Wednesday, November 26, 2014
7

La ayuda sirve

NUEVA YORK – Los críticos de la ayuda extranjera se equivocan. Una creciente oleada de datos demuestra que las tasas de mortalidad en muchos países pobres están cayendo marcadamente, y que los programas respaldados por la ayuda extranjera destinados a ofrecer atención sanitaria desempeñaron un papel importante. La ayuda funciona; salva vidas.

Uno de los estudios más recientes, a cargo de Gabriel Demombynes y Sofia Trommlerova, demuestra que la mortalidad infantil de Kenia (muertes antes de cumplirse un año de vida) decayó en los últimos años, y lo atribuye, en gran medida, al uso masivo de mosquiteros para cama destinados a combatir la malaria. Estos hallazgos coinciden un importante estudio de las tasas de mortalidad causada por la malaria realizado por Chris Murray y otros, que de la misma manera determinó una caída significativa y rápida de las muertes ocasionadas por la malaria después de 2004 en el África subsahariana, como resultado de las medidas de control de la malaria respaldadas por la ayuda extranjera.

Volvamos el reloj atrás una docena de años. En 2000, África luchaba contra tres epidemias importantes. El sida mataba más de dos millones de personas por año, y se propagaba rápidamente. La malaria estaba en aumento, debido a la creciente resistencia del parásito a la medicina convencional en ese momento. La tuberculosis también crecía, en parte como resultado de la epidemia del sida y en parte por la aparición de una tuberculosis resistente a la droga. Por otro lado, cientos de miles de mujeres morían al dar a luz cada año, porque no tenían acceso a partos seguros en una clínica u hospital, o a ayuda de emergencia cuando la necesitaban.

Estas crisis interconectadas llevaron a que se tomaran medidas. Los estados miembro de las Naciones Unidas adoptaron los Objetivos de Desarrollo del Milenio en septiembre de 2000. Tres de los ocho objetivos -reducciones de las muertes infantiles, muertes maternas y enfermedades epidémicas- se centran directamente en la salud.

En la misma línea, la Organización Mundial de la Salud emitió un llamado importante para que se aumente la asistencia para la salud. Y los líderes africanos, encabezados por el presidente de Nigeria en su momento, Olusegun Obasanjo, asumieron el desafío de combatir las epidemias del continente. Nigeria fue sede de dos cumbres históricas, sobre malaria en 2000 y sobre sida en 2001, que fueron un estímulo crucial para la acción.

En la segunda de estas cumbres, el entonces secretario general de las Naciones Unidas Kofi Annan hizo un llamado a la creación del Fondo Global para Combatir el Sida, la Tuberculosis y la Malaria. El Fondo Global comenzó a funcionar en 2002, financiando la prevención, el tratamiento y los programas de atención para las tres enfermedades. Los países con ingresos elevados finalmente también acordaron reducir la deuda de los países pobres altamente endeudados, permitiéndoles gastar más en atención médica y menos en pagos agobiantes a los acreedores.

Estados Unidos también llevó a cabo medidas, como la adopción de dos programas importantes, uno para combatir el sida y otro para combatir la malaria. En 2005, el Proyecto Milenio de las Naciones Unidas recomendó maneras específicas de mejorar la atención médica primaria en los países más pobres, a la vez que los países de altos ingresos ayudaban a cubrir los costos que los más pobres no podían pagar por sí solos. La Asamblea General de las Naciones Unidas respaldó muchas de las recomendaciones del proyecto, que luego se implementaron en varios países de bajos ingresos.

En efecto, la ayuda de los donantes comenzó a aumentar marcadamente como resultado de todos estos esfuerzos. En 1995, la ayuda total para la atención médica era de aproximadamente 7.900 millones de dólares. Este nivel deficiente comenzó a aumentar lentamente y llegó a 10.500 millones de dólares en el año 2000. En 2005, sin embargo, la ayuda anual para la salud había subido otros 5.900 millones de dólares y para 2010, el total se había incrementado otros 10.500 millones de dólares, hasta alcanzar 26.900 millones de dólares en ese año.

El mayor financiamiento permitió que se llevaran a cabo campañas importantes contra el sida, la tuberculosis y la malaria; que se registrara un incremento considerable de los partos seguros, y que se ampliara la cobertura de las vacunas, lo que implicó la erradicación casi total de la polio. Se desarrollaron y se adoptaron muchas técnicas innovadoras en materia de salud pública. Siendo que en los países de ingresos elevados viven 1.000 millones de personas, la ayuda total en 2010 aumentó a alrededor de 27 dólares por persona en los países donantes -una suma modesta para ellos, pero que les salva la vida a las personas más pobres del mundo.

Los éxitos en salud pública hoy se pueden ver en muchos frentes. Aproximadamente 12 millones de niños menores de cinco años murieron en 1990. En 2010, esta cifra había disminuido a alrededor de 7,6 millones -un número todavía demasiado alto, pero definitivamente un logro histórico-. Las muertes ocasionadas por la malaria en niños de África disminuyeron de un pico de aproximadamente un millón en 2004 a alrededor de 700.000 en 2010 y, a nivel mundial, las muertes de mujeres embarazadas se redujeron casi a la mitad entre 1990 y 2010, de 543.000 a 287.000 estimativamente.

Otros 10.000 a 15.000 millones de dólares en ayuda anual (es decir, aproximadamente 10 a 15 dólares por persona en el mundo de altos ingresos), que llevarían la ayuda total a alrededor de 40.000 millones de dólares por año, permitirían que se hiciera un progreso aún mayor en los próximos años. Los Objetivos de Desarrollo del Milenio para la salud podrían cumplirse incluso en muchos de los países más pobres del mundo.

Desafortunadamente, frente a cada medida que se tomó en los últimos diez años -y aún hoy-, un coro de escépticos se manifestó en contra de la ayuda necesaria. En repetidas ocasiones dijeron que la ayuda no sirve; que los fondos simplemente se malgastan; que no se les puede dar mosquiteros de cama a los pobres para combatir la malaria porque los pobres no los van a usar; que los pobres no toman los medicamentos contra el sida como corresponde; etcétera, etcétera. Sus ataques no han cesado (yo enfrenté mi cuota).

Quienes se oponen a la ayuda no sólo se equivocan. Su antagonismo ruidoso sigue amenazando el financiamiento que es tan necesario para que se tomen medidas, para recortar las muertes infantiles y maternas lo suficiente como para cumplir con los Objetivos del Milenio en 2015 en los países más pobres, y para continuar luego hasta asegurar que todas las personas en todas partes finalmente puedan acceder a servicios médicos básicos.

Una década de progreso significativo en el área de la salud demostró que los escépticos están equivocados. La ayuda destinada a la atención médica sirve -y de manera magnífica- para salvar y mejorar vidas. Sigamos respaldando estos programas que salvan vidas, y que defienden la dignidad y el bienestar de todas las personas del planeta.

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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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