7 Deadly Sins: Global Health Governance

I recently came across a very thought provoking article entitled “Seven Challenges in International Development Assistance for Health and Ways Forward” by Dr. Devi Sridhar. Her analysis of the challenges associated with global health governance and how it perpetuates dependency is quite striking. The seven challenges or what I refer to as deadly sins have not only created a level of dependency between donor agencies and developing countries, but it has prioritized diseases based on collective global priorities with little regard to local priorities. If you examine the lists of current global health priorities you will notice that they are almost entirely communicable diseases (HIV/AIDS, Malaria and Tuberculosis). As a result, billions of dollars are being spent on initiatives aimed at reducing the global burden of communicable diseases (Rollback Malaria, Stop TB, President’s Emergency Plan for AIDS Relief (PEPFAR), Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) in the lower and middle countries. However, countries with fragile states and poor infrastructure receive the majority of donor funding.  In exchange, local governments are at the mercy of the donors, who set the policy agenda, creating an environment that supports and reinforces their priorities. As you delve deeper into the article you begin to see a pattern: global health governance creates an environment where countries become increasingly “dependent on dependency.” This brings into question whether a global health agenda can effectively improve health outcomes of populations. At its current state the answer is no.  But there is hope. A paradigm shift is needed in the way Donors conceptualize development.  Donors should also take into account the disease priorities of local populations. Take the case of non-communicable diseases (NCDs).  NCDs contribute significantly to the global burden of disease with 63% of all deaths. Finally, there needs to be a true partnership between donor agencies and local governments. By focusing on building local capacity and strengthening health infrastructure, countries are more likely to sustain positive health outcomes as health priorities shift.

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