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Advocacy for Aid for AIDS

18 November 2009

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.

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3 Comments leave one →
  1. 19 November 2009 7:43 am

    This is something i’ve been thinking about more and more lately (in no small part because of some of the links you post). One of the “explanations” i’ve come up with (and i’d be interested to know if there is any empirical validity behind) is that it seems it may be harder to mobilize for things that people know as “controlled” (or at least controllable) in their context, despite them having devastating effects elsewhere (e.g., diarrhea, Malaria, etc.).

    The additional (and admittedly much larger) second leap tied to that question is about a potential reason that’s so (if it is). Am i being overly cynical about people to think that the only reason those with control over the dollars are interested in preventing the particular things “over there” that they are is to avoid them potentially “crawling across my lawn”. IOW, they aren’t really interested in the “real” health of the people they’re intervening “on behalf of”. IOW, AIDS is a priority because people are still fearful of it here, since we don’t have, say, a vaccine for it. But Malaria? That’s “there” problem.

    i’d be more interested in your response to / inclined to assume there is work on the first of my questions. The second is likely more in the realm of speculation. Though i am open to being shown to be wrong on that too…in either way – that it’s not mere speculation and there’s evidence to support the theory (though that would be depressing). Or that that theory doesn’t hold water (and donors aren’t as bad as i’m painting them to be).

    As we may or may not have discussed previously about this, the additionally corollary is then sorting out how my work’s focus on HIV contributes to furthering an overemphasis on it. That’s a (more personal) balance/choice of questions issue i haven’t figured out my stance on in a way i’m comfortable with just yet.

  2. 19 November 2009 11:02 am

    jimi – I think that your two questions are inextricably linked. There is more work on the latter (self-interest of the donors plays a large part in their allocation of aid — AIDS crosses borders more easily than malaria or diarrheal disease). As for the former, I actually think there is a lot less known about other diseases in the general aid population. Part of that has to do with the paucity of data collected in comparison to the data collected for HIV/AIDS.

    Taking your characterization a bit further, I feel like part of the problem rather than the solution. As yet another person who is studying HIV/AIDS in Africa, I am contributing to the overemphasis of the disease’s importance in Africa and in public health more generally. Based on my findings of its low level of importance among rural Malawians, I’ve decided to refocus my energies with a new topical area of study to follow all of my work on AIDS: access to clean water. It’s the primary concern among respondents in our sample, and let’s be honest, water is life.

  3. 19 November 2009 2:35 pm

    i said something along those lines (water) in my dissertation defense and was met with a question that honestly surprised me – “Where’s the evidence that that would help the HIV/AIDS situation?”

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