https://arab.news/2qazc
For the past half-century, the economics of global health were straightforward. Rich countries gave grants to poor countries, which used the funds to meet their populations’ health needs. Success was measured in services provided or lives saved, rather than balance sheets balanced. While this model was far from perfect, the approach that is now replacing it — focused on using tools like guarantees and blended finance to crowd in private capital — threatens to produce even worse outcomes.
There are legitimate criticisms of the grant-based approach. Grants are finite, draw on limited public budgets and are subject to donor-country politics. Official development assistance for health has stagnated, in real terms, since the late 2010s, even though need has grown. Moreover, the grant-based system makes much use of vertical health programs, which advance specific, measurable, narrow and often short-term objectives. Since these programs have their own procurement systems, reporting requirements and priorities that run parallel to overarching national objectives, they tend to lead to more fragmented health systems, not stronger ones.
More fundamentally, the grant-based system makes recipients accountable to donors, rather than citizens. Donor “earmarks” — restricting contributions to specific projects, objectives or places — create perverse incentives, as they are often narrow in scope and reflect short-term thinking. As a result, countries might be left with gleaming tuberculosis clinics but no funds for basic child health services. And grants often breed dependency, with services collapsing as soon as the money dries up.
