Category: APHA IH Section

Over the past two decades, the role of good governance in aid effectiveness has been a topic of debate. Both donor and recipient countries have questioned why investments of official development assistance (ODA) over many years have not resulted in stronger economic and health outcomes. This blog post focuses on health aid (in particular HIV/AIDS aid) and the impact control of corruption and democratic accountability may have on improving health outcomes.

More than 95% of HIV infections are in developing countries. As a result, global communities have invested billions of dollars in the fight against HIV/AIDS using funding from ODA and other substantial donors. Although AIDs-related deaths have decreased by 35% and HIV infections have decreased by 40% since 2000, the decrease has not been significant and millions of new HIV cases are still diagnosed each year. The World Bank’s 1998, “Assessing Aid,” report is part of a body of literature that proposes that good economic policies in recipient countries are associated with (and may be necessary for) successful outcomes like preventing disease  and building stronger  economies. Furthermore, control of corruption in government leadership can be a major factor for growth and poverty reduction, due to good fiscal and trade policies that seek to invest in growth-promoting activities.

According to findings stated in the Hwa-Young Lee et al. article titled, “Control of corruption, democratic accountability,  and effectiveness of HIV/AIDS official development assistance,” control of corruption contributes to aid effectiveness in healthcare delivery. HIV/AIDS is a strong example of this since large amounts of funding are needed to control the illness due to the stigma associated with it, the price of drugs, and the breadth of the epidemic. Corruption at any level can weaken health outcomes by raising the price of services or weakening the quality of treatment . This can, in turn ,  discourage further investment from donors. Consequently, HIV/AIDS policies have to involve broad, democratic consensus about how to invest resources in a way that ensures improved health outcomes.

Hwa-Young Lee et al. used data from 2001-2010 to measure the role control of corruption and democratic accountability on improving HIV/AIDS outcomes. General Methods of Moments estimation showed that control of corruption and democratic accountability had independent effects on the amount of HIV/AIDS aid and the incidence of HIV/AIDS. Furthermore, democratic accountability had a negative interaction with the amount of HIV/AIDS aid on new cases of the disease. The results indicate that more funding may not lead to better outcomes in countries that do not have strong democratic accountability. The authors also propose that HIV/AIDS aid is effective because it focuses on preventing new   cases.  Although prevalence of HIV/AIDS was explored,  an increase in prevalence can be attributed to better treatments and prolonged life. As a result, looking at the relationship between HIV/AIDS prevalence and corruption or democratic accountability may not paint an accurate picture of aid effectiveness.

The debate over the effectiveness of aid in developing countries will likely not be going away soon. Now more than ever, it is important for recipient countries to share their success stories and for donors to work with them to deliver effective economic and health outcomes. At the same time, donors should evaluate their roles in helping alleviate or exacerbate corruption and democratic accountability in developing countries.

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According to the International Institute for Democracy and Electoral Assistance’s (IDEA’s) Democracy and Development programme, democratic accountability refers to: ways in which citizens, political parties, parliaments and other democratic actors can provide feedback to, reward or sanction officials in charge of setting and enacting public policy. Well functioning accountability mechanisms are believed to provide incentives for governments to work in the best interests of citizens…Read more in their discussion paper titled, “Democratic Accountability in Service Delivery: A Synthesis of Case Studies.”

Global warming and climate change are real and pressing issues for today’s world that cannot continue to grow without any action. Both natural events as well has human activity have led to an increase in average global temperatures. Shifts in climate, extreme weather events, and rising temperatures affect each and every one of us, but more importantly, disproportionately affect our most poor and vulnerable populations.

The impoverished not only face more difficulty obtaining medical care, food, and proper shelter, but also lack the resources to recover from natural disasters quickly. Homes and livelihoods are often lost or significantly damaged because of floods or droughts never seen in this magnitude before. Because of this, we cannot even begin to think about ending poverty without first addressing the issue of climate change.

One proposed solution is to reduce deforestation, and keep tropical forests standing to keep carbon sinks intact. These intact forests not only store large quantities of carbon, but also absorb about one-fifth of carbon dioxide emissions each year. These forests are so vital that they were recognized in the Paris agreement, calling for countries to conserve these forests along with other carbon reservoirs in order to mitigate the effects of climate change.

Not only do tropical forests help mitigate the impacts of global warming, but can also contribute towards the achievement of 4 of the Sustainable Development Goals (SDGs). The SDGs revolving around food, water, health, energy, and human safety are all impacted by the success of maintaining these critical forests.

Maintaining tropical forests make sense economically. Carbon pricing, which is putting a price on carbon pollution based on its wide-ranging effects, has been implemented among 40 countries already, with many seeing success. One of these countries is Brazil, who has already seen a reduction in its deforestation rate of 80% since 2004. Brazil has been utilizing satellite-based technologies to track illegal deforestation and alert environmental police to these areas quickly, with other countries hoping to follow similar models.

Other economic incentives include performance-based payments (PBMs) between high and low-income countries. One such partnership between Guyana and Norway, has seen success in 6 areas, including for example broad buy-in throughout Guyana and strengthening its institutions of forest governance. However, this has not been without difficulties as well, including increasing commercial pressures from logging markets, and long-term uncertainty about the success of these partnerships.

While these initiatives have shown initial success, more impactful solutions such as a reduction in energy subsidies worldwide could free up government spending. This spending in turn, could be targeted towards poor populations in a variety of ways, such as strengthening social protection systems.

So why now? As the impacts of global warming and climate change increase, so too do their effects on poverty. Unless we decide to act now, our ability to target extreme poverty will become even more difficult. In order to reach our SDG of ending all poverty by 2030, we must act now and we must act quickly. Protecting and restoring tropical forests, establishing more global partnerships between low and high income countries, and improving other incentives are critical for the future our Earth as well as its inhabitants.