Resident Fellow Roger Bate

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During the past few years, Africa has received far more support in terms of health aid than ever before. The results of this increase have been varied--generally disappointing and occasionally even counterproductive. There are several reasons for this interesting anomaly.

Some of the cash promises have yet to materialise (eg for malaria from the World Bank).

USAID and other aid agencies often reserve a significant amount of pledged funds to be used only by Western contractors. USAID, for example, often purchases American products at higher costs, a practice which is inefficient and has reaped less effective results.

Immeasurable and odd targets are set, as in, for example, the UN Millennium Development Goals (MDGs).

Aid agencies tend to operate using Western subjectivity and perspective rather than addressing local needs objectively. This often means that interventions that are politically popular with donor nations are chosen over more pragmatic solutions. For example, many Western organisations and governments are inclined to promote the use of Permethrin-treated mosquito nets as a preventive measure against malaria, over the cheaper and more effective option of using safe indoor insecticides. Another example is the Western preference for propagating sex abstinence messages as a method of HIV prevention, rather than practical programmes for improving safe injection practices and providing general sex education. The Western tendency to place popularity over practicality (eg Sierra Leone's HIV prevention and treatment programme) may entirely displace efforts that should take priority, such as the immunisation of children.

Mission creep (at the World Bank, the WHO, etc) results in many international agencies seeming to be responsible for everything, which means, ironically, that they are responsible for nothing. Agencies should have clearly defined roles in accordance with their skills-set, rather than roles dictated by their donor base or an exhaustive mission statement.

African nations are not demanding programmes that will suit their particular needs. In order to fully take advantage of the aid directed toward them, African nations must first put their own houses in order. This is best achieved by implementing stronger and more resilient health systems, reducing absenteeism and other forms of corruption in the workplace, and removing tariffs on essential medical interventions. . . .

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Roger Bate is a resident fellow at AEI.