Tuesday, September 16, 2014
7

援助是有用的

纽约—对外部援助的批评是错误的。越来越多的数据表明,很多国家贫困人口的死亡率在迅速下降,卫生援助项目居功至伟。援助是有用的,它能够拯救生命。

德莫姆比尼斯(Gabriel Demombynes)和特罗穆勒洛瓦(Sofia Trommlerova)的最新研究表明,近几年来,肯尼亚婴儿(1岁以下)死亡率显著下降,其中很大一部分原因在于防疟疾床帐的大规模使用。这一发现与穆雷(Chris Murray)关于疟疾死亡率的重要研究是是一致的,穆雷发现,2004年以后,非洲撒哈拉以南地区的疟疾致死率出现了显著而快速的下降,其原因在于外部援助所支持的疟疾控制措施。

让我们从12年前开始。2000年,非洲饱受三大传染病的肆虐。艾滋病每年夺走200万以上生命,并在快速蔓延。由于寄生虫对传统药物的抗药性越来越强,疟疾出现了大爆发。结核病也在肆虐,一部分是由于艾滋病所致,一部分是因为具有抗药性的结核病的出现。此外,每年有数十万妇女在分娩时丧命,因为她们无法在安全的诊所和医院中生产,也得不到所需的紧急救援。

这些危机刺激了行动。联合国各成员国在2000年9月通过了千年发展目标(MDG)。在MDG的八大目标中,有三个直接关注卫生状况,即减少儿童夭折、难产致死和传染病致死。

类似地,世界卫生组织也大力呼吁加大卫生发展援助力度。以时任尼日利亚总统奥巴桑乔为首的非洲领导人接受了与非洲大陆传染病作战的重任。尼日利亚举办了两次标志性峰会,即2000年的疟疾峰会和2001年的艾滋病峰会,这两次峰会在促进采取行动方面居功至伟。

在第二个峰会中,时任联合国秘书长安南呼吁建立全球抵抗艾滋病、结核病和疟疾基金(Global Fund to Fight AIDS, TB, and Malaria)。该全球基金于2002年开始运作,为这三种疾病的预防、治疗和看护提供融资。高收入国家也最终形成协议,同意免去重债穷国的债务,减轻它们的还债负担,将更多的钱用于卫生项目。

美国也采取了行动,出台了两大项目,一个针对艾滋病,另一个针对疟疾。2005年,联合国千年项目给出了如何增进最穷国家初级卫生保障的具体办法,其中高收入国家应该帮助最穷国家承担后者无法独力承担的成本。联合国大会通过了该项目的多项建议,并开始在多个低收入国家实施。

在这些努力的推动下,捐赠援助的确出现了蓬勃发展。1995年,卫生援助总额约为79亿美元。这一远远不够的援助水平缓慢地增加着,2000年上升到了105亿美元。但是,到了2005年,年度卫生援助大涨59亿美元,而到了2010年,援助总额在增加105亿美元,达到了269亿美元。

资金的充裕使得抵抗艾滋病、结核病和疟疾的项目得以启动、安全分娩得到了大普及,也增加了疫苗的覆盖面,小儿麻痹症基本上被消灭了。许多创新性卫生技术被开发出来并得到了使用。约10亿人口生活在高收入国家中,2010年的援助总额意味着他们人均贡献了27美元——对他们来说算不了什么,但对最贫困人口来说足以救命。

如今,公共卫生领域的诸多方面都可以看到进步。1990年,有1200万不到5岁的儿童夭折。到了2010年,该数字下降至760万左右——依然很高,但毫无疑问是历史性的进步。非洲疟疾儿童致死数量也从2004年的最高峰(约100万)下降至2010年的约70万,而全球孕妇死亡数量在1990—2010年间下降了几乎一半,从543 000降至287 000(估计值)。

如果年度卫生援助能增加100—150亿美元(即高收入国家居民每人再拿出10—15美元),达到每年400亿美元,那么未来几年还能取得更大进步。卫生相关MDG即使在世界最贫困国家也能够实现。

不幸的是,在过去十年所采取的每一个步骤中(现在也不例外),总有一群援助怀疑者对必要的援助指手画脚。他们一再声称援助根本没什么效果;援助资金都打了水漂;抗疟疾床帐不能给穷人使用,因为他们根本不会去用;穷人不会正确服用抗艾滋药物;如此等等。他们的攻击是冷血的(包括对我的攻击)。

