Moving beyond aid to set the global health agenda

An international meeting aims to shake up donor−recipient relations in a quest for more enduring health gains, reports Beverly Petersen Stearns.

This year, a well-known international meeting on global health research will adopt a provocative new theme.  

The subtitle of Forum 2012, the successor to the conferences organised by the former Global Forum for Health Research, will be 'Beyond Aid'.

No longer will the conference focus mainly on the use of funds from traditional donors and funders of health research in Europe and North America to improve the developing world's morbidity and mortality statistics.

Instead, the meeting, which will take place in Cape Town, South Africa (24–26 April), will consider a funding model in which poor countries develop their own contracts and partnerships, and use their own resources ― and how donors can support that model rather than just provide development aid.

"Forum 2012 will be the first major way in which we try to integrate global efficacy and national capacity building to build on what countries can do — rather than home in on their problems," says Carel IJsselmuiden, director of the Council on Health Research for Development (COHRED) Group in Geneva, which now incorporates the Global Forum.

COHRED advocates health research and development (R&D) in the world's poorest countries. But IJsselmuiden says this might be better achieved by focusing more on human resources, infrastructure and capacity building, and less on statistics about diseases.

Merger stimulates new approach

COHRED itself had been heading in this direction in recent years and the merger with the Global Forum for Health Research — which imploded in 2010 — has now given the latter's regular meeting this new voice.  

The Global Forum's troubles came to a head in late 2010. Some of its problems, according to IJsselmuiden, were those common to many non-governmental organisations ― problems with governance at board level, and funding.

At its 2009 conference in Cuba, Stephen Matlin, the then executive director, introduced his successor, Anthony Mbewu, formerly head of South Africa's Medical Research Council. But Mbewu resigned without explanation after less than a year and the organisation lost many of its staff, who left, were fired or took early retirement.

According to IJsselmuiden, it was Mbewu's resignation that paved the way for the merger with COHRED this year. "The vacancy of a CEO is always a good time to talk about a merger or an intensive collaboration. There is a flexibility that would not have been there if a CEO were in place."

The Global Forum's funding problems might seem to exemplify the reasons why the merged organisation is now encouraging countries to look 'beyond aid', but IJsselmuiden says his motivations are more profound.

"COHRED itself had already been working for a long time on the premise that for development, local, rather than international, funding is needed," he says.

New alternatives to aid

This 'beyond aid' strategy should not be viewed as either courageous or too optimistic, says IJsselmuiden, who before taking the helm of COHRED in 2004 was director of the University of Pretoria's School of Health Systems and Public Health.

"We live in a new world, one in which funding is no longer just done by aid and donor agencies," he explains. "We need to look at alternatives to aid as the main driver of development.

"Maybe it seems strange if you still think of development as being dependent on European and North American aid, but not if you look at what is happening in low− and middle− income countries and what could reasonably be done with what is already available."

He argues that we should start from the point of view that it will be low- and middle-income countries, their relations with each other, and their rising gross domestic products (GDPs) that will drive development.

His view echoes that of Bill Gates, expressed when he addressed the G20 last year (3 November), and IJsselmuiden also claims support from the words of Robert Zoellick, president of the World Bank, who in a speech last year (29 September) called for a 'beyond aid' approach.

The economic performance of Brazil, China and India has boosted the confidence of such nations tremendously, he adds, as they outperform advanced economies in building capacity for technological innovation.

Africa poised for growth

One example where developing countries are investing in their own capacity is the construction of vaccine production facilities in Africa. In 2010, when the GAVI Alliance, the vaccines partnership, celebrated its tenth anniversary, IJsselmuiden says he was dismayed that Africa had only one WHO approved laboratory (the Institut Pasteur de Dakar, in Senegal) that produces a vaccine, for yellow fever.

But he is optimistic that this is gap is now filling rapidly, with the construction of a vaccine-producing biotechnology unit near Cape Town, South Africa.

"For me as an African, and as a human being, it would be inconceivable to think of Africa in the next ten years still being entirely dependent on the foreign world for vaccines," he says.

He invites a comparison with China. "If they can do it, we can do it, provided that Africa starts seeing itself as a continent with one billion consumers, as opposed to 54 countries that are having problems, which is what the typical aid point of view would be.

"Africa's been the continent with substantial growth — six to eight per cent economic growth in the past six years — and it has not been exposed to the housing crisis in the United States or the financial crisis in Europe. The unemployment figures in Africa are better than they have been in many years.

"The science and technology capacity in Africa is increasing very rapidly, along with political commitment."

An example he cites is Tanzania, one of the poorest countries and a donor favourite in Africa. "The president is now committed — and is actually spending — one per cent of GDP on science and technology development."

Meanwhile, fibre-optic cables are being installed around Africa and six are almost completed, so the continent may be networked in the next year or two.

Details up for discussion

In the next five years,  IJsselmuiden says, the nature of meetings such as Forum 2012 will change. Instead of hearing classical scientific presentations, delegates will be discussing ways to access capital and creative ideas crucial for driving R&D.

The current financial crisis, he adds, provides an excellent opportunity to rethink how an NGO such as the COHRED Group should set its goals and achieve them. But he admits that it is not clear how funding will work in this new world.  

He suggests "improbable" partnerships between key stakeholders to align the interests of researchers, government, business, social enterprise, media and donors. Much can be done locally, though no research, science or production is entirely local.

Pursuing these ideals, the COHRED Group intends to restructure itself as a social enterprise, moving away from the model of using only donor money. How this will be done is a key topic for discussion at the Cape Town meeting.

In addition, he expects most of his staff to be located in low- and middle-income nations in future, so that the countries feel they have ownership of programmes.

And so the virtual collapse of the Global Forum for Health Research, and its merger with COHRED, may not just be the story of an NGO falling on hard times. It may also, symbolically, mark the end of an outmoded system whose time has come and the start of an approach that suits the new world order.