Basic Health Care is the Key; Well, One of Them

A recent article from Integrated Regional Information Networks (IRIN) argues that basic health care is vital to HIV treatment and care, as well as HIV prevention. While it is refreshing to hear expressions of this view from such an influential source, the article doesn't make any suggestions as to where money to build up basic health care in Kenya and other developing countries would come from. Most of the large sources of donor money (the President's Emergency Fund for Aids Relief (PEPFAR), the Global Fund, the Bill and Melinda Gates Foundation) are earmarked for HIV or one or two of a handful of other diseases. Even funding for so called 'neglected diseases' does not usually aim to build up basic health care. And non-transmissible diseases (for example nutritional deficiencies, various forms of cancer, type 2 diabetes, etc) receive hardly any funding at all, despite being responsible for a sizeable proportion of deaths in developing countries.

There are those who would defend these approaches to health and disease, often arguing that health care in general does benefit from programmes that address one disease or health area. But this is not good enough. There are too many diseases, transmissible and non-transmissible, that are being ignored. Health services are in a terrible state. The number of qualified health personnel is a disgrace to a country that is nowhere near the poorest in Sub-Saharan Africa. And the health infrastructure has been crumbling since the 1980s. Most health services are inaccessible to the majority of Kenyans and people will continue to die and suffer from easily curable and treatable conditions if this state of affairs doesn't change.

In addition to basic health care, many children still don't receive basic education, many don't receive enough basic education and most receive a poor standard of education. Levels of equality between males and females and between the haves and the have-nots are inexcusable and, in common with almost every country in the world, developing and developed, these are disimproving. And bad health is almost guaranteed in countries where there is little food security, very low levels of nutrition and low access to clean water and modern sanitation facilities.

The article in question refers to an ActionAid report which rightly points out that basic health care is the key to tackling HIV. But health on its own is not enough. The health of a country also depends on levels of education, social services, infrastructure, equality, opportunity and many other things. I hope this is a sign that a climate of more inclusive development programmes is on the horizon, but the global economy will not make this an easy job. continuing to involve NGOs and the private sector is all very well but most NGOs are focused on one or a relatively small group of issues. No NGO is big enough to be particularly inclusive. And the private sector are completely single minded. They will ship condoms to countries regardless of what happens to those condoms when they get there; they will ship pills to people who have no water or food. They want markets and little else.

I hope ActionAid is right but they may also like to lobby the World Bank and the International Monetary Fund while they are at it. These international financial institutions spent the last few decades persuading developing countries that the best way to develop was to reduce spending on health, education, social services and infrastructure, to limit the number of public sector personnel they employ (teachers, nurses, doctors, etc), cap spending on public sector wages and to introduce a whole host of 'austerity' measures. The institutions have continued to insist on the continuation of these measures and the introduction of even more of them, despite overwhelming evidence of the damage they were doing to people's lives. Ironically, these institutions are also big donors, so it's not as if they couldn't help out, if and when they eventually see the light.

Health and HIV don't exist in a vacuum and they are not short term emergencies. Unless developing countries are helped to develop and the many obstacles to their developing are removed, HIV treatment and eradication programmes have limited success.