Donor led policies: analysis of an underlying doctrine

Jean‐Pierre Unger · Pierre De Paepe · Kasturi Sen · Werner Soors

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International Development and Aid Healthcare Systems and Reforms Public health and occupational medicine

Abstract

Chapter 1 contains material previously published in: De Paepe P., Soors W., Unger J. -P. International Aid Policy: Public Disease Control and Private Curative Care? Cadernos de Saude Publica 2007; 23(Suppl. 2): S273–281. Introduction Many authors advocate integrating vertical programmes into local health facilities in order to achieve reasonable prospects for successful disease control (Bossyns, 1997; Loretti, 1989; Oxfam, 2003; Tulloch, 1999). An editorial in the influential New England Journal of Medicine (Mulholland & Adegbola, 2005) on bacterial infections (as a major cause of death among children in Africa), for example, stressed the need for comprehensive, integrated and accessible health services to address health needs and questioned the narrow, disease-based approach that has prevailed to date. Whilst there is a need for some non-integrated vertical programmes in most countries (Criel et al., 1997), any health policy allocating public health activities and disease-control programmes to Ministry of Health (MoH) structures and general health care to private facilities remains highly problematic since it precludes the integration of disease control with general health care. Through a review of multilateral aid policies, this chapter examines whether current international aid policies have supported the allocation of health care and disease control to different health facilities rather than integrating them into one. In other words this section will focus on outlining the doctrines informing policy rather than describing their implementation, which will be addressed in later sections. The actual implementation may differ due to specific political, social, geo-strategic, and economic factors.

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