{"id":936,"date":"2025-10-02T04:00:21","date_gmt":"2025-10-02T04:00:21","guid":{"rendered":"https:\/\/www.thebrokeronline.eu\/donors-must-develop-resources-equitably-and-commit-long-term\/"},"modified":"2025-10-02T04:00:21","modified_gmt":"2025-10-02T04:00:21","slug":"donors-must-develop-resources-equitably-and-commit-long-term","status":"publish","type":"page","link":"https:\/\/www.thebrokeronline.eu\/blogs\/archived-online-discussions\/health-for-all\/donors-must-develop-resources-equitably-and-commit-long-term\/","title":{"rendered":"Donors Must Develop Resources Equitably And Commit Long Term"},"content":{"rendered":"<section class=\"content column wide left article content view\" id=\"content\">\n<article class=\"fader\">\n<header class=\"contents\">\n<div class=\"share\">\n\t\t\t<script type=\"text\/javascript\">\n    var addthis_config = {\n        ui_language = 'en'\n    }\n<\/script><\/p>\n<div class=\"addthis sharing\">\n\t<!-- AddThis Button BEGIN --><\/p>\n<div class=\"addthis_toolbox addthis_default_style addthis_32x32_style\" addthis:title=\"Donors must develop resources equitably and commit long-term\">\n\t<a class=\"addthis_button_twitter\" tw:via=\"thebrokeronline\"><\/a><br \/>\n\t<a class=\"addthis_button_facebook\"><\/a><br \/>\n\t<a class=\"addthis_button_pinterest_share\"><\/a><br \/>\n\t<a class=\"addthis_button_preferred_4\"><\/a><br \/>\n\t<a class=\"addthis_button_compact\"><\/a><br \/>\n\t<a class=\"addthis_counter addthis_bubble_style\"><\/a>\n\t<\/div>\n<p>\t<script type=\"text\/javascript\">var addthis_config = data_track_addressbar;<\/script><br \/>\n\t<script type=\"text\/javascript\" src=\"https:\/\/www.thebrokeronline.eu\/files\/js\/300\/addthis_widget.js\"><\/script><br \/>\n\t<!-- AddThis Button END -->\n<\/div>\n<div class=\"addthis article_options\">\n    \t\t\t\t\t\t<a title=\"Export article to PDF\" class=\"pdf\" href=\"https:\/\/www.thebrokeronline.eu\" target=\"_blank\"><img decoding=\"async\" src=\"https:\/\/www.thebrokeronline.eu\/files\/extension\/broker\/design\/broker\/images\/pdficon.png\" alt=\"pdf\"><\/a>\n\t\t\t<\/div>\n<\/p><\/div>\n<div class=\"clear\"><\/div>\n<h1>\n\t\t\t\t\t\t\tDonors must develop resources equitably and commit long-term<br \/>\n\t\t\t\t\t<\/h1>\n<div class=\"clear\"><\/div>\n<div class=\"pubDate\">\n\t\t\t\t\t<a href=\"https:\/\/www.thebrokeronline.eu\">Carel &nbsp;IJsselmuiden<\/a>\t\t|<br \/>\n\t\t\t\t\t\t\tApril 16, 2025\n\t\t\t\t<\/div>\n<\/header>\n<div class=\"intro contents\">\n<p class=\"yunu3cvqabft7vifv\">Arnold Toynbee observed in 1931 that &quot;The twentieth century will be chiefly remembered by future generations not as an era of political conflicts or technical inventions, but as an age in which human society dared to think of the welfare [health] of the whole human race as a practical objective.&quot;<br \/>\n<a name=\"t1\"><\/a><sup><a class=\"footnote\" href=\"#f1\">1<\/a><\/sup> If this is true \u2013 then we should ensure that the twenty-first century will be remembered as the era in which we actually made this happen \u2013 in which we achieved \u2018health for all\u2019.<\/p>\n<\/p><\/div>\n<div class=\"body contents\">\n\t\t<!-- body --><\/p>\n<p class=\"yunu3cvqabft7vifv\">\n<p class=\"yunu3cvqabft7vifv\">Barten and colleagues seem to remember, as I do, the excitement of 1978 and the few years beyond it \u2013 of the \u2018rainbow\u2019 booklet series on comprehensive primary health care (PHC) \u2013 of the promise of building sustainability, systems, processes \u2013 of being \u2018inclusive\u2019 and achieving \u2018community participation\u2019 \u2013 and of dealing with the core problems of health and health inequities in and between countries. They also recall the frustration of the early challenge halting this momentum<br \/>\n<a name=\"t2\"><\/a><sup><a class=\"footnote\" href=\"#f2\">2<\/a><\/sup> and the subsequent seemingly unstoppable drive towards technical solutions, product focus, short time horizons, and pursuit of \u2018measurable objectives\u2019.<\/p>\n<p class=\"yunu3cvqabft7vifv\">Looking for a \u2018radical new\u2019 approach to global health, the authors return to \u2018comprehensive PHC\u2019 and towards reforming the world economic order. They question why we deviated from this in the first place, but do not offer an answer. While fully agreeing with the renewed (was it really ever there ?) focus on systems, the article does not offer much in the way of preventing that this renewed interest in comprehensive PHC will not follow the same rapid route into disuse.<\/p>\n<p class=\"yunu3cvqabft7vifv\">With this commentary I will focus on an element in making a systems-approach work \u2013 something that was not there in 1978 but that is there now: research and management capacity in low and middle income countries. Just like the informed citizen is the cornerstone of democracy, so is the informed (low and middle income) country the cornerstone of development. Countries (and regions) with the ability to generate and use substantive national management information, conduct or commission key research and development, design tools \u2013 approaches \u2013 methods to engage, for example, the international \u2018aid\u2019 communities or their own national health, social and economic problems and potentials can much better modulate externally driven change towards local priorities and more sustainable solutions.<\/p>\n<p class=\"yunu3cvqabft7vifv\">I remain deeply suspicious of global initiatives developed in the north \u2018to deal with the problems of south\u2019 \u2013 unless the global south has the capacity and opportunity to engage with this debate, challenge the solutions prescribed, and drive the cycle of implementation and evaluation. The complexities of achieving global health, health equity and development combined with the bureaucracies of international organisations and their lack of direct accountability to citizens of the world ensure that it is never clear what goals are really served by new campaigns. The ravages of \u2018structural adjustment\u2019 are still fresh in memory, the MDGs are far from met, and yet we are starting up \u2018alignment and harmonization\u2019 with equal gusto, equal \u2018appeal\u2019 and equal absence of any evidence that it will do more good than harm. And now \u2013 yet another new campaign \u2013 back to comprehensive primary health care.<\/p>\n<p class=\"yunu3cvqabft7vifv\">What would really constitute a \u2018radical new approach to global health\u2019 would be to ensure that partner countries have individuals, institutions and systems that allow them to set priorities, measure progress, negotiate with donors \u2013 in fact \u2013 select with which donors they wish to work and which not \u2013 without financial penalties. Why not engage in \u2018pilots and evaluations\u2019 instead of \u2018scaling up\u2019? Why not take risks in \u2018one-to-one\u2019 national engagements instead of hiding behind large global funds where individual country-contribution \u2013 and therefore accountability &#8211; is obscured? Why not focus on increased accountability of low and middle income countries and their institutions and systems to their own \u2018informed citizens\u2019? It would be \u2018radical\u2019 if donor countries would take the many years of capacity building in Africa and elsewhere seriously: in spite of the \u2018brain drain\u2019, Africa now has substantially more individual, institutional and system capacity than ever before<br \/>\n<a name=\"t3\"><\/a><sup><a class=\"footnote\" href=\"#f3\">3<\/a><\/sup> \u2013 although, as the authors imply, it is still not enough. Why not change the new WHO research strategy into a strategy to deliver funding to such national institutions and systems instead of a strategy that builds the WHO itself ?