Read this brief commentary in the Lancet by James Pfeiffer and Rachel Chapman on health systems strengthening (or lack thereof) in Mozambique. They write,
“The “golden age” of global health aid, as some have called it, was not a golden age of health system building. So after 10 years and millions of dollars, on the day we visited that health centre there was still only one nurse who could provide 7 minutes each to dozens of pregnant women waiting for hours, with leaking roofs, broken filing cabinets, and no activistas (since the funding had dried up)—not because the money was stolen or lost by the government, but because the health system itself received very little of it. Instead, aid funds built a massive NGO infrastructure that will dissipate as soon as donors tire of the effort.”
This is consistent with my own experience. When we analyze these global health “interventions” we must ask if they are locally owned and operated. Are they truly integrated into the health system? Are they sustainable? All too often, the answer is no.