Emerging societal dynamics in donor countries are altering the perception of aid and curving its impact. However, a new generation of donors can – and must – be supported in their ability to drive change
By Hiromi Murakami, adjunct fellow, Global Health Policy Center at the Center for Strategic and International Studies, and Kiyoshi Kurokawa, professor emeritus, National Graduate Institute of Policy Studies and the University of Tokyo
We are living in an uncertain era of a globalised world where leaders must think disruptively beyond the existing frameworks. The western world’s model of donors assisting the unprivileged has been sustained for decades, chiefly due to a relatively stable global order, the middle classes electing ‘sensible’ leaders and the consciences of those leaders with apparently ambivalent feelings of guilt.
That creed of development assistance is now passé, as donor countries experience political polarisation and growing economic inequality, with middle class incomes dropping. It is increasingly difficult to attract political support from voters to pump cash unconditionally into international agencies, as ever-striving middle classes are also concerned about their own future.
This situation foments anger and discontent, divides societies into radical movements, encourages xenophobia and increasingly gives rise to populist leaders. The more domestic politics are strangled, the less attention is paid to synergistic collaborative efforts to solve international problems. There is widespread apathy among national leaders to truly engage on common agendas, while those leaders are under extreme pressure to survive ‘democracy’ at home.
Since World War Two, the United Nations and the World Bank have not been consistently successful in improving the living standards of the poorest. Yet advances in digital technology and the wide distribution of mobile phone services have now made it easier to reach people in remote villages and for them to receive education and training at very low cost.
Still, the poor remain poor, and we witness mounting frustration and violence amplified by sheer despair. Development assistance has not functioned as intended, as aid money has often been dispersed before reaching those who need it.
Access to basic socially supportive infrastructure, including health and income generation, has remained at a minimum.
The reality we see today is far from what we had envisaged.
Dramatic strides were made when the private sector stepped into the global health realm. The Bill and Melinda Gates Foundation deserves recognition, with its clear goals of alleviating extreme poverty and health inequality. By using cost-benefit analyses and accelerating the development of novel technologies with an annual budget that exceeds the World Health Organisation’s, it brought a dramatic shift in the mind-set of the development assistance community, swapping aid-based assistance for an outcome-based efficient model that facilitated actual progress.
This new perspective will lead to new models. The risk, however, is the sustainability of governance where power rests in the hand of only a few founders.
Wealth has been steadily accumulating in a small number of the super rich. Globalisation and the rise of digital technology have not created enough jobs. Millennials and the so-called Generation X will be deciding investment trends for years to come. In fact, almost half of American households with net assets of $25 million or more are dominated by millennials.
The encouraging news is that those individuals are keen to invest in and support environmental, social and governance issues, which should stream money flows into emerging enterprises and socially conscious businesses that may contribute to socio-economic equality. Therefore, it is gravely important to build a consensus among these ‘haves’, in particular with Google, Apple, Facebook and Amazon, to invest in environmental, social and governance issues and actively engage in tackling inequality in all its forms among the ‘have nots’.
In 2005, the World Health Organization initiated a bold move to advocate a new concept of evaluating the social determinants of health from a broader perspective. With such a pioneering spirit, it could start by creating a new platform for cross-border and cross-stakeholder public-private alliances. Such a platform would accommodate various forms of contributions, not necessarily in financial form. Private corporations would be able to offer technology, products, supply chains, expertise and any other resources.
Some endeavours already exist: the Global Health Innovation Technology Fund promotes global health research and development and sheds light on dormant innovation efforts, through a public-private funding scheme. Since 2013, the fund has invested $170 million in 80 projects to fight infectious diseases.
The Coalition for Epidemic Preparedness Innovation has also initiated collaboration involving the governments of Japan, Norway, Germany and India as well as industries, philanthropy and civil society to finance, coordinate and accelerate development of vaccines against infectious diseases, especially critical ones such as Ebola, before they reach crisis levels. The coalition has committed over $280 million, and has a unique risk-sharing scheme for R&D costs and benefits among vaccine developers when market incentives fail.
The Hideyo Noguchi Africa Prize also provides individuals with an opportunity for initiating collaborative efforts. Using their honorariums, the inaugural laureates Brian Greenwood and Miriam Were respectively established the Africa London Nagasaki Fund to provide training and education opportunities for African doctors and expanded the public health programme in Kenya to train community health workers.
We continue to search for a new form of government – not an authoritarian one – to enable an allied framework of global multi-stakeholders who work together to build capacity among the poorest. Inequality has also become a central issue in developed countries, as fears of losing jobs to artificial intelligence rise. By reallocating resources and available technology, offering expertise and providing opportunities for education and training, we can harness the collective will to build capacity to allow each one of us to tackle the fundamental problem of inequality.
It is critical that international agencies, including the World Health Organization, continue to raise awareness and remind national leaders to engage in such vital challenges. With an outcome-oriented approach, delivering visible returns, with an innovative spirit and open mind, we welcome the fusion of ground-breaking experiences and develop novel, cost-effective solutions that must become accessible to all those who need them.