Advocacy for Aid for AIDS
Owen abroad discusses the lethal effects of development advocacy. His first example is of earmarked funding for HIV/AIDS in Ethiopia:
…we should also make sure that people have bednets and drugs to stop malaria, provide childhood vaccination to prevent easily preventable diseases, ensure access to contraception and safe abortions, and, above all, enough funding to provide basic health services that would save thousands of lives and suffering. Yet we are not willing to provide enough money to do all of this. It is in this context that it is damaging to earmark 60% of health aid to HIV.
He quotes from the Open Budget Blog a quick-and-dirty “value-of-life” estimate:
Using these estimates, it would cost an additional US$29.7 million to treat all of the 540,000 kids who died from pneumonia/diarrhea in Nigeria and Ethiopia. Were this money to come out of the HIV budget, it would reduce the number of HIV patients that could be provided treatment by about 61,240. So, using these admittedly very rough estimates, our current allocation of resources from the pot of money for disease treatment suggests that we value the life of a person with HIV at 8.8 times the value of the life of a child with pneumonia.
I was just at the University of Tennessee presenting a chapter from my dissertation about the weak demand for HIV/AIDS services in rural Malawi, even among those most affected by HIV/AIDS. The audience of mostly political science faculty and graduate students raised a few good questions:
- When I compared the morbidity/mortality and international funding of HIV/AIDS against diarrheal disease, one professor asked, but doesn’t AIDS typically affect adults whereas diarrheal disease has greatest impact on children? (Yes. [Insert here discussion of how children have little if any political power.])
- Why does the international community prioritize AIDS over other health problems if the other health problems are actually cheaper to deal with? (That’s a long answer, for which I have little evidence and mostly conjecture.)
- What does international prioritization of HIV/AIDS over the concerns most important to local citizens mean for democratic governance? (Well, in the nascent democracies where HIV rates are the highest in the world, I can’t say the path international actors is good or consistent with their contemporary rhetoric about local governance.)
I just read a paper written by a former colleague about the unintended effects of the international outpouring of aid following the 2004 tsunami in the Indian Ocean (earlier, ungated version here). By trying to aid those impacted by the tsunami, international actors gave undue hope to rebel leaders that international aid flows could sustain their governance operations, and thus they’d no longer need a relationship with the state — escalating the violence between the government and the rebel group.
All of this is to say: I’m not anti-humanitarian or anti-aid. But people on the outside need to think about what their compassion does to people on the inside — in broader strokes and in the longer term.