What is the Effect of International Aid on Health Systems?
What is the effect of international aid on health systems? Former HAI intern Abdul Mussa tackles this question in the latest edition of Human Resources for Health. HAI’s James Pfeiffer, Stephen Gloyd, and Kenneth Sherr were co-authors of the paper. For the study, Mussa interviewed 41 Ministry of Health workers in Mozambique to learn about their perspective of the impact of vertical funding to the health sector. Abdul Mussa’s thesis gives voice to Mozambique Ministry of Health workers’ concerns about international aid and vertical funding to the health sector. Recent increases in international aid for health projects, Mussa points out, have been mostly channeled through NGOs or to very specific programs or diseases. This approach generally does not support broad strengthening of infrastructure and human resources because it bypasses Ministries of Health.
Interviews with MOH workers in Mozambique showed that while this influx of aid to health has been effective in supporting certain projects and programs (many cited increased access to antiretroviral medications for HIV, for example), there were also many disadvantages to disease specific, or “vertical” funding. The primary challenges that emerged were a lack of coordination between the MOH and NGOs, imbalances within the national health system as certain diseases are prioritized over other areas of care, and internal brain drain as workers from the public sector are drawn to higher wages at NGOs. These consequences of vertical aid serve to undermine the Mozambique Ministry of Health, Mussa argues.
Mussa’s findings are an important call to the field of global health to critically examine the power imbalances created by large donors and NGOs. Though the incredible growth in funding for health issues has made a positive impact worldwide, health funding should not focus narrowly on support for only NGOs or specific diseases. As Mussa concludes, “NGOs and donors should consider practices that support the strengthening of public sector human resources and capacity building and avoid practices that contribute to internal brain drain” (p.8). One existing tool for service organizations that share these concerns is the NGO Code of Conduct, of which HAI is a signatory and co-author. HAI is proud to be a leader in this approach of partnering with Ministries of Health to strengthen Primary Health Care.
Abdul Mussa at HAI Seattle/ photo by Emily deReil