PHA-Exch> Funding for primary health care in developing countries(6)

[Claudio Schuftan]

From: Ronald Labonte rlabonte at uottawa.ca

 AK's comments about donor financing of health systems are correct if we
assume that aid is charity and dependence is begging. But it doesn't have to
be. Nor is the notion of 'self-sufficiency of sovereign states' helpful.
Increasing competition over scarce resources essential for survival render
self-sufficiency an environmental myth. The partitioning of countries by
imperialist colonizing nations, and the ongoing balkanization of countries
in several parts of the world, also make it an economic myth. Moreover,
resource redistribution within nations through state taxation, regulation
and spending policies has been shown countless times to be essential to
correct for market failures and to reduce poverty more effectively,
sustainably and efficiently than economic growth per se. Economies and their
resource base are increasingly global/globally entwined. This perforce
demands efforts to create globally systems of redistribution and regulation
that have worked, and continue to work, at national and regional levels. I
reference here how federated nations (or in the case of the European Union,
a federation of countries) have used transfer payment schemes to share
resources between member polities where the population base is large and/or
wealth-generating activities are plentiful, with areas where the population
base is small and/or wealth-generating activities are limited. The purpose
of these transfers has generally been to finance health, education, social
and other infrastructure programs essential to collective well-being. Such
transfers, while occasionally critiqued by conservative economists and
politicians as dependency-producing and always subject to politicking over
how much should be transferred and to where, are nonetheless accepted as
citizen entitlements and political obligations.

 What we presently call 'aid' should be viewed in the same light. Resource
transfers from rich to poor countries is ethically defensible (invoking the
principles of relational justice) and legally obliged (under various human
rights covenants). Until rich countries (and particularly the rich within
them) cease consuming proportionately more of the benefits of economic
growth (which national histories have shown can only be accomplished through
taxation and regulation of consumption for redistributive purposes) poorer
countries attempting to catch up through more macroeconomic
self-determination will find that there is nothing left for them to
autonomously choose to spend on or consume.

 I offer these comments not to take away from the rightful criticisms of
aid, albeit many recent studies have found less base for some of these
criticisms than existed in the past. But I fear that such critiques, in the
absence of tackling finite global resource limits and the empirical
implausibility of many poor countries to have a sufficient population and
resource base within their borders to function autonomously, could reduce
the political incentives to create more consistent, untied, pooled and
recipient driven forms of global resource (wealth) transfers. Improving
global systems for such transfers is not to the exclusion of creating more
economic justice, the point underscored by AK; but it is a recognition that
economic justice also demands such transfers.



 I would add to D Barzagar's comments, that Alma Ata was predicated on a new
international economic order (fair and rational) so that all states could
provide for the basic needs of their people, without outside interference.

 "Aid" is outside interference and locks poor countries into all kinds of
other dependencies which are invariably exploitative. It is absolutely the
wrong way to go.  The goal must be self sufficiency of sovereign states
which is perfectly feasible with macroeconomic reforms for economic justice.
(It goes without saying that if that goal were being pursued, international
aid would be justified to deal with emergencies arising but it is not in
itself a goal to be pursued.)

 Like the millennium development goals, these goals are inadequate and
worse, they are cosmetic. They are far less ambitious than the goals of
Health for All. Financing of health and health services through "aid" is
incompatible with health as a human right.  No citizens of the so-called
first world would accept that their health services be provided through
international aid.

 These are lessons learned decades if not centuries ago. People are not
interested in making begging a way of life and giving up sovereignty in
return for the latest rescheduling of odious debt.  They are interested in
winning and enjoying their rights.

 If any of us want to "help", it is in that endeavour - emancipatory
development - that we should put our energy and money!

 AK
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