Transcript LECTURE 1 * GET ON IT!

The Realities of Foreign Aid

Name key obstacles that third world countries
must overcome for long term improvement.

What effects do political turmoil and corruption
play in country health status?

What approaches to foreign aid has proven to be
the most effective in the current aid-era?

Article 25
Everyone has the right to a standard of living
adequate for the health and well-being of himself
and of his family, including food, clothing, housing
and medical care and necessary social services, and
the right to security in the event of unemployment,
sickness, disability, widowhood, old age or other
lack of livelihood in circumstances beyond his
control.
 Issue is multifaceted and highly
complex
 We’re only skimming the
surface!
The King of Condoms

Doyen Rainey, MS
 UT-Dallas Health Professions Advisor
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A few definitions…
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The traditional definition of sustainability
calls for policies and strategies that meet
society’s present needs without
compromising the ability of future
generations to meet their own needs.

Health is both a resource for, as well as an
outcome of, sustainable development. The
goals of sustainable development cannot be
achieved when there is a high prevalence of
debilitating illness and poverty, and the
health of a population cannot be maintained
without a responsive health system and a
healthy environment… Ill-health, in turn,
hampers poverty alleviation and economic
development.
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Wikipedia:
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Sustainability is the capacity to endure.
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Sustainability for us means overcoming
barriers to health in ways that are:
 Respectful of patient’s individual will
 Culturally sensitive
 Economically viable
 Fully functional
 ‘Easily’ reproduced and maintained
So that people may not just
endure, but thrive.
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Government
Infrastructure
Religion
Culture
Dependence
Health Worker Issues
Collaborations
Global Costs
SUSTAINABILITY!

1. Corruption
 Transparency International: A Global Coalition
Against Corruption
▪ Corruption Perception Index 2010
Corruption Perception Index: 2010

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Addicted To Aid
Many Types
 Impoverished
 Over-centralized
 Greed-driven
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Selling What's Free
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Red Tape
 Slow functioning government (or corrupt
government) leads to a lack of established policy
for treatment, lack of funding, inability of aid
workers to enter/practice medicine in the country,
lack of investigation into misappropriation of aid,
etc.
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2. Donor Country’s National Interest
 Developmental Assistance vs. Humanitarian Aid
▪ Developmental assistance considers that when you help
a community develop, they become better partners in
commerce.
▪ In humanitarian aid, you get nothing in return.

