NCDs and Development: Is Aid the Right Solution?

NCDs and Development: Is Aid the Right Solution?

Greg Paton currently works in Uganda as a Technical Advisor to the Uganda NCD Alliance. He previously coordinated the campaign for the 2011 United Nations Summit on NCDs while working for the NCD Alliance and International Diabetes Federation. On Twitter: @gregjpaton

Prior to last year’s United Nations Summit on Non-communicable Diseases (NCDs) in September 2011, a representative from one government aid agency stated that “Ministers don’t think they have the legitimacy to engage on NCDs. The public perception is that they’re seen as diseases of affluence.”

Such attitudes are still common among funders and are a key battleground for those working on diabetes, cancer and other NCDs. To counter this, advocates have pushed governments to acknowledge that NCDs are inextricably linked to poverty and affect the poorest of the poor – an impressive effort that shifted the mindset of many governments. Such narratives have immense power to shape global priorities, as the AIDS movement has shown.

While the primary aim of this effort should be holding governments accountable for addressing the health needs of their own people, the dominant focus has been on western aid as the solution to low-income countries (LIC) challenges in addressing NCDs. This is where the logic gets problematic.

Aid and the Bottom Billion

The majority of the world’s bottom billion (a phrase coined by Paul Collier to describe the world’s poorest citizens) now live in middle-income countries – 72%, according to the Institute of Development Studies. 60% live in just four counties – India, China, Nigeria, and Indonesia, all ranked among the 40 richest countries in the world by the World Bank.

While the current Millennium Development Goals focus on low-income countries, all signs point towards the follow up goals adopting a global focus. In either scenario, the assumption that these goals will lead to increased funding for NCDs to the world’s poor is problematic. If we want to reach the bottom billion in preventing and treating NCDs, we need to look beyond aid and work in partnership with countries like China and India.

A 2008 study estimates that only 19% of health spending in Africa comes from foreign aid. In countries whose health systems do rely heavily on aid, more disease specific aid is not the answer – they need more fundamental support to establish a functioning health system, focused on training health workers, primary care, basic surveillance and access to medicines.

The Dangers of Aid

Many leaders in the NCD arena agree that increased funding for health systems is ultimately going to benefit NCDs and should be an overarching goal. Despite this, we’ve created an expectation among many NCD constituents in LICs that by getting NCDs on the UN agenda, we will secure earmarked donor funding for cancer, diabetes, tobacco and other areas. This creates a dangerous mindset of dependency on western countries rather than encouraging citizens to hold their own governments to account. It also presents a narrative that focuses on money, rather than political will and cost saving policy interventions, as the solution.

We need to convince our counterparts to put more pressure on their governments to make much needed domestic reforms. There is a long list of NCD interventions that not only cost nothing, but are cost saving. These include tobacco taxes, implementing legislation, national NCD plans, health education in schools, integrating NCD programs into primary health care, reducing taxes on essential medicines and reducing salt content in foods.

Without the systemic and sustainable change these interventions will bring, aid is the equivalent of a temporary bandaid in a system that will have an infinite amount of leaks. No amount of aid could stop the endless flow of sick people created by government inaction on tobacco or unhealthy food. Too many governments have failed to roll up their sleeves and take the necessary action. Only a few have met their 2001 commitment to spend 15% of their budgets on health.

A Fight We Can Win

There has been little attention since the Summit to support the rollout of the NCD best buys identified by The Lancet and the World Health Organization – and few case studies or technical guides on these best buys are available.  The one goal agreed by Heads of Government at the UN Summit – to implement National NCD Plans by 2013 – has already expired, with little attention garnered. The global NCD targets recently agreed by governments should renew our effort to support implementation of such interventions.

There is a place for aid. But the link between global UN goals, increased aid, and helping the world’s poorest with NCDs is – at best – full of assumptions, and misleading at worst.

I support the current effort led by the NCD Alliance to have NCDs included in the post 2015 UN goals. This work will help bring attention to the need to address NCDs and can only strengthen the case for action – hopefully, with more focus on governments owning up to their responsibilities to their citizens, and less on blaming lack of progress on donor policies and UN goals.

Global narratives have immense power to shape action. If we continue to blame western aid for lack of progress, where will this leave us in a decade? How will we help the majority of the bottom billion who live in emerging economies? It’s time to empower countries to take action and show that, despite limited resources, this is a fight we can win. The halls of the UN are where we declared battle, but it’s on the ground where the fight will be won.

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