The dangers of disease specific programmes for developing countries

Last week saw the launch of the new International Health Partnership that Prime Minister Gordon Brown hopes will accelerate progress towards achieving the United Nations' millennium development goals for health (see News doi: 10.1136/bmj.39335.610394.DB). Will the partnership make a difference? Certainly, the joint press releases with Chancellor Merkel of Germany made the right noises (www.number-10.gov.uk/output/Page13047.asp). Politicians are realising, perhaps, that throwing money at countries through disease specific global programmes might make good press, but it is not the way to help Africa.

Although international aid to developing countries for health has doubled to $14bn (£7bn; €10bn) since 2000, much of the increase is tied to individual diseases and is delivered outside of recipient countries' planning and budgeting systems, causing big problems for the recipients. Money for combating HIV and AIDS is the worst. This now exceeds the whole health budget of many of the recipient countries, such as Uganda (figure).⇓ It distorts countries' efforts to deal with their problems, because most of this new aid is delivered “off budget,” resulting in separate plans, operations, and monitoring—all in parallel with government systems. Just as …