No One in Charge (And That’s Okay?)

by Alanna Shaikh · 2009-07-07 01:40:00 UTC
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(photo credit: one from RM)

There is no governing body in charge of global health. No overall regulation, no one controlling aid flows, and no one choosing which countries and problems get money and which don't. Every donor develops their own priorities and policies, and follows them to whatever extent they see fit.  Donors, of course, range from tiny faith-based groups and high school fundraising efforts to major foundations like Gates and Rockefeller, government donors and UN agencies. Their levels of skill and competence vary widely.

The Aid Watch blog pointed out today that this wreaks havoc on accountability and even accounting. "Nearly one-third of the global health money spent by the very largest donor by far-the US government-is untraceable. The study highlights the large gaps in existing health data and comments, ‘Surprisingly, discussions about global health financing continue to take place in the absence of a comprehensive system for tracking [development assistance for health].'"

That, I admit, is a problem. It is very hard to find out what's working when you don't even know what is going on. Inefficiency is everywhere, and information does not flow. Bad projects get buried by their donors and implementers, so no one ever knows they happened. Good projects may not get copied and expanded the way they ought to be.

However, I am not convinced that a global health regulatory body would make things better. It would have to be huge to actually track and monitor the enormous amount of money that goes into global health. Huge bureaucracies do not have a good track record for efficiency, responsiveness, or good knowledge sharing. I think that a global health governing body would either slow down funding for global health programs to a painful degree, or it would end up as an irrelevant layer of ineffective bureaucracy.

Alanna Shaikh
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