Thursday, December 9, 2010

Do we really need those powerful donors?

Public health projects are donor-driven except a few. It is the donor who, most of the time decides the fate of the programs. The programmatic activities are performed as long the funds are available. After sometimes, it so happens that activities become routine, not need-based and the program gradually starts losing its gravity. One prominent example is World AIDS Day. It is no more appealing to those who need the services and attention maximum as far as the HIV/AIDS epidemic is concerned. World AIDS Days are observed mostly because the funds are still available to celebrate them. Another striking example is Pulse Polio Program. In countries like India, Pulse Polio Programs have overtaken Routine Immunization activities in states like Bihar and UP because of the mounting pressure of the external donors and agencies and uninterrupted flow of funds. Pulse Polio is completely a donor-driven program but can polio be eradicated chiefly by the supplementary immunization activities?
The value of true partnership, though strongly advocated and highlighted, is not practically visible in the donor-recipient relationship.  The donor enjoys the heavier side of the power dynamics and freely dictates the terms and conditions to the recipients who have no option other than obliging them. The beneficiaries, in whole of the negotiation process with donor, remain in the backseat. Their needs and challenges are not expressed in their languages and emotions but through the reflections of the ‘so called’ specialists representing the recipients’ side. It is generally perceived that poor and vulnerable people having no/poor literacy generally lack capacity to deal with the donors and handle their tricks.
Community based organizations and networks have been established over years, especially associated with AIDS programs. These bodies are represented mainly by literate. English-speaking and smart folks. How many poor and underprivileged people are linked to those networks and enjoying the benefits is still doubted.
So, how long the donors will exclusively enjoy the overall authority of the public health projects? How long they will keep on providing funding to address the issues that are not exactly located in the agenda of the beneficiaries? How long they will enjoy the control over the projects and exerting the right to withdraw funding as per their own decisions and convenience without thinking a bit about the agonies and helplessness of the beneficiaries? How long they will remain ‘God’ of the public health and development sectors?
The answer is till the time the public health projects become truly the people’s program.  
About five years back, while making a field trip to Chhattisgarh I came across the community clinic which was established by the poor people of the slum.  They invested their hard-earned money into setting up their own health-centre within their slum. A local woman donated a part of her house to provide space for the clinic. The joint subscription of the local people enabled to purchase furniture including electric devices like ceiling fans and lights, medical instruments and medicines. A part-time lady gynecologist and full-time nurse were hired as salaried staffs of the clinic. Subsequently, when clinic became busier, the local district hospital sent regularly their ANM (Auxiliary Nurse Midwife) with vaccines to the clinic to immunize the local children. The local hospital also promised the slum dwellers to provide free supply of medicines and a larger space for the clinic in the near vicinity.
Five years down the line, the community clinic is still functional. The doctor and nurse are still associated with the clinic with the same kind of enthusiasm and spirit. The linkages with the local district hospital have become stronger. The local people’s investment to ensure their own healthcare is giving the dividend now.
Where do you find a better model of private-public partnership than the community clinic? Do you need an external donor to initiate and support such models?
Nothing actually can match with the power and commitment of the people.    
Sugata Mukhopadhyay
Universal Health

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