donated and the number of NGO’s have both increased drastically. Whether this is a good thing is the question. Would it be better if there were only a few NGO’s who controlled a majority of the donations and are likewise specific to certain sectors of public heath, or should there be an unlimited amount of agencies who all intermix to figure out how to allocate resources, labor, and donations? In my ideal world, some sort of combination of both would be the perfect solution; however this why I used the word ‘ideal’ as there are many, almost impossible, obstacles to confront. There does not need to be fifty different organizations trying to help fight HIV in one African country; that could lead not only to confusion on how and where to place the resources, but would also cause competition among the organizations and the very reason why they are there will be forgotten.
As of right now there are too many organizations trying to do much with too much power. One aspect I think is incredibly important is for countries who receive all of this aid to not become dependent on it and stop reforming their own infrastructure in favor of donations from other countries. The term used by Cohen, “new colonists”, while a little extreme is also very appropriate. It is wrong to criticize NGO’s such as the HIV/AIDs initiative or the Gates foundation because they are contributing so much to global public health in terms of money and manpower, however the relationships between certain NGO’s and countries should be examined more carefully. While many agencies long term goals are to help restore and implement new health policies in the countries they help, an almost skewed relationship can develop. The countries increasingly rely on the NGO’s (according to Devi Sridhar and Rajale and Batnaji’s article 40-60% of Tanzania, Kenya, and Uganda health budgets come from donors) and these organizations likewise rely on the countries health problems to continue running. One of the most startling yet truthful quotes I read was, “aid organizations and humanitarian groups need dysfunction to maintain their relevance” (Cohen). I am in no way saying that these humanitarian groups want to see the worlds health problems continue, but I think that this quote summarizes perfectly the relationship that many of the countries and aid agencies have. It is a symbiotic relationship that needs to be not extinguished but definitely analyzed to make sure that what is happening in the present will benefit the future.
One program that was successful yet still has been highly criticized has been GAVI, which is trying to provide children in developing countries with vaccinations. While acknowledging the fact that GAVI has been successful in preventing around 1 million premature deaths a year, Cohen is also critical of it saying that they failed in one of their main goals which was that after five years countries would have implemented a system like GAVI into their own health system framework. I personally think that while GAVI’s own goals were a little too optimistic, the ‘bottoms up’ approach is the best way to have optimal health outcomes. It provides health training and education for integral people in the community who would not leave to more attractive pastures in other countries. Likewise, it involves the local governments to a large extent and this could teach political officials how to implement practical and efficient health policies that would actually make a difference. While everybody has their own opinion on the subject, it is important that we do not loose sight of the main objective here: to improve others health to the best of our ability.