Development and Global Health Aid Cuts Would Be Cruelest of All

The election of Barack Obama has raised expectations throughout the world that America will now turn its attention and support towards the needs of the world’s poorest citizens. Though it faces its toughest budgetary and economic challenge since the Great Depression, the United States cannot afford to eliminate, or even reduce, its foreign assistance spending. For reasons of political influence, national security, global stability, and humanitarian concern, the United States must, at a minimum, stay the course in its commitments, meeting prior promises to double aid to global health and development, as well as basic humanitarian relief.

The Bush administration sought not only to increase foreign assistance, targeting key countries (Iraq and Afghanistan) and specific health issues (AIDS and malaria), but also executed a vast array of programmatic and structural changes in U.S. aid efforts. Europe, Japan, Canada, Australia, and several other wealthy nations mounted a similar drive to improve conditions for the poorest world citizens over the last decade. Between 2000 and 2006, estimated donor commitments, from all sources, on global health efforts alone, rose from $15 billion to $45 billion. Estimated total Official Development Assistance (ODA) rose from $53.7 billion in 2000 to $103.7 billion in 2007. On average, sub-Saharan African governments also increased spending on the health of their population. According to the World Bank, in 1990, the average sub-Saharan government spent $6 per capita annually on health, with spending ranging across the region from a low of $2.27 per capita to a high of $21 per capita.

Since 2000, these efforts have led to great achievements despite the shortfall in committed dollars versus real dollars for health and development. The Global Fund for AIDS, Tuberculosis and Malaria was launched in 2003, and by October 2008 had dispersed $6.4 billion in grants for country-designed programs. According to Global Fund data (PDF), its dispersement mechanism is both without precedent and empirically successful in achieving its targets some 80 percent of the time. PEPFAR, the U.S. President’s Emergency Plan for AIDS Relief, had by March 31, 2008 started 1.73 million people on antiretroviral treatment for HIV infection, and provided antiretroviral prophylaxis for women in more than 1 million pregnancies to prevent infant in utero infection. By the end of 2008, the combined donor, Global Fund, and UN efforts to tackle malaria had pushed down deaths due to malaria (PDF) by 50 percent in key African and Asian countries, according to World Health Organization (WHO) figures, in large part due to insecticide spraying campaigns and the dispersal of pesticide-treated mosquito nets.

But in September 2008, the UN Secretary-General’s office concluded that both funding and program development were falling far short of what was needed to reach the 2015 Millennium Development Goals (MDGs), and at least six of the eight targets were on course to fail. MDG 5--maternal survival--has not shown significant improvement in any poor countries, or most emerging market countries. Well before the impact of the financial meltdown was felt, donor support had declined: Aid dropped 8.4 percent in 2007, after a 4.7 percent drop in 2006. The Group of Eight (G8) industrialized nations pledged in 2005 to donate more than $25 billion to Africa by 2010, but just $4 billion has actually been delivered. “We are running out of time,” UN Secretary-General Ban Ki-moon warned.

Concerns about the ’Knock-on Effect’

Since the credit crisis of 2008 unfolded, countries and small companies in the developing world have found it more difficult to obtain loans for programs such as road construction and business development, and governments also have found it difficult to offset declining revenue streams to cover the costs of essential public goods. In October 2008, World Bank President Robert Zoellick warned, “While people in the developed world are focused on the financial crisis, many forget that a human crisis is rapidly unfolding in developing countries. It is pushing poor people to the brink of survival.” World Bank statistics show the number of malnourished people globally will grow by 44 million, to 967 million in 2008, as several countries experience double-digit food inflation.

Africans often say, “When Washington catches a cold, we get pneumonia.” Since mid-2008, the credit crisis and financial meltdown have put Washington metaphorically in an intensive care unit, which means Africa and other very poor regions of the world are heading to hospice. It is a sad truism of foreign assistance that the very times that cry out most loudly for help for the poor are those during which the wealthy world is itself suffering. To put it bluntly, in the face of catastrophic levels of necessary spending on the banking bailout and mortgage crisis, it might seem reasonable to hack at the modest $36-billion foreign assistance budget, as was suggested in the presidential campaign. Yet in so doing Congress risks not only reversing all that has been achieved with U.S. tax dollars since 1990, but endangering the lives of millions of people. Furthermore, any backpedaling in U.S. support risks undermining disease surveillance and response capabilities, thereby directly threatening American security.

It is a cruel formula. Inflating seed, fertilizer, energy, and food costs mean that 2009 promises to be a brutal year. Yet provision of tied food aid, food that is supplied by the donor country rather than purchased locally, means the United States and other wealthy nations have not built serious agricultural development programs that can sustain millions of farms and lives worldwide. Provision of anti-HIV drugs cannot cease, as countries lack the capacity to purchase these medicines on their own, and treated individuals will almost certainly die within weeks, at best months, of cessation of their medication. Amid a global crisis in the emergence of drug-resistant microbes--especially untreatable forms of tuberculosis--the United States cannot afford to reduce efforts to control and treat bacterial diseases properly. As bird flu continues its evolution and spread, the United States must continue to sustain influenza surveillance and control measures or face the dire possibility of being caught off guard by a virulent pandemic. As the costs and risks of the business of humanitarian aid increase, so must U.S. financial support; otherwise, the American people face the continued dangers posed by alienation and anti-American anger in unstable, impoverished parts of the world.

It is a sad truism of foreign assistance that the very times that cry out most loudly for help for the poor are those during which the wealthy world is, itself, suffering.

Nobody at the World Bank is very happy with this situation. Seven months ago, Zoellick was warning that the food crisis was forcing hundreds of millions of people--especially in southern Asia and sub-Saharan Africa--into desperate poverty. Now Zoellick’s hair is on fire. “We need a Facebook for multilateral economic diplomacy,” he said in October 2008, referring to the successful social networking website, declaring that the G8 is nonfunctional, and that global financial leaders are not communicating with one another to stave off this crisis.

He also warned, “The events of September could be a tipping point for many developing countries.  A drop in exports, as well as capital inflow, will trigger a falloff in investments.  Deceleration of growth and deteriorating financing conditions, combined with monetary tightening, will trigger business failures and possibly banking emergencies.  Some countries will slip toward balance of payments crises.  As is always the case, the most poor are the most defenseless.”

Though the wealthy nations’ economies are just now officially entering recessions, financial events that started unfolding a year ago have already had devastating impacts in poor countries. For example: