Africa, Development & Aid, Europe, Headlines, Health, Poverty & SDGs

EUROPE: Failing to Step Up Medical Support to Africa

David Cronin

BRUSSELS, Sep 25 2008 (IPS) - Almost two years after the European Union resolved to step up its efforts to address the shortage of doctors and nurses in poor countries, its progress has been found unsatisfactory by the bloc’s own officials.

In December 2006, the EU’s governments approved a ‘programme of action’ for ensuring that a higher number of qualified health workers are made available to treat the world’s poor.

But a new assessment by the European Commission, the EU executive, says it is impossible to tell if the level of funding provided to obtain this goal has increased since then because not enough data has been furnished by the EU’s governments. It complains, too, that most of the relevant activities financed by the Union are being pursued in an “uncoordinated manner” that runs counter to the 2006 plan and to more general commitments that aid should be more effective than it has been in the past.

While the paper notes that Sweden is funnelling its aid to Mali through a partnership with the Netherlands, it indicates that few other examples of such concrete cooperation between EU donors can be found.

“There is need to coordinate EU assistance in health, both to minimise overlapping or disconnected actions and also to avoid having a strong focus on some countries while neglecting others with similar needs,” says the report, which is based on data from 18 of the EU’s 27 countries.

This “imbalance” is especially striking in parts of Africa, the paper adds.

The paper lists 10 African countries where several EU governments are supporting health projects in the same locality, stating that further details are required to evaluate whether these projects complement each other or involve unnecessary duplication.

On the other hand, many African countries are only receiving aid that specifically targets their health sector from a single EU government. These include Burundi, the Central African Republic, Guinea, Eritrea, Gabon, Ghana, Guinea-Bissau