援助的反对者不仅仅是错误的。他们异口同声的反对仍在威胁取得成就所必须的融资——减少婴幼儿死亡从而让最贫困国家在2015年完成MDG以及此后再接再厉确保所有国家所有人民都能获得基本卫生服务都需要资金。

十年来卫生成果的巨大进步已经证明,怀疑者是错的。卫生援助在拯救生命、改善生活方面是有用的,而且很有用。让我们继续支持这些生命挽救计划,提升所有地球人的尊严和福利。

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  1. CommentedNirmalan Dhas

    A NEW DYNAMIC FOR AID
    by Nirmalan Dhas on Thursday, January 5, 2012 at 4:12am ·



    The Context

    The world we live in is not the world into which we were born. It is a hotter world where floods, fires, tsunami, earthquakes and other sudden and unannounced disasters are increasing in their frequency. It is a world in which these sudden disasters cause billions of dollars worth of damage that take years to re build and draw heavily on already scarce resources.

    The world we live in is a world challenged by Rapid Resource Depletion (RRD), Pollution and Global Climate Change (P&GCC), Global Monetary Collapse (GMC) and the increasing incredibility of the Growth Model of Development (GMD) and the very nature of aid has to change in response to these hitherto ignored phenomena.

    Our models of aid are old and outdated and do not meet the requirements of the world we live in today and the one we are likely to make for ourselves tomorrow…



    Humanitarian Aid

    Humanitarian Aid was never designed to respond to the kind of disasters that we have faced in recent times and will likely face more frequently in the future. Humanitarian aid has always been emotionally driven and this emotional drive rests on the understanding that disasters are random un related events to the occurrence of which we contribute nothing and whose victims are in effect the victims of misfortune and therefore worthy of the sympathetic assistance of those who have not thus been afflicted. But today we are all afflicted by these four dynamics that have arisen out of our own greed based and desire driven actions over the last two centuries or so and there is no one who stands un affected and in a position to sympathize with us and help us.

    We have to prepare to help ourselves and so humanitarian aid must be transformed into a component that responds to emergencies within a larger process that is consciously engineered to engage the disasters that appear to lie ahead and mitigate their impact with the clear and conscious objective of ensuring the survival of as many human individuals as possible so that the human species itself may survive and regenerate itself.

    The human species cannot however survive or regenerate itself without ensuring the survival of its environment and its regeneration as well as ensure the survival of life on Earth, as we know it. The survival of the human species, the survival of life as we know it on Earth and the survival of the planetary environment, cannot be looked at separately but as a single indivisible whole.



    Development Aid

    This would render our growth model of development both destructive and dangerous so that our development aid would then have to be a holistic process that devotes the bulk of energy and resources to environmental repair and regeneration while channeling a significant quantum into research into new less dangerous technologies and into the designing of new ways to live, new habitats, new relations with food and nutrition, new ways of enhancing human health and wellness, new attitudes to death and new ways by which human knowledge can be passed down generations.

    Initially and for a very long time to come, a large amount of development aid will have to be devoted to disaster forecasting and warning systems, community training in disaster mitigation, the preparation of responses to likely disasters and the maintenance of stockpiles of food water and medicines as well as the training of communities in new ways of living and relating to each other for survival.



    Aid re-conceptualized

    As you can see, within this context aid ceases to be aid and becomes instead a vital component of the emerging model of development. It ceases to be a "one third of one percent" effort and instead it becomes the central force of the drive to ensure the survival of the human species and it is generated not by emotion but by clear and calm perceptions of what has occurred and what lies ahead of us and how we may respond with the objective of ensuring the survival of our human species.

    The understanding of this need for change is what we must bequeath the young of our species. We must ensure that the wisdom we have gathered through the eons of evolution of our species in the course of which so much energy has been expended and so many resources consumed must be handed over to them. Wisdom must become the mark of youth so that our young may survive the turbulence ahead.

    We have perhaps clumsily and perhaps crudely and perhaps blindly and perhaps unthinkingly clawed our way along the evolutionary pathways we were able to perceive until today at least some of us are able to perceive the price we have paid and the price we may be called upon to yet pay and who know that the extinction of the human species within whom such a high level of autonomy has been evolved, and life as we know it on earth and earths planetary environment which generates and sustains such life, cannot be permitted.



