| A retort to Philip Stevens |
[Nov. 20th, 2009|04:44 pm] |
Philip,
I agree that one of the main ways in which child deaths can be reduced is to raise the incomes of poor people. It’s clear from East Asia and Latin America, where child mortality rates have fallen sharply in the last twenty years, that rising incomes are an important part of the story.
However, it’s not the whole picture. Malawi is no African economic tiger, but despite its poverty it has almost halved the child mortality rate since 1990. It’s done this largely by using its small health budget well, and investing in low-cost prevention: things like skilled birth attendance and immunisation.
As Malawi shows, you don’t need to wait for high growth rates to kick-in in order to make marked improvements in child survival (and there are plenty of countries that have failed to translate high growth in to lasting gains in human wellbeing).
When it comes to the case for aid, caricature gets in the way of a sensible discussion about what’s needed to improve health outcomes. The answer to bad aid is good aid, not no aid. The aid provided to Zambia through debt relief enabled the government there to scrap user charges for basic health care in rural areas. Utilisation of services has shot up as a result. Four million people on antiretroviral treatment for HIV and AIDS would be dead today were it not for donor aid.
Our recent Child Health Now report makes clear that donor aid has an uneven track record, and that there are too few success stories. But where aid is used as a complementary tool to support national efforts, it can make a positive difference. Let’s not oversell aid – it’s not a magic bullet, and given in the wrong way can create its own problems – but let’s also avoid a scorched earth approach to shortcomings in the aid system. |
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