Too Many Cooks in the Kitchen

Of late, Global health is finding many non-profit organizations, like Oxford Committee for Famine Relief (OXFAM), Médecins Sans Frontières (MSF), and the Bill and Melinda Gates Foundation (BMGF), as global aid front runners in order to tackle the pertinent issues in public health such as childhood immunizations, maternal health, nutrition, water sanitation, etc.  “better” than say, government funded organizations like President’s Emergency Plan for AIDS Relief (PEPFAR) or United Nations Children’s Fund (UNICEF).  If that seemed like a lot of letters, it’s because it was.  Given the state of developing countries after decades of foreign aid, you have to ask if this divide and conquer approach is actually successful, or has it become a scenario where there are too many cooks in the kitchen? 


Do these dysfunctional governments rely too heavily on foreign aid to meet their citizens’ needs rather than devise their own solutions? Do the resources they provide along with their agenda now become that of the country’s for whom they are meant to help?  I think yes to both.  


Between any two organizations, there will be different ideas, approaches, and resources, but is more always better?  In my opinion, it is, only when these foundations operate efficiently, avoid redundancies and work in conjunction with existing programs to ensure long-term improvements.  It is paramount that large organizations like the World Health Organization (WHO) be more transparent regarding which programs they fund, and act in concordance with the longitudinal needs of the country.  Funds should be allocated according to disease burden, prevalence, and incidence, particularly in regards to of manageable illnesses like malaria, TB, or HIV/AIDS.  Allotment of funds should not be influenced by personal political gain. 


While foreign donors often produce results for citizens in the short term, they ultimately erode the people’s trust in their government, education, or healthcare systems in the long term.  Problems seem to arise when too few local staff are available to carry out agency work, resources are mismanaged, leading to a cycle of countries becoming dependent on donors to function.


Donors should also take into account timing of offered aid.  It takes roughly one year for aid to arrive, so delays only lead to loss of lives and disenchantment.  I appreciate that donor organizations send, nutritional experts, technical specialists for water sanitation, or visiting health workers to train/educate the existing healthcare staff.  This attempts to address long-term issues after organizations leave.


So with all of the readily available aid, questions still remain regarding which programs donors should give assistance, and for how long?  Before committing, they should ask themselves, who will actually benefit? 



Bloom, B.  (2011) “WHO needs change.”  Nature vol. 473 (7436): 143-5.

 Cohen, MA. (2008) “The New Colonialists.” Foreign Policy 167: 74-79.

 Grepin KA. (2012) “HIV Donor Funding Has Both Boosted And Curbed The Delivery Of Different Non-HIV Health Services In Sub-Saharan Africa.” Health Affairs. 31 (7): 1406-14.

 Sridhar, D, Batniji, R. (2008) “Misfinancing global health: a case for transparency in disbursements and decision making.” The Lancet 372 (9644): 1185-1191.


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