Excerpt from 9 May 2009 Lancet editorial.
This is the same point I have tried to make with regard to HIV/AIDS funding in Uganda. But it is hard to tell/convince donors that their massive spending on HIV/AIDS may actually be hurting other healthcare programs (not to mention that the funding decisions are often made by those in Washington, etc who have no idea what is going on on the ground). The response of the program and project managers, of course, is that they believe they are helping more than hurting. There are at least two problems with this argument though. One, measuring how much one is helping or hurting a country/population/sector/etc is difficult, especially as unintended/unrecognized consequences abound (i.e. doctors migrating from cash-starved district health centers to donor-funded HIV clinics). Two, what happened to “first do no harm”? Should one even be involved if the consequences of one’s actions cause harm of unknown/unquantifiable amounts?
The good news is that the discussion regarding priorities/allocation of money within the health sector is emerging in policymaking circles — New Vision, for example, reports today that parliament has recommended sh36b earmarked to purchase anti-retrovirals (ARVs) be re-allocated to other pressing government programmes. (Although, reading through the article again, I am thoroughly confused as to what MPs are proposing…anyone have insight?)
Meanwhile, Easterly and Wronging Rights have an interesting (and related) discussion on aid and the Love Actually Test.