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Studies question effectiveness of UN aid programs

In the last two decades, the world has spent more than US$196 billion trying to save people from death and disease in poor countries.

But just what the world’s gotten for its money isn’t clear, according to two studies published yesterday in the medical journal The Lancet.

Millions of people are now protected against diseases like yellow fever, sleeping under anti-malaria bed nets and taking AIDS drugs.

Much beyond that, it’s tough to gauge the effectiveness of pricey programs led by the UN and its partners, and in some cases, big spending may even be counterproductive, the studies say.

Trying to show health campaigns actually saved lives is “a very difficult scientific dilemma,” said Tim Evans, a senior WHO official who worked on one of the papers.

In one paper, WHO researchers examined the impact of various global health initiatives during the last 20 years.

They found some benefits, like increased diagnosis of tuberculosis cases and higher vaccination rates. But they also concluded some UN programs hurt health care in Africa by disrupting basic services and leading some countries to slash their health spending.

In another paper, Chris Murray of the University of Washington and colleagues tracked how much has been spent on public health in the last two decades — the figure jumped from US$5.6 billion in 1990 to US$21.8 billion in 2007 — and where it’s gone. Much of that money is from taxpayers in the West. The US was the biggest donor, contributing more than US$10 billion in 2007.

They found some countries don’t get more donations even if they’re in worse shape. Ethiopia and Uganda both receive more money than Nigeria, Pakistan or Bangladesh, all of whom have bigger health crises.

Some experts were surprised how long it took simply to consider if the world’s health investment paid off.

Richard Horton, The Lancet’s editor, labeled it “scandalous” and “reckless” that health officials haven’t carefully measured how they used the world’s money.

Experts said that in some cases, the UN was propping up dysfunctional health systems.

Murray and colleagues also found AIDS gets at least US$0.23 of every health US$1 going to poor countries. Globally, AIDS causes fewer than 4 percent of deaths.

“Funds in global health tend to go to whichever lobby group shouts the loudest, with AIDS being a case in point,” said Philip Stevens of International Policy Network, a London think tank.

In WHO’s study, researchers admitted whether health campaigns address countries’ most pressing needs “is not known.”

UN agencies, universities and others working on public health routinely take between 2 percent and 50 percent of a donation for “administrative purposes” before it goes to needy countries.

Others said there is little incentive for health officials to commission an independent evaluation to find out what their programs have achieved.

“The public health community has convinced the public the only way to improve poor health in developing countries is by throwing a ton of money at it,” Stevens said. “It is perhaps not coincidental that thousands of highly paid jobs and careers are also dependent on it.”
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