Tied aid is foreign aid that must be spent in
the country providing the aid (the donor
country) or in a group of selected countries. A
developed country will provide a bilateral
loan or grant to a developing country, but
mandate that the money be spent on goods
or services produced in the selected country.
From this it follows that untied aid has no
geographical limitation.
 Wikipedia!
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3. Terrorism
 Working With Terrorists
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People will argue that the health of their
children and nation is up to God’s will.
 How do you argue with that?
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Conflict of Interest?
 Are people simply converting because they’re
being given resources?
 Is this culturally insensitive or a hindrance to
national stability?
 Lack oversight?
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Voodoo Doctors
 Medications that aggravate conditions/allow for
disease progression instead of receiving care
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Need to discuss patient beliefs
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As a medical practitioner, you should be
asking:
 What do you CALL your problem?
 What do you think CAUSED it?
 How have you COPED with it?
 What CONCERNS do you have?
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Cultural Practices
 What is the communal response to a certain
symptom?
 What are the hygiene behaviors?
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Education is of primary importance, but must
be done with respect to cultural/religious
views.
Literacy rates (including Health Literacy)
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Stigma- Africa
Stigma – Thailand
Stigma - Peru
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Western Medication is not always the right
choice.
 It’s resource heavy, expensive, requires personnel
training and retention, reliable power sources,
and a lower doctor : patient ratio.
 It can strain limited capital in countries struggling
to fund health programs.
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Paternalism
 The policy or practice on the part of people in
positions of authority of restricting the freedom
and responsibilities of those subordinate to them
in the subordinates' supposed best interest
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When Religion, Culture and Medicine Collide
 Some of the hardest trials are overcoming
resistance of the people.
 Again, education is of primary importance but
must be done without offending religious/cultural
views
▪ What do you do when the very help you’re giving is
found to be offensive?
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Self-Reliance. The most important steps taken to improve
the long-term success of developing nations will come from
within those countries. In successful and self-sustaining
projects, local leaders are the engines of change. Conversely,
encouraging leadership and good policies may mean ending
or reducing aid to a country. We must not be afraid to
withdraw funds to ensure that assistance does not result in
dependency in recipient countries.
▪ Foreign Aid: What Works and What Doesn’t
By Carol C. Adelman and Nicholas Eberstadt
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“…that these state-to-state transfers inhibit
competitiveness, create dependency, and absorb or
misallocate political resources or energies in
recipient countries; that aid is motivated by
nondevelopment donor and contractor interests;
and that aid engenders a lack of feedback and
accountability, encouraging host country graft and
corruption.”
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Dutch Disease
▪ The claimed mechanism is that an increase in revenues
from natural resources (or inflows of foreign aid) will
make a given nation's currency stronger compared to
that of other nations (exchange rate), resulting in the
nation's other exports becoming too expensive for other
countries to buy, making the manufacturing sector less
competitive.
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Local effects:
 By shipping food in, put local businesses out of
business
▪ This is especially a problem in places where long term
aid is established
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Expectation of Assistance
 This is an attitude you will come across- but
hopefully not the majority of patients.
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Rwanda
 Paul Farmer (founder of Partners In Health)
discussed Rwanda on NPR’s Fresh Air program
 He emphasized that Rwanda’s recovering economy and
approach on everything from justice to reestablishing the
million refugees for their country was as successful as it
was because they refused foreign aid from organizations
that were not willing to work directly with the government
and via the means they chose.
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Dra. Patterson’s River Trips
 Canoes and military support
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Michael Parsa, MD – Papau, New Guinea
 CB Radios and a commuter plane
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Riders for Health
“Without mobility, an outreach healthcare
worker is almost useless.”
(5:30)
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How do you provide consistent health care
when remote villages are hours apart, there’s
no emergency transportation… there are no
cars at all.
 How do you get people to the hospital in an
emergency?
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Casa Materna in Nicaragua
Thank you
Kourtnee
Lindgren !!
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Many vaccines require refrigeration or they
go bad.
 Flu, diptheria, tetanus, polio, whooping cough,
MMR, chicken pox, and Gardasil- just to name a
few.
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“Waste costs the $2 billion-a-year federal Vaccines for
Children Program about $20 million a year, and the biggest
single problem is improper refrigeration, Rodewald said.
Other causes: The vaccines expire or were damaged in
shipment.”
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Lack of TV/Radio programming/availability:
 Limits abilities of awareness campaigns
▪ How do you let people in remote villages with no
electricity about an incoming tsunami? Or that condoms
decrease AIDS contraction? (How would you distribute a
consistent supply of condoms?)
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Manipulating what TV/Radio is available
 North Korea
Additional issues will be discussed in the next
lecture but the main point is…
It’s complicated.
Despite good programs, financial and political
support, organized aid, and available drugs,
people across the world are still suffering
from potentially solvable problems.
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There are more people in need now than ever
before…
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Applying the country-specific growth
projections to our survey-based data and
aggregating, we calculate that the crisis will add
53 million people to the 2009 count of the
number of people living below $1.25 a day and
64 million to the count of the number of people
living under $2 a day.
▪ The impact of the global financial crisis on the world’s poorest.
Chen, S. & Ravallion, M., 30 April 2009.
▪ Chen, Shaohua and Martin Ravallion, 2008, “The Developing World
is Poorer than we Thought, but no less Successful in the Fight
against Poverty,” Policy Research Working Paper 4703, World Bank.
There are stories of and guidance for future
success.
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Reviews of multiple country’s self evaluation of aid
programs:
 found that successful projects involved local initiative,
good governance, measured results, and the creation of
local institutions for sustainability.
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Input from local actors – programs should
reflect the actual needs of the country
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Local ownership increases the prospects of
long-term success by involving local
institutions.
▪ “Successful projects and programs demonstrate collaboration
between American and developing-country institutions, especially
private institutions.” These collaboration are essential for a
sustained partnership and lead to long term partnership even after
external funding is gone.
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“The U.S. government should always attempt
to ensure partners are committed to a
program before it makes an investment; as a
general rule, the U.S. contribution should be
the second or third dollar on the table, not
the first.”
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With mutual accountability comes
sustainability.
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“take advantage of the myriad new sources
and techniques of global support for
developing countries, including foundations,
private voluntary organizations,
corporations, universities, and remittances.”
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The decades old governmental mandates
regarding aid prevent the flexibility to
address issues as they arise.
▪ There are different needs at different levels of
development and no universal assistance plan will be
effective as the needs of communities differ.
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Peer-to-peer approaches to relationship
building between organizations
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The application of technology to improve the
human condition (bed nets, rehydration salts)
(requires local interest/ownership for sustainability)
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Self reliance: local leadership as the ‘engines of
change’
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Real-time, continuous feedback of program
successes and challenges (requires flexibility for change!)
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Mexico approached a widespread cholera
outbreak in Central America as a “national
security” issue.
 In taking a multifaceted approach, they were able
to prevent widespread outbreak and improve
their public health infrastructure- from water
quality control to disease surveillance and more.
Int J Infect Dis. 2006 Jan;10(1):4-13. Epub 2005 Dec 1.
Cholera in Mexico: the paradoxical benefits of the last pandemic.
Sepúlveda J, Valdespino JL, García-García L.
Coordination of the National Institutes of Health, Periférico Sur, No. 4118- r. piso, Mexico, DF CP 01900,
Mexico.
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"It is demonstrating that it is possible to reach
beyond tragedy and rekindle hope.“
▪ Recovery In Rwanda