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[afro-nets] Funding for primary health care in developing countries(2)

  • From: "Ronald Labonte" <rlabonte@uottawa.ca>
  • Date: Tue, 18 Mar 2008 04:50:11 +0700

AK's comments about donor financing of health systems are correct if we assume that aid is charity and dependence is begging. But it doesn't have to be. Nor is the notion of 'self-sufficiency of sovereign states' helpful. Increasing competition over scarce resources essential for survival render self-sufficiency an environmental myth. The partitioning of countries by imperialist colonizing nations, and the ongoing balkanization of countries in several parts of the world, also make it an economic myth. Moreover, resource redistribution within nations through state taxation, regulation and spending policies has been shown countless times to be essential to correct for market failures and to reduce poverty more effectively, sustainably and efficiently than economic growth per se. Economies and their resource base are increasingly global/globally entwined. This perforce demands efforts to create globally systems of redistribution and regulation that have worked, and continue to work, at national and regional levels. I reference here how federated nations (or in the case of the European Union, a federation of countries) have used transfer payment schemes to share resources between member polities where the population base is large and/or wealth-generating activities are plentiful, with areas where the population base is small and/or wealth-generating activities are limited. The purpose of these transfers has generally been to finance health, education, social and other infrastructure programs essential to collective well-being. Such transfers, while occasionally critiqued by conservative economists and politicians as dependency-producing and always subject to politicking over how much should be transferred and to where, are nonetheless accepted as citizen entitlements and political obligations.

What we presently call 'aid' should be viewed in the same light. Resource transfers from rich to poor countries is ethically defensible (invoking the principles of relational justice) and legally obliged (under various human rights covenants). Until rich countries (and particularly the rich within them) cease consuming proportionately more of the benefits of economic growth (which national histories have shown can only be accomplished through taxation and regulation of consumption for redistributive purposes) poorer countries attempting to catch up through more macroeconomic self-determination will find that there is nothing left for them to autonomously choose to spend on or consume.

I offer these comments not to take away from the rightful criticisms of aid, albeit many recent studies have found less base for some of these criticisms than existed in the past. But I fear that such critiques, in the absence of tackling finite global resource limits and the empirical implausibility of many poor countries to have a sufficient population and resource base within their borders to function autonomously, could reduce the political incentives to create more consistent, untied, pooled and recipient driven forms of global resource (wealth) transfers. Improving global systems for such transfers is not to the exclusion of creating more economic justice, the point underscored by AK; but it is a recognition that economic justice also demands such transfers.

I would add to D Barzagar's comments, that Alma Ata was predicated on a new international economic order (fair and rational) so that all states could provide for the basic needs of their people, without outside interference.

"Aid" is outside interference and locks poor countries into all kinds of other dependencies which are invariably exploitative. It is absolutely the wrong way to go. The goal must be self sufficiency of sovereign states which is perfectly feasible with macroeconomic reforms for economic justice. (It goes without saying that if that goal were being pursued, international aid would be justified to deal with emergencies arising but it is not in itself a goal to be pursued.)

Like the millennium development goals, these goals are inadequate and worse, they are cosmetic. They are far less ambitious than the goals of Health for All. Financing of health and health services through "aid" is incompatible with health as a human right. No citizens of the so-called first world would accept that their health services be provided through international aid.

These are lessons learned decades if not centuries ago. People are not interested in making begging a way of life and giving up sovereignty in return for the latest rescheduling of odious debt. They are interested in winning and enjoying their rights.

If any of us want to "help", it is in that endeavour ? emancipatory development - that we should put our energy and money!

Ronald Labonte