<br \/>\n<a name=\"t4\"><\/a><sup><a class=\"footnote\" href=\"#f4\">4<\/a><\/sup><\/p>\n<p class=\"yunu3cvqabft7vifv\">To build systems and institutions takes a long-term commitment \u2013 let us start with, say, 25 years. That would be radically new \u2013 and would take the sting out of \u2018sustainability\u2019 concerns. Spreading development resources more equitably \u2013 between populations, countries, regions and between areas of interest (why \u2018just\u2019 HIV\/AIDS, TB and Malaria \u2013 while the majority of people in low and middle income countries die from other causes?).<br \/>\n<a name=\"t5\"><\/a><sup><a class=\"footnote\" href=\"#f5\">5<\/a><\/sup> Making sufficient data sufficiently easily available to hold donors and partners to account? resourcing \u2018south-south\u2019 collaboration \u2013 for example, to encourage learning and critique of the inappropriate interventions without fear of financial penalisation.<\/p>\n<p class=\"yunu3cvqabft7vifv\">The world is inevitably divided into \u2018vertical\u2019 and \u2018horizontal\u2019 thinkers and doers. It is a \u2018no-win\u2019 debate to promote one over the other, but it may just be a \u2018win-win\u2019 proposition to enable low and middle income countries to build their systems, infrastructure and institutions so that they can do the balancing act instead.<br \/>\n<a name=\"t6\"><\/a><sup><a class=\"footnote\" href=\"#f6\">6<\/a><\/sup> Investing in information, innovation and R&#038;D may result in involving 4 billion more brains into finding solutions to global inequity than are currently taking part.<br \/>\n<a name=\"t7\"><\/a><sup><a class=\"footnote\" href=\"#f7\">7<\/a><\/sup><\/p>\n<p class=\"yunu3cvqabft7vifv\">COHRED is about building national systems and capacity for \u2018research for health\u2019 that enable countries to conduct \u2018essential national health research\u2019 and design solutions towards their own health, health equity and development.<\/p>\n<p class=\"yunu3cvqabft7vifv\">\n\t\t\tSo, of course, we agree with the authors and the tenets of this article. However, in line with our own suspicion of more untested global campaigns \u2013 even this approach needs to be accompanied \u2013 from the start \u2013 with substantive evaluation, monitoring, research and information \u2013 done in and by the south \u2013 and involving more than short-term outcome measures! Research and information systems are certainly not the only way forward nor perhaps a guarantee to success \u2013 but without these how are we to \u2018put countries in the driver\u2019s seat\u2019. After all, \u2018knowledge is power\u2019 \u2013 also, or especially, if you are dependent!<\/p>\n<\/p>\n<p>\t\t<!-- body --><br \/>\n\t\t<!-- footnotes --><\/p>\n<h3>Footnotes<\/h3>\n<ul class=\"footnotes\">\n<li>\n\t\t\t\t\t\t\t<a href=\"#t1\" name=\"f1\"><br \/>\n\t\t\t\t\t\t\t1.<br \/>\n\t\t\t\t\t\t\t<\/a><\/p>\n<p class=\"yunu3cvqabft7vifv\">Toynbee A. A study of history. 1931.<\/p>\n<p><br class=\"yunu3cvqabft7vifv\"\/>\n\t\t\t\t\t<\/li>\n<li>\n\t\t\t\t\t\t\t<a href=\"#t2\" name=\"f2\"><br \/>\n\t\t\t\t\t\t\t2.<br \/>\n\t\t\t\t\t\t\t<\/a><\/p>\n<p class=\"yunu3cvqabft7vifv\">J.Walsh and K.Warren, \u201cSelective Primary Health Care: An Interim Strategy for Disease Control in Developing Countries,\u201d New England Journal ofMedicine 301, no. 18 (1979): 967\u2013974.<\/p>\n<p><br class=\"yunu3cvqabft7vifv\"\/>\n\t\t\t\t\t<\/li>\n<li>\n\t\t\t\t\t\t\t<a href=\"#t3\" name=\"f3\"><br \/>\n\t\t\t\t\t\t\t3.<br \/>\n\t\t\t\t\t\t\t<\/a><\/p>\n<p class=\"yunu3cvqabft7vifv\">Volmink J, Dare L. Addressing inequalities in research capacity in Africa. Brit Med J 2005;331;705-706.<\/p>\n<p><br class=\"yunu3cvqabft7vifv\"\/>\n\t\t\t\t\t<\/li>\n<li>\n\t\t\t\t\t\t\t<a href=\"#t4\" name=\"f4\"><br \/>\n\t\t\t\t\t\t\t4.<br \/>\n\t\t\t\t\t\t\t<\/a><\/p>\n<p class=\"yunu3cvqabft7vifv\">WHO research strategy:Accessed 9 March 2025<\/p>\n<p><br class=\"yunu3cvqabft7vifv\"\/>\n\t\t\t\t\t<\/li>\n<li>\n\t\t\t\t\t\t\t<a href=\"#t5\" name=\"f5\"><br \/>\n\t\t\t\t\t\t\t5.