While donor-driven programs undoubtedly saved millions of lives, they also created unintended distortions in national health priorities. Many governments in sub-Saharan Africa and parts of Asia actually scaled back domestic health investments, as donor program filled key gaps in HIV/AIDS, maternal and child health, and infectious disease control. In some cases, domestic health budgets shrank in real terms, even as external funding increased. This phenomenon, often referred to as “fiscal substitution,” led to national health systems that were heavily donor-dependent, externally managed, and vulnerable to funding shocks. Notably, this reliance emerged despite countries pledged to allocate at least 15% of their national budgets to health. More than two decades later, only a handful has met this target.
That is from the new and useful book by Michael John Alastair Reid and Eric Paul Goosby. But $150 for a not so thick volume!? If the authors believe in aid, as they should, perhaps they could consider giving this book away for free rather than turning it over to Elsevier…?
