Yes, foreign aid does work
by Jeffrey D Sachs
6 June 2012
The critics of foreign aid are wrong. A growing flood of data shows that death rates in many poor countries are falling sharply and that aid-supported programmes for healthcare delivery have played a key role.
Aid works. It saves lives.
One of the newest studies, by Mr Gabriel Demombynes and Ms Sofia Trommlerova, shows that Kenya's infant mortality - deaths under the age of one year - has plummeted in recent years.
The study attributes a significant part of the gain to the massive uptake of anti-malaria bed nets.
These findings are consistent with an important study of malaria death rates by Mr Chris Murray and others, which similarly found a significant and rapid decline in malaria-caused deaths after 2004 in sub-Saharan Africa resulting from aid-supported malaria-control measures.
Let's turn back the clock a dozen years. In 2000, Africa was struggling with three major epidemics. AIDS was killing more than two million people each year and was spreading rapidly. Malaria was surging, owing to the parasite's growing resistance to the standard medicine at the time.
Tuberculosis was also soaring, partly as a result of the AIDS epidemic and partly because of the emergence of drug-resistant TB.
In addition, hundreds of thousands of women were dying in childbirth each year, because they had no access to safe deliveries in a clinic or hospital, or to emergency help when needed.
These interconnected crises prompted action. United Nations member states adopted the Millennium Development Goals (MDGs) in September 2000.
Three of the eight MDGs - reductions in children's deaths, maternal deaths and epidemic diseases - focus directly on health.
Likewise, the World Health Organization (WHO) issued a major call to scale up development assistance for health.
And African leaders, led by Nigeria's President at the time, Mr Olusegun Obasanjo, took on the challenge of battling the continent's epidemics.
Nigeria hosted two landmark summits, on malaria in 2000 and on AIDS in 2001, which were a crucial spur to action.
At the second of these summits, then-UN Secretary-General Kofi Annan called for the creation of the Global Fund to Fight AIDS, TB and Malaria. The Global Fund began operations in 2002, financing prevention, treatment and care programmes for the three diseases.
High-income countries also finally agreed to reduce the debt owed by heavily indebted poor countries, allowing them to spend more on healthcare and less on crippling payments to creditors.
The United States took action as well, adopting two major programmes - one to fight AIDS and the other to fight malaria.
In 2005, the UN Millennium Project recommended specific ways to scale up primary healthcare in the poorest countries, with the high-income countries helping to cover the costs that the poorest could not pay by themselves.
The UN General Assembly backed many of the project's recommendations, which were then implemented in numerous low-income countries.
Donor aid started to rise sharply as a result of all of these efforts. In 1995, total aid for healthcare was around US$7.9 billion (S$10.2 billion). This inadequate level crept up slowly to US$10.5 billion by 2000.
By 2005 annual aid for health had jumped another US$5.9 billion and, by 2010, the total had grown by another US$10.5 billion to reach US$26.9 billion for the year.
The expanded funding allowed major campaigns against AIDS, TB and malaria, a major scaling-up of safe childbirth and increased vaccine coverage, including the near-eradication of polio.
Many innovative public-health techniques were developed and adopted. With one billion people living in high-income countries, total aid in 2010 amounted to around US$27 per person in the donor countries - a modest sum for them but a life-saving one for the world's poorest people.
FALL IN INFANT MORTALITY
The public-health successes can now be seen on many fronts.
Around 12 million children under five years old died in 1990. By 2010, this number had declined to around 7.6 million - still far too high but definitely a historic improvement.
Malaria deaths in children in Africa were cut from a peak of around one million in 2004 to around 700,000 by 2010 and, worldwide, deaths of pregnant women declined by almost half between 1990 and 2010, from an estimated 543,000 to 287,000.
Another US$10 to US$15 billion in annual aid (that is, roughly US$10 to US$15 more per person in the high-income world), bringing total aid to around US$40 billion per year, would enable even greater progress to be made in the coming years.
The MDGs for health could be achieved even in many of the world's poorest countries.
Unfortunately, at every step during the past decade - and still today - a chorus of aid sceptics has argued against the needed help.
They have repeatedly claimed that aid does not work, that the funds will simply be wasted, that anti-malaria bed nets cannot be given to the poor since the poor won't use them, that the poor will not take anti-AIDS medicines properly, and so on and so forth. Their attacks have been relentless.
The opponents of aid are not merely wrong. Their vocal antagonism still threatens the funding that is needed to get the job done, to cut child and maternal deaths by enough to meet the MDGs by 2015 in the poorest countries and to continue after that to ensure that all people everywhere finally have access to basic health services.
A decade of significant progress in health outcomes has proved the sceptics wrong. Aid for healthcare works - and works magnificently - to save and improve lives.
Let us continue to support these life-saving programmes, which uphold the dignity and well-being of all people on the planet. PROJECT SYNDICATE
Jeffrey Sachs is Professor of Economics and Director of the Earth Institute at Columbia University. He is also Special Adviser to United Nations Secretary-General on the Millennium Development Goals.