The Business of Benevolence

by Dr. Sosena Kebede

The Global Fund (an international financing organization that pools resources to fight against the top three leading infectious diseases in the world: AIDS, TB and Malaria, to date has committed $22.4 billion) just announced that, due to the current financial crisis, it is canceling round 11 of grant renewals for recipient countries. Most of the recipient countries are in the sub-Saharan Africa and the United States has been the single largest donor (traditionally about 33% of all donations through the GF come from the US) since the organization’s inception in 2002.

My initial reaction on hearing this news mirrors that of most of my colleagues in global health – let’s do something, anything; this can be catastrophic and may mean winding the clock back to when hundreds with HIV were perishing because they didn’t have access to drugs. Other thoughts that flash through my head include: What does this mean to governments of poor nations, NGOs, other donor agencies, pharmaceutical companies, health care workers in poor nations, business people, rich people with the disease, or poor people with the disease?  Will this mean drug rationing? Will this give rise to drug resistance if some treatments are stopped due to lack of funding? Will this mean a lucrative business for someone out there who will stand to gain big when resources shrink, and the rich will find a way to get access?  Speculations, speculations.

Some, all or none of the feared may come to pass. However, the more I think about it, the more I am bothered by the commentary this issue makes rather than the potential outcome, however grim it may (or may not) end up being.

It is deeply saddening to face the fact that the very livelihood of millions of poor people can often depend on the benevolence of the rich. Our world is changing fast; emerging economies are flexing their muscles and contending with Western powers for influence in poor countries. Yet, millions of the world’s poor will have no say on how this phenomenon called globalization will affect their lives. Poor nations have also been below the radar detection when debates rage all over the world about the global mess that years of fiscal irresponsibility and corporate greed has brought. For millions of the world’s poor, our new world order and the concept of globalization, the shift in power/wealth etc., whether good or bad, might as well be happening in another planet for all they have any part in it. Unfortunately, their lack of participation in the process does not shield them from the consequences – they stand to lose the most having no means or power for self-determination.

Poverty, health and human rights are inextricably intertwined. We can’t truly advocate for global health equity when the world continues to have millions of voiceless people and people will not have a voice unless they are economically empowered. The business of benevolence, however generous and much needed it may be, is only a temporary measure for the poor that merely affirms to us our implicit sense of moral superiority.

Sosena Kebede, MD, MPH is an assistant professor of medicine in the department of medicine at Johns Hopkins University in Baltimore, MD. She is also an associate faculty at the Johns Hopkins Bloomberg School of Medicine in the department of International Health. Her work in global health focuses on health systems strengthening works such as directing a hospital management training program in Ethiopia for Yale University as well as doing consultancy work for the World Bank. Her professional memberships include being a section counsilor for APHA’s international health advocacy and policy committee, as well as member of the advisory board for the international Association in Technology, Education and Development.