What is the new role of Charity in Global Health?
Improving the effectiveness of charity in global health
Billions of dollars are donated every year to improve the health of the poor in developing countries. Is Global Health all about charity? Could we solve all the problems with more money? My answer is no. Let me explain why. Global health is about helping developing countries develop their health sector. We saw all the funding donated to Haiti during the aftermath of the 2010 earthquake and how little has been achieved so far…
Global health requires a long-term commitment of at least 10 years to see and measure impact. This is achieved by setting annual targets for developing at least 10% of the country’s 10 year goals every year. For instance, a country has 1000 health facilities and they all need to have their pharmacy services developed to ensure patients get the medicines they need when they need them. By working with various development partners, the country can develop a 10 year plan that has the annual target of developing the pharmacy in 100 health facilities, starting with those in most need. Each development partner such as USAID, DfID, Irish Aid, Gates Foundation, etc. needs to commit to help the country achieve the annual target.
Charity does not usually work well for long-term commitments. Donor fatigue and changes in priorities are common. Consequently, they are not focused on achieving annual development targets. Charity is sometimes the way to fund some of the global health work, but mostly, charity is best used to solve a crisis or urgent situation that overwhelms the health sector such as an earthquake, war, or an epidemic like the recent Ebola crisis.
Charity is not a way to fund the development of a nation that needs highly specialized subject matter experts to address countrywide systemic challenges of access, coverage, consistent quality and efficiency of its services, public and private. Funding of development plans for the health sector must have dependability and certainty for the long term to meet the needs of not only the current population but to develop the system for the population the country will have in 10 year’s time.
For example, Malawi has about 17 million people. By the year 2025, there will be 26 million citizens. How will Malawi serve the health needs of 9 million more people? By developing its health system to serve .9 million extra people every year. Even if population growth were reduced, the momentum will keep it growing for a while longer and even 1 or 2 million more people would require concerted planning, partnerships with development organizations, banks and expert support to plan and implement programs that account for results at a pace of 10% of the target every year for the next 10 years. The charity organizations I know are not organized that way, yet. They are driven by their mission of helping the poorest of the poor. In short, to use a common metaphor, they give “fish” but do not empower the country to develop its own fishing industry and teach its citizens to fish.
Charity organizations must play a new role in global health if they want to achieve lasting impact and see sustainable results. Here is the plan:
- Make a long-term commitment in the countries they work or want to support to help the implement the countries’ ten-year health development plan;
- Commit certain and predictable funding for the activities they agreed to in the ten-year plan, e.g. fund the upgrade of 10 health facilities of the 100 annual target set by the country;
- Ensure the charity organization’s projects contribute to improve the country’s health programs;
- Ensure their programs contribute to improve the country’s health information and knowledge management system, and most important of all;
- Ensure the charity organization has an exit strategy to transfer their expertise to country’s institutions and structures.
If you want to learn more about improving aid effectiveness, I invite you to sign up for the free RGH webinar entitled “Aid Effectiveness in Global Health: Getting Back to Basics in Global Health”.
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