    The new developmental mission

    Life as we know it on earth can survive to continue its evolution through and beyond human being and to spread throughout the universe. It is up to us to ensure that it is facilitated in its attempts to survive and realize its potential to do so.

    Our context now demands much more than the Millennium Development Goals. It demands that we concentrate our every effort on the survival of our species and the survival of all that its survival requires.

  2. CommentedOliver R

    Although you cite many impressive figures to do with falling child mortality and fewer deaths of women during childbirth, to a certain extent the gains will surely be harder to maintain in the future. In a sense the development you describe must be the result of plucking low hanging fruit. For example mosquito nets can be manufactured and distributed fairly cheaply let yield large immediate falls in cases of malaria. However the only way that developing countries can truly become developed countries and sustain the gains made so far is with effective governance and the right economic and social policies in place. These vital factors are sadly lacking in many poor areas of the world. Hence although aid definately helps, it cannot act as a substitute for good governance.

  3. CommentedJosué Machaca

    Completamente de acuerdo, por todos lados he escuchado que la ayuda es ineficiente. Esto despeja mis dudas.

  4. Commentedsandesh kotte

    I agree with Prof.Sachs argument that aid works but it is also true that in some situations/conditions it does not worked as well...Research shows both positive and negative outcomes of aid..But this does not favor giving up aid..What's important is,to go after some particular characteristics/political factors which determine the outcome of aid process...after all we are talking about life and death here..so i don't think it gives us other choice than how to work aid..

  5. CommentedBob Quiggin

    The point behind Prof Sachs's piece is that aid has worked. It has worked not only in his illustrated area of health care, but in emergency food supplies, food security, education, infrastructure, water and sanitation, training, capacity building and more. Given limitless space he could have detailed all these. And yes, aid dollars have to be spent effectively. But the contention he is battling is the simple claim that 'Aid does not work'.

    That claim is not only wrong, it is often promoted selfishly and endangers the lives of the most vulnerable and the security of us all.

    NB. My views are my own and do not necessarily reflect those of my employer.

  6. CommentedMoctar Aboubacar

    I almost agree with the title, but not with professor Sachs' choice of content. Two points to illustrate this:

    1. The title reads: "Aid Works" but the last paragraph reads "aid for health care works". What is being discussed is not all of aid, but aid to health care, and specifically aid to health care to reach MDGs. This is fine if it worked as an in-depth example illustrating a larger point, but I am unsure to what extent the argument on effectiveness applies in all other development contexts.
    Health care is relatively 'simple' in that it has a fixed logic and obvious end goal: 'diseases are detrimental to humanity, therefore they must be eradicated'. But not all issues in development have this basic normative line. Debates on democracy are far from over, and there is no consensus on an end goal to economic development (growth or redistribution?). Given this, the solution that aid brings is not always found in the aid money, as the health care example in this article by and large illustrates.

    2. Aid is not necessarily aid money, and I wish professor Sachs made this distinction much clearer. Professor Sachs' argument would be much stronger if he included more examples of effective aid that cannot be put into dollar amount (the UN Millennium Project is one good example cited). One wouldn't tell by reading the article that policy planning, strategy, creative problem solving and knowledge sharing can all be forms of aid.

    There is much to be said for how effective aid money to certain projects and in certain areas can be. But putting the emphasis on the quantitative side of things, while useful, can be distracting.
    With last year's Busan High Level Forum on Aid Effectiveness and with the upcoming Rio+20 summit, the logic is not, as professor Sachs suggests 'Aid works. So are we giving enough money?'.
    Rather, the logic is 'Aid _can_ work. How effective is it? What is the future of cooperation for development?'

  7. CommentedLara Gautier

    Unfortunately, appart from studies on malaria, Professor Sachs does not provide any evidence that decline in mortality in developing countries is actually due to increased funding and aid by rich countries... Who can prove that the good news (evidence should also be found: e.g. when we notice that immunization coverage in several districts exceeds 100%, we should seriously question data reliability...) can not be explained more generally by an improvement of basic hygiene & sanitation and economic development of these countries (which assign an increasing share of national budgets to health)?

    In addition, the Health MDGs are far from being met by 2015 and most experts in international health acknowledge this unfortunate perspective. Dr. Margaret Chan herself expressed some concerns during the last WHA which ended a few days ago...

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