The dangers of disease specific programmes for developing countries

England’s1 perspective that funding disease-specific programs without
first addressing national health systems hampers the achievement of better
health in developing countries requires qualification. While a long-term
goal of sustainable healthcare delivery through functioning health systems
is obviously important2, there are sick people for whom revitalization of
health systems will be too late, and for such people disease-specific aid
programs are lifesaving. Non-governmental organizations like Medecins
Sans Frontieres have specific mandates that govern their fundraising and
healthcare activities, and they cannot be expected to divert such funds to
augmenting salaries of competent national healthcare workers. My
experience with operating vertical leprosy programs in northern Nigeria
indicates that these programs provide ‘homegrown’ best-practice benchmarks
for stimulating health system reform, including the integration of mature
vertical programs into general health services.3

The benefits of disease-specific aid programs have been shown with
regards to effective short-term efforts to control polio, measles and
leprosy epidemics in specific regions in spite of their poor health
systems. Chronic poverty of most developing countries compound efforts
to promptly revitalize health systems. In Kyrgyzstan, where I worked
earlier this year, the Government’s WHO-supported (MANAS) health reform
program has been on-going since 1996 with good results. However, the
maximum government annual budget for tuberculosis control has remained at
$US1 million since 1996. The World Bank estimates that the country needs
at least $US5 million yearly for TB control.4 Ongoing tuberculosis-
specific aid programs in Kyrgyzstan are appropriate and have been
producing positive dividends with regards to tuberculosis control as well
as influencing the revitalization of the health system. Let’s not throw
away the baby with the bathwater.

References

1) England R. The dangers of disease-specific aid programs. BMJ, 2007;
335: 565

2) Jha P, Mills A, Hanson K et al. Improving the health of the global
poor. Science, 2000; 295: 2036-2039.

3) Awofeso N. Life after Multidrug therapy: the managerial implications in
leprosy control in Kaduna state, Nigeria. Tropical Doctor 1997; 27(4):
196-8.

4) Godinho J, Veen J, Dara M, Cercone J, Pacheco J. Stopping tuberculosis
in central Asia: priorities for action. Washington, World bank, 2005.

Competing interests:
None declared