The world has changed rapidly over the past 25 years. Economies have grown, and people in the poorest parts of the world are living longer, healthier lives. The United States and other donors have contributed to this progress and have an interest in sustaining it. Reducing premature mortality in developing countries will depend on improvements to the health system: the workforce, leadership, information system, service delivery, and financing of the health sector. Building the infrastructure that supports health will reduce disease and lengthen lives, fostering economic growth and global security.
Every year, 150 million people fall into poverty because of health expenses. The threat of financial catastrophe keeps the poorest and most vulnerable people outside the formal health system. In an effort to mitigate their risks, countries are moving towards a universal health coverage system that would provide a basic package of essential services to the whole population. As low- and middle-income countries start to build universal coverage systems, weaknesses in their health systems are becoming a binding constraint.
Support for health systems will help protect the United States standing investments in malaria, HIV and AIDS, and child health. By building local capacity to manage the health system the United States would help reduce dependence of foreign aid. Capacity building is a long process, however. Success toward this goal should be measured in a longer time frame than Congress has previously allowed for development projects. Taking a longer view of global development and paying closer attention to the outcomes (rather than the inputs) of the United States’ investment in health could do much to change the tone of foreign aid.
An aid strategy that emphasizes research and training, global public goods, efficient management, and rigorous program evaluation would go
far to improving the health infrastructure in low- and middle-income countries, and making good use of the proportionately decreasing prominence of U.S. assistance in national health budgets. These few, simple changes could have far-reaching repercussions for building a healthier, more prosperous, and stable world.
