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By Rachel Bonham Carter
NEW YORK, 7 April 2005 – “We’ve got to stop thinking that it’s all about money,” says Josh Ruxin, Assistant Clinical Professor of Public Health at Columbia University, who is exploring ways of improving healthcare in developing countries. He believes it is critical to address the healthcare systems - or lack of - before we can expect donations to be wholly effective.
“There’s about $75 billion needed to finance programmes to achieve the Millennium Development Goals. While there’s no question that money is a critical source which is needed to help build the foundations upon which you can achieve the MDG’s, there are lots of systems that need to be put in place to make the dollars start to move.”
Ruxin says the problem is not about donations sitting idle, but an over-enthusiastic focus on the well-funded areas to the detriment of wider public healthcare. As an example, he describes the situation in Rwanda, where doctors are offered salaries three or four times greater than the national average to work in the HIV/AIDS programme. In a nation of 7.6 million people, with roughly 400 qualified doctors, “how can it be beneficial,” he asks, “to keep taking doctors away from child health and reproductive health, etc… This is not long-term thinking.” He says that governments of developing nations just aren’t geared to looking at the knock-on effects of the “vertical results of doing the most they can with the money they’ve got.”
Ruxin would see expert business strategists sent in to work along side ministers of finance and ministers of health, particularly in sub-Saharan Africa, “to radically rethink the approach to public health,” and convince ministers of the long-term financial benefits to a country from investing in public health. He insists three, five, or 10-year strategic plans are needed if they’ve any hope of scaling up the capacity of national healthcare programmes.
It’s not just the ministers who Ruxin wants to work with though, he believes the real onus on improving the systems lies at the top: “I think we have to work much more actively with the leadership in countries. Currently, the leaders of poor countries tend not to place the needs of their poorest citizens at the top of their priority list,” in spite of the pledge to reach the Millenium Development Goals, which focus on the worst off groups. UN agencies have to figure out how to work closer with the leadership to get that commitment converted into action right now.”
And Ruxin’s suggestion for achieving that? Pressure.
“If activists can put pressure on pharmaceutical companies to lower the price of essential drugs for sick people in poor countries, then the same could work on governments. Similar types of pressure needs to be applied to the poor countries themselves. You certainly don’t see demonstrations being held in front of the embassies of sub-Saharan African countries that aren’t currently meeting their people’s needs. I think that we actually need to work on a movement - not so much blame - but rather to put the focus of attention on the poor - the rights and needs of the poor - and to encourage countries to do what’s right by them.”