Ana B. Amaya MPH (Currently DrPH candidate at the London School of Hygiene and Tropical Medicine)
June 14th marks world blood donor day, a date when we celebrate the countless selfless individuals all over the world who decide to donate blood. The day also serves to raise awareness about the need for safe blood and blood products to save lives. According to the WHO, the blood donation rate per 1000 population in middle-income countries is around 12 donations, while in low-income countries this drops to a staggering low figure of 4 donations. Despite the importance of this issue, today I want to discuss another type of donors, global health donors. These donors, while not completely selfless in their motivations and frequently criticized for imposing their priorities over national needs, also save lives through the activities they fund. However, similar to the blood donor situation, money is becoming increasingly scarce in the current economic climate, generating the need to target funding towards areas that need it most. The importance of financial and technical support and the effects it has produced on the health of populations in developing countries have been widely documented. However, information on the sustainability of this aid at the national level and the long-term effects of it, is still in its infancy.
This is particularly relevant for nations that are currently heavily donor-dependent (to plan for the future, towards a sustainable scenario or in the case international money ceases) and for those countries whose economies are growing and thus at some point no longer “require” aid. The latter is the case for HIV/AIDS in Peru. Peru has boasted robust economic growth rates in recent years, and the country is now classified by the World Bank as an upper-middle-income country. In principle, Peru now has the fiscal space to invest more in social sectors and the country is therefore no longer eligible for Global Fund HIV/AIDS grants. Yet equity in the country remains a challenge and although the national HIV prevalence is below 1%, some reports estimate the prevalence among most-at-risk populations to be up to 40%. The Global Fund’s involvement in HIV/AIDS in Peru via four successful rounds, propelled the provision of free antiretroviral treatment in the country and also helped increase the visibility of the rights of people living with HIV/AIDS. At the same time, a large amount of these funds were aimed at supporting health promotion and a significant number of prevention activities were implemented through non-governmental organizations.
With these Global Fund grants winding down, many local actors now wonder what will happen next. What has already happened is the inclusion of HIV together with TB in the government’s results-based budget (as one of the strategic lines). So the economic component of sustainability seems feasible; but how about the other components of this process, such as the political, technical and social dimensions of sustainability? The shift occurs against the political backdrop of a still expanding decentralization process, in which the regions are tasked with managing this budget and thus must be prepared for these added responsibilities. In question is also how the absence of the Global Fund will affect the work of the non-governmental sector in the country, a sector which has had a large role in implementing projects and has a rather lukewarm relationship with the government, to say the least. Also, what will be the fate of the already formed country-coordinating mechanism; and most importantly, how to build on achieved successes?
While we were analyzing the effectiveness of aid, we seem to have forgotten to think beyond aid and help build the foundations for making aid at some point redundant. This is not only about money, but also about establishing the political, social and technical pillars for countries to be able to successfully manage their own projects once they have the fiscal space. Arguably, the focus on strengthening health systems and fostering country ownership has done a great deal to prepare countries but it is evident that what we have been doing so far has not been enough. Fortunately, it is not too late to reconfigure our thinking and to begin to engage stakeholders, as well as include clear criteria for sustainability in order to reduce uncertainty in the future (or at least enable us to cope better with uncertainty). What is more than certain, however, is that unlike aid, blood is easily replaced in your body so please consider visiting your local blood bank today!