How to spend aid wisely: the politics of global health

The amount of money spent on aid for health in developing countries has increased dramatically in recent years, from around $6.6 billion in 2000 to $20 billion today. Yet the health problems of the developing world remain intractable. The problem, says Dr Devi Sridhar, University Lecturer in Global Health Politics in the Department of Public Health and the Blavatnik School of Government, is in the politics.

'For example, international donors have neglected problems such as poor nutrition, injury and chronic disease', she says, 'while putting huge resources into global programmes targeting individual diseases such as HIV/AIDS and malaria.' While such programmes are invariably well-meaning, they risk being suddenly brought to an end as fashions change, or failing because of inadequate scrutiny or lack of infrastructure.

Dr Sridhar saw the impact of this mismatch between policy and need at first hand when researching the failure of strategies to end childhood malnutrition in India in the 1990s and early 2000s. Today her focus is on gathering evidence that can inform policies to achieve a better balance between the ambitions of governments and donors and the rights to health of low-income communities. She has just launched a comparative project looking at how local priorities relate to global and government priorities in Brazil, Bolivia, Bangladesh and India.

'International organisations, such as the WHO and the World Bank, are trying to be more responsive', she says. 'The challenge for institutions is how to do that, from the community level all the way to global level.' Dr Sridhar is on the steering committee of an international network called the Joint Action and Learning Initiative on National and Global Responsibilities for Health (JALI). JALI is a partnership between academics and civil society organisations including Section27 in South Africa and the Centre for Health, Human Rights and Development in Uganda. It is working towards a Framework Convention on Global Health that would give meaning to the concept of a human right to health. Fieldwork is due to begin in the autumn of 2012, gathering information from communities in several countries.

The aim is to develop a set of indicators that can inform health policies after 2015, the deadline for the existing Millennium Development Goals. JALI is asking what essential services and goods underlie the human right to health; what responsibility states have for the health of their own populations, and for the world's population; and what kind of global health governance is needed to ensure states live up to their mutual responsibilities.

Dr Sridhar has received funding for the project from the EU to develop an evidence base that can be used in future European negotiations. 'The focus will be on health systems, universal coverage, and primary care', she says. While she spends much of her time bending the ears of global policymakers, her own are tuned to the voices of individuals, most recently through Twitter: she's 'currently following a midwife in Uganda'.