Foreign Affairs - The Challenge of Global Health - Laurie Gar...

Another problem is the lack of coordination of donor activities. Improving global health will take more funds than any single donor can provide, and oversight and guidance require the skills of the many, not the talents of a few compartmentalized in the offices of various groups and agencies

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This points to yet another problem, which is that aid is almost always "stovepiped" down narrow channels relating to a particular program or disease. From an operational perspective, this means that a government may receive considerable funds to support, for example, an ARV-distribution program for mothers and children living in the nation's capital. But the same government may have no financial capacity to support basic maternal and infant health programs, either in the same capital or in the country as a whole.

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Stovepiping tends to reflect the interests and concerns of the donors, not the recipients

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This means that advocacy, the whims of foundations, and the particular concerns of wealthy individuals and governments drive practically the entire global public health effort

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Today the top three killers in most poor countries are maternal death around childbirth and pediatric respiratory and intestinal infections leading to death from pulmonary failure or uncontrolled diarrhea. But few women's rights groups put safe pregnancy near the top of their list of priorities, and there is no dysentery lobby or celebrity attention given to coughing babies.

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At the 2006 International AIDS Conference, former U.S. President Bill Clinton suggested that HIV/AIDS programs would end up helping all other health initiatives. "If you first develop the health infrastructure throughout the whole country, particularly in Africa, to deal with AIDS," Clinton argued, "you will increase the infrastructure of dealing with maternal and child health, malaria, and TB. Then I think you have to look at nutrition, water, and sanitation. All these things, when you build it up, you'll be helping to promote economic development and alleviate poverty."

But the experience of bringing ARV treatment to Haiti argues against Clinton's analysis. The past several years have witnessed the successful provision of antiretroviral treatment to more than 5,000 needy Haitians, and between 2002 and 2006, the prevalence of HIV in the country plummeted from six percent to three percent. But during the same period, Haiti actually went backward on every other health indicator

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