“My twin daughters died when they were only two years old. I didn’t know what was wrong with them, they were both very ill and I was weak with a fever. So I carried them for two days to the nearest health centre, walking as fast as I could. It was hot and dry and my babies just kept getting worse. When I was a few hours away from the health centre they both stopped crying. When I arrived, the nurse told me that it was too late to treat their malaria.”
Hasena lives in Kodae village in the remote desert region of Afar, 40 miles from the nearest health centre. Sadly, her story is not uncommon. But AMREF refuses to accept this situation. Just because people live in remote rural areas of Africa doesn’t mean they should struggle to find basic health care and die of easily preventable and treatable diseases (http://www.amref.org/personal-stories/hasenas-story/).
AMREF (African Medical and Research Foundation) represents one of a number of institutions that have taken up the gauntlet of taking responsibility for finding solutions to the health and social challenges of our communities. With the advent of HIV/AIDS, there has been a greater focus on coordinating international aid and funding efforts, however, that coordination does not necessarily translate into better health outcomes.
The experiences of this mother who lost two children are not a rare occurrence in poor countries that that are also heavily reliant on donor funding. In many instances donor funding, which also funds institutions such as AMREF, represents over a quarter of countries health care funding- particularly in low to middle income countries across Africa and around the world. The truth of the matter is that no matter what context we speak across, there are fundamental issues that have not yet been adequately resolved. These are issues which centre around weak governance structures, poor accountability of the state to its electorate(s) and shifting focus between democracy and development. They impact all levels of society and ultimately result in poor economic, social and health outcomes.
Ultimately what we should be asking is to what extent do our governments prioritize health and treat it as a public good as opposed to a brokered commodity? Does the health expenditure in our countries approximate the target of 15% of total government expenditure as agreed by the African Heads of State in Abuja in 2001? The status quo determines that it is inevitably the poor and vulnerable (particularly women and children) that are the greatest affected and marginalised.
Secondly, what is the real and lasting legacy that external funding and solutions will leave with us? The HIV/AIDS and TB pandemics have received major inputs as a result of international pressure and attention and in the same vein, so have other diseases of poverty been placed under the spotlight and been given significant focus through cash injections into health systems strengthening, drug and vaccine development, research, advocacy and social mobilisation. One does not dispute these facts and indeed it is important to give credit where credit is due, however, does the link between the issues and agendas of governance, democracy, development and health care not beg the fundamental question of what the definitive conclusion of external funding is? Between the cracks of our own structures of government falls the security of stewardship and this is what determines the capacity of countries to create autonomous, sustainable and effective interventions against health crises. It is an open secret that aligning our health priorities with international imperatives and subsequent reliance on external funding is a compromise and there is a real risk of falling into a situation of perpetual subservience to agendas that are not locally developed. These external priorities unequivocally come with the peril of conditionality in spheres that matter most such as in health and at economic policy and trade levels.
The challenge of malaria is illustrative of a disease that causes untold suffering yet despite this, home brewed solutions have not received the necessary capacity nor momentum that they warrant. I challenge local communities, researchers and activists at home and abroad to manoeuvre to create new power bases that will result in the collection and creation of knowledge for local use. Change must happen from within our communities and countries of impoverishment first before it can be relevant to the international community, yet so often we are so obsessed with reverse. The gauntlet to be taken up is to develop lasting solutions which women like “Hosae” in partnership with the health care workers of “Kodae village” can implement, because ultimately the death of her children is the death of our children and our brothers and sisters and no life, no matter how brief can be replaced.