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This is an archived USAID document retained on this web site as a matter of public record.
Implications for the philosophy and pursuit of "Foreign Assistance"
>> Foreign Aid in the National Interest >> Chapter 3 >> Implications of trends for future directions Jump to Chapter 3 Sections:
>> Health, development and aid >> Broad progress, startling changes, persistent quandaries >> Health indicators: advances and obstacles >> Health systems and services >> To review the bidding >> Implications of trends for future directions >> Implications for the philosophy and pursuit of "foreign assistance" >> Notes >> Background paper >> References
After more than four decades, foreign assistance programs in health, focused largely on public health endeavors aimed at women of reproductive age and children under five, look out on a changed health landscape. Decisions about how to allocate and manage aid on that landscape can be guided by various considerations.
First, resources confront a growing diversity of complex problems many of which will be of increasing seriousness. The world is very different than it was even 20 years ago; it will be different still 20 years hence. What is striking is the progress that has been made, albeit with continued serious lags in the least developed countries. Entirely new generations of public health problems require entirely new portfolios. Health conditions not previously considered part of a foreign assistance portfolio are increasingly worthy of attention. New skills, such as finance, become as important as public health credentials.
Second, progress in health is not just in health programs. Health portfolios must be interdisciplinary, combining the best of health and medical innovation with simultaneous attention to problems as diverse as capital investment capacity, biofortification in agricultural systems to correct micronutrient deficiencies, wireless communication distribution systems, and women’s education. In turn, this will mean that portfolios will need to be fairly slim; one cannot undertake multiple complex partnerships in one place (let alone many places) at once. Limited resources means being selective about investments with an eye to their economic contributions, staying rigorous and brutally honest about measuring impact, and being insistent on the long-term self-reliance of partners.
Third, public health challenges of tomorrow argue for flexibility. No longer are there simple categories of health challenges, if there ever were. Nor are the challenges defined by narrow age categories or by gender. Achieving equality in partnerships means that the U.S. must have the flexibility to adapt the discussion to priorities as defined by the emerging health conditions. Accelerating the progress of some countries still in the grip of conventional global health and disease problems must be combined with the ability to help other countries address new challenges not conforming to old categories.
Fourth, despite 40 years of effort, health progress in some countries continues to lag and only slow progress is projected for the future. Clearly quality, impact and sustainability have remained elusive. The prospect of continuing need for future investment in conventional problems argues for frank and open discussion with partners on new approaches to achieving results. Newly recognized problems with impact and sustainability suggest that money is not at the heart of the matter. The partnership dialogue with countries still struggling to make health progress requires that entirely new strategies be explored and developed.
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Last Updated on: October 07, 2009 |
