Harmful effects of global health initiatives are exaggerated
An evaluation of the scientific evidence on the effects of global health initiatives on the health systems of developing countries concludes that the harmful effects have been exaggerated.
The systematic review found that much of the research literature did not fulfil the requirements of rigorous scientific evidence. Published today by JRSM Short Reports, the review focused on negative health system effects because these have been a source of criticism for global health initiatives and if true, have important implications for policy-makers. Billions of pounds of taxpayers’ money are channelled as aid through these initiatives.
The systematic review identified 24 studies published in peer-reviewed scientific journals between 2002 and 2009 that have commented on adverse effects on health systems arising from investments by the Global Fund. The Global Fund is one of the largest international financing institutions distributing almost £15 billion of taxpayers’ money in developing countries. All the studies evaluated contained only seemingly anecdotal evidence or authors’ perceptions or interpretations of circumstances.
Senior author Professor Rifat Atun, Professor of International Health Management at Imperial College London, said: “Ever since the emergence of the major global health initiatives, there has been an assertion that they undermine the performance of already weak national health systems by bypassing them. Yet these assertions are based on opinion and not fact.”
Professor Atun, explaining the significance of the systematic review, said: “Uncritical repetition of anecdotal evidence carries the risk that unsubstantiated claims and perceptions are eventually accepted as a valid representation of the objective reality.” None of the studies were originally designed to capture or assess health system effects, positive or negative. The evidence extracted from the studies often repeated commonly expressed concerns over potential negative health system effects of disease-specific programmes.
Professor Atun added: “The current evidence on potentially negative health system effects of global health initiatives used in scientific literature seems to rely on personal views and anecdotal evidence. Institutions that invest taxpayers’ money must be accountable for demonstrating results or any negative effects through independent and objective evaluations of their work.”
Royal Society of Medicine
