It all about MONEY The World Bank’s AIDS Programs: a look at failures of international aid
While funding global public health is of course crucial to implementing public health policies, it’s also crucial to ensure that the funding is being used efficiently. Recently, an internal evaluation of the World Bank’s programs revealed that their AIDS programs have failed in effectiveness, particularly in Africa.
The World Bank has invested $17 billion in health, nutrition, and population programs since 1997, and will be tripling that investment from $1 billion in 2008 to $3 billion in 2009. Recently, more and more global health agencies, including the World Bank, have focused many of their resources on HIV/AIDS programs. In fact, 60% of the bank’s projects between 1997 and 2006 on communicable diseases were HIV/AIDS programs–but their HIV/AIDS programs in Africa have had only a 25% success rate. 7 of 10 of the bank’s AIDS projects globally, and 8 of 10 of the programs in Africa, have had “unsatisfactory outcomes”, according to the report. This is astoundingly low compared to the 80% success rate of all World Bank programs around the world. This could be due to poor accountability of programs, overly complex programs, and ineffective implementation. For example, from 2000 to 2005, the World Bank provided $26.6 million to fund an HIV/AIDS program in Ghana, which DID NOT target groups at-risk of HIV contraction–a highly inefficient use of funds.
To me, what’s most disturbing about this report is the fact that though these HIV/AIDS programs were mostly ineffective, much of the World Bank’s funding was diverted towards those programs–despite the high efficacy of their other health programs. Only 2% of their communicable disease projects were tuberculosis programs, and 3% were malaria programs, even though one malaria campaign in Eritrea reduced malaria mortality by 85%! The report suggests that simplifying projects (so that the governments of the countries are actually able to implement and maintain the programs) could increase the efficiency of these programs, as well as coordinating between numerous donors, nonprofits and government agencies. Naturally, the more organizations that are involved, the more difficult maintaining communication between them, which decreases efficacy–which raises another interesting topic: how can we increase communication between the hundreds of public health organizations working in an area, or field, to decrease overlap, and increase the reach and efficiency of all organizations? But that’s a topic for another day.
Anyways, this brings up a difficult dilemma: obviously, HIV/AIDS is a pandemic of disastrous proportions, but is all the funding being funneled towards combating HIV/AIDS useful? Or would it be better to use that money to fund programs known to be efficient? Certainly malaria and TB are not as “popular” causes as HIV/AIDS is, but they are also widespread and incredibly devastating to the large populations exposed to those diseases. So how much funding out to be used to fund perhaps riskier, but potentially very beneficial programs, as opposed to programs known to be effective? |
