Charity and Health in Sub-Saharan Africa, Too Much Money on AIDS?

I just came across an interesting article by two dutch economists arguing that the rate at which international aid targeting HIV/AIDS has grown in the past decade is doing more harm than good. It essentially misses the most important demographic issues and fails to strengthen health infrastructure in Sub-Saharan Africa. As they conclude, and many of us already adhere to, "Foreign aid ought to be guided not by fleeting opinion and charity but by evidence and true engagement, aiming at long-term sustainable solutions."

The authors specifically point to the decrease in maternal health care as the major problem. The graph posted shows the evolution of AIDS funding crowding out family planning and basic reproductive health service.


Two interesting points from the authors:

1) HIV/AIDS programmes would profit considerably from a more balanced approach, as maternal health and family planning investments go to the heart of the problems of Sub-Saharan countries – high population growth rates keeping numerous countries trapped in poverty...

In most countries, the total fertility rate, the expected total number of children per woman, hovers around five, far above the replacement rate of 2.1 children. Judging from the demographic health surveys carried out in developing countries, desired fertility rates fell faster over time than the actual rates. This is reflected in high levels of unmet need and high proportions of births that are ill-timed or unwanted. High fertility leads to rapid population growth rates, exacerbating scarcity in health care, education, land for farmers, and all other public domains of life.

2) The unprecedented rise of HIV/AIDS funds is disrupting fiscal policy and local health care systems whereas a more balanced investment in reproductive health and HIV/AIDS would make use of the existing infrastructure.

Vertical programs like HIV/AIDS erode the primary health care systems in developing nations. The new HIV/AIDS funds are swamping public health budgets, in some cases exceeding 150 percent of the government’s total allocation to health care (Lewis, 2006).

Too much money must be spent in too short a time. Such a situation, particularly in the conditions of extreme poverty and poor governance prevalent in Sub-Saharan Africa, easily results in “poaching” of health care workers and bureaucrats from other worthy public projects.

Does this beg the question of how and if the big charities should go about fighting AIDS?