Politics & Policy

Who’s in Charge?

Taking bad NGO advice.

Last week the World Health Organization resolved, in the name of improving human health, that the world should beef up welfare provision, stiffen employment legislation, impose tougher regulations on a host of industries, and promote the reach of government into practically every aspect of life. This is the program peddled by powerful multinational NGOs; this is the sure socialist policy for perpetuating poverty; this is an agency 20 percent funded by the United States.

The WHO–the U.N. agency responsible for global health–invited various NGOs and members of “civil society” to Stockholm to discuss its strategic direction for the next decade. On the guest list were representatives from powerful multinational NGOs such as Oxfam, Médecins Sans Frontières (MSF), and Save the Children.

The whole exercise was actually rather superfluous, as the strategy document read like a fantasy wish-list for the big NGOs being consulted. Indeed, there is little in there that would have looked out of place in the Communist Manifesto.

This WHO strategy document lays bare the power big NGOs now have in shaping WHO policy. The document is bursting with things for which the various NGOs at the consultation have lobbied long and hard.

It is no coincidence that the WHO’s agenda is uncannily similar to that of the NGOs. These groups have been colonizing the WHO for many years and now wield enormous influence.

But what exactly is the agenda of these NGOs? While they are clearly motivated by a desire to improve the conditions for the poor, they cling to a set of beliefs that have been utterly discredited.

High on the agenda of these NGOs is a call for more “aid” transfers from rich to poor countries. They hope that using such funds to build up public-health infrastructure will encourage economic growth and offer a sustainable path out of poverty.

History and experience tells us that the opposite is likely to be the case. One study shows that a vast proportion of child deaths could be averted for as little as $10 each, but public-health systems in the poorest countries spend $50,000 to $100,000 on each life saved. This breathtaking inefficiency is hardly surprising when one considers the levels of corruption that plague the health bureaucracies of the world’s poorest countries.

Seen in this light, the unconditional pouring of money into the public-health systems of lower-income countries is highly irresponsible.

Yet years of NGO advocacy have ensured that the WHO does not abandon such aid transfers, even though they have been shown to prop up oppressive, undemocratic regimes. As a result, the trillions of dollars that have been spent on aid in the past 50 years have had no net impact on economic growth or life expectancy. Worse, African average product per capita and life-expectancy have fallen during the last few decades.

The NGOs have also been the driving intellectual force behind the WHO’s flagship HIV/AIDS program, catchily entitled “3 by 5.” This adventure was launched in 2003 and hoped to get three million people onto life-saving antiretroviral treatment by the end of 2005. With less than a few weeks to go, it is clear that this target is going to be missed spectacularly.

Leading public-health experts are virtually unanimous in concluding that prevention is of paramount importance in the fight against AIDS. Education and other prevention strategies have reduced HIV infection rates in Uganda, Senegal, and other forward-thinking countries.

But instead of promoting prevention, the WHO has slavishly followed the NGOs’ demands to pour money into free treatment for all. This is despite the well-documented fact that Africa’s dilapidated healthcare infrastructure is in no position to deliver effectively the complex drugs to all who need them, let alone monitor treatment and follow up.

Partially as a result of this submission to the NGO’s agenda, the number of people currently living with HIV/AIDS is at its highest ever level, currently standing at 40.2 million. 2005 was the worst year for new infection rates since the disease was first detected.

It is tragically ironic, then, that World AIDS Day this week is being used by the NGOs to demand more government money for this failing program.

Despite the NGOs’ lamentable track record of promoting sensible policies, other dissenting voices are excluded from the WHO policy process. The International Chambers of Commerce has twice tried to gain official accreditation at the WHO, for instance, and has been turned down twice.

Admittedly, the World Health Organization does pay some lip service to soliciting as wide a range of views as possible. My organization was invited to participate in the Stockholm consultation, for example, as were several other groups.

But the reality is that the strategy document on which we were invited to comment has been all but finalized already. The first we saw of it was one month before it was due to be sent to the executive board for approval, rendering our presence at the “consultation” a mere formality.

Oxfam and MSF, however, have been closely consulted since the document’s inception 18 months ago. These organisations’ stubborn and anachronistic belief in the power of redistributive economics is legendary.

The U.S. government has the power to do something about this. Last year, it gave nearly 20 percent of all WHO contributions from member states. If the U.S. were to reduce its support substantially, the WHO would be forced to scale back its operations and focus on delivering value for money–or risk further budget cuts.

Given that the World Health Organization is increasingly working against American values and the interests of the poor, the U.S. should seriously consider cutting back the funds until the WHO adopts a more practical outlook.

Philip Stevens is the author of “The Real Determinants of Health,” a study by the International Policy Network.


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