<br \/>\n\t\t\t\t\t\t\t<\/a><\/p>\n<p class=\"yunu3cvqabft7vifv\">Moran M, Guzman J, Ropars AL, McDonald A, Jameson N, et al. Neglected Disease Research and Development: How Much Are We Really Spending? PLoS Medicine Vol. 6, No. 2, e30 doi:10.1371\/journal.pmed.1000030 <\/p>\n<p><br class=\"yunu3cvqabft7vifv\"\/>\n\t\t\t\t\t<\/li>\n<li>\n\t\t\t\t\t\t\t<a href=\"#t6\" name=\"f6\"><br \/>\n\t\t\t\t\t\t\t6.<br \/>\n\t\t\t\t\t\t\t<\/a><\/p>\n<p class=\"yunu3cvqabft7vifv\">Council on Health Research for Development. Responsible Vertical Programming (RVP): COHRED, Accessed on 9 March 2009.<\/p>\n<p><br class=\"yunu3cvqabft7vifv\"\/>\n\t\t\t\t\t<\/li>\n<li>\n\t\t\t\t\t\t\t<a href=\"#t7\" name=\"f7\"><br \/>\n\t\t\t\t\t\t\t7.<br \/>\n\t\t\t\t\t\t\t<\/a><\/p>\n<p class=\"yunu3cvqabft7vifv\">IJsselmuiden C The role of Europe and of international science and technology cooperation. In: Responding to global challenges. The role of Europe and international science and technology cooperation. Workshop Proceedings Brussels, 4-5 October 2007. European Commission. Directorate-General for Research (Eds). Brussels, European Commission, 2008.<\/p>\n<p><br class=\"yunu3cvqabft7vifv\"\/>\n\t\t\t\t\t<\/li>\n<\/ul>\n<p>\t\t<!-- footnotes -->\n\t\t<\/div>\n<\/article>\n<div class=\"clear\"><\/div>\n<section class=\"commentform content column wide left\">\n<div class=\"disqus_content\">\n\t\t\t<a name=\"comments\" id=\"comments\"><\/a><\/p>\n<div id=\"disqus_thread\"><\/div>\n<p>\t\t\t<script type=\"text\/javascript\">\n\t\t\t\t\/* * * CONFIGURATION VARIABLES: EDIT BEFORE PASTING INTO YOUR WEBPAGE * * *\/\n\t\t\t\tvar disqus_shortname = 'broker'; \/\/ required: replace example with your forum shortname\n\t\t\t\tvar disqus_identifier = '2542';\n\t\t\t\t\/* * * DON'T EDIT BELOW THIS LINE * * *\/\n\t\t\t\tfunction trackComment(comment)\n\t\t\t\t{\n\t\t\t\t\tconsole.log(comment);\n\t\t\t\t}\n\t\t\t\tfunction disqus_config() {\n\t\t\t\t\tthis.callbacks.onNewComment = [function() { \n\t\t\t\t\tconsole.log(comment);\n\t\t\t\t\t}];\n\t\t\t\t}\n\t\t\t\t(function() {\n\t\t\t\t\tvar dsq = document.createElement('script'); dsq.type = 'text\/javascript'; dsq.async = true;\n\t\t\t\t\tdsq.src = '\/\/' + disqus_shortname + 'https:\/\/www.thebrokeronline.eu\/files\/blogs\/archived-online-discussions\/health-for-all\/.disqus.com\/embed.js';\n\t\t\t\t\t(document.getElementsByTagName('head')[0] || document.getElementsByTagName('body')[0]).appendChild(dsq);\n\t\t\t\t})();\n\t\t\t<\/script><br \/>\n\t\t\t<!--\n\t\t\t<noscript>Please enable JavaScript to view the <a href=\"http:\/\/disqus.com\/?ref_noscript\">comments powered by Disqus.<\/a><\/noscript>\n\t\t\t<a href=\"http:\/\/disqus.com\" class=\"dsq-brlink\">comments powered by <span class=\"logo-disqus\">Disqus<\/span><\/a>\n\t\t\t-->\n\t\t<\/div>\n<\/section>\n<\/section>\n","protected":false,"raw":""},"excerpt":{"rendered":"<p>Donors must develop resources equitably and commit long-term Carel [&hellip;]<\/p>\n","protected":false},"author":0,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"template_2.php","meta":{"footnotes":""},"class_list":["post-936","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.2 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Donors must develop resources equitably and commit long-term \/ Health for all \/ Archived online discussions \/ Blogs - The Broker<\/title>\n<meta name=\"description\" content=\"Arnold Toynbee observed in 1931 that &amp;quot;The twentieth century will be chiefly remembered by future generations not as an era of political conflicts or technical inventions, but as an age in which human society dared to think of the welfare [health] of the whole human race as a practical objective.&amp;quot;1&amp;nbsp;If this is true \u00e2\u20ac\u201c then we should ensure that the twenty-first century will be remembered as the era in which we actually made this happen \u00e2\u20ac\u201c in which we achieved \u00e2\u20ac\u02dchealth for all\u00e2\u20ac\u2122.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.thebrokeronline.eu\/blogs\/archived-online-discussions\/health-for-all\/donors-must-develop-resources-equitably-and-commit-long-term\/\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Donors must develop resources equitably and commit long-term \/ Health for all \/ Archived online discussions \/ Blogs - The Broker\" \/>\n<meta property=\"og:description\" content=\"Arnold Toynbee observed in 1931 that &amp;quot;The twentieth century will be chiefly remembered by future generations not as an era of political conflicts or technical inventions, but as an age in which human society dared to think of the welfare [health] of the whole human race as a practical objective.&amp;quot;1&amp;nbsp;If this is true \u00e2\u20ac\u201c then we should ensure that the twenty-first century will be remembered as the era in which we actually made this happen \u00e2\u20ac\u201c in which we achieved \u00e2\u20ac\u02dchealth for all\u00e2\u20ac\u2122.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.thebrokeronline.eu\/blogs\/archived-online-discussions\/health-for-all\/donors-must-develop-resources-equitably-and-commit-long-term\/\" \/>\n<meta property=\"og:site_name\" content=\"Homepage - Broker Online\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"6 minutes\" \/>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Donors must develop resources equitably and commit long-term \/ Health for all \/ Archived online discussions \/ Blogs - The Broker","description":"Arnold Toynbee observed in 1931 that &amp;quot;The twentieth century will be chiefly remembered by future generations not as an era of political conflicts or technical inventions, but as an age in which human society dared to think of the welfare [health] of the whole human race as a practical objective.&amp;quot;1&amp;nbsp;If this is true \u00e2\u20ac\u201c then we should ensure that the twenty-first century will be remembered as the era in which we actually made this happen \u00e2\u20ac\u201c in which we achieved \u00e2\u20ac\u02dchealth for all\u00e2\u20ac\u2122.","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.thebrokeronline.eu\/blogs\/archived-online-discussions\/health-for-all\/donors-must-develop-resources-equitably-and-commit-long-term\/","og_type":"article","og_title":"Donors must develop resources equitably and commit long-term \/ Health for all \/ Archived online discussions \/ Blogs - The Broker","og_description":"Arnold Toynbee observed in 1931 that &amp;quot;The twentieth century will be chiefly remembered by future generations not as an era of political conflicts or technical inventions, but as an age in which human society dared to think of the welfare [health] of the whole human race as a practical objective.&amp;quot;1&amp;nbsp;If this is true \u00e2\u20ac\u201c then we should ensure that the twenty-first century will be remembered as the era in which we actually made this happen \u00e2\u20ac\u201c in which we achieved \u00e2\u20ac\u02dchealth for all\u00e2\u20ac\u2122.","og_url":"https:\/\/www.thebrokeronline.eu\/blogs\/archived-online-discussions\/health-for-all\/donors-must-develop-resources-equitably-and-commit-long-term\/","og_site_name":"Homepage - Broker Online","twitter_card":"summary_large_image","twitter_misc":{"Est. reading time":"6 minutes"}},"_links":{"self":[{"href":"https:\/\/www.thebrokeronline.eu\/wp-json\/wp\/v2\/pages\/936","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.thebrokeronline.eu\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.thebrokeronline.eu\/wp-json\/wp\/v2\/types\/page"}],"replies":[{"embeddable":true,"href":"https:\/\/www.thebrokeronline.eu\/wp-json\/wp\/v2\/comments?post=936"}],"version-history":[{"count":0,"href":"https:\/\/www.thebrokeronline.eu\/wp-json\/wp\/v2\/pages\/936\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.thebrokeronline.eu\/wp-json\/wp\/v2\/media?parent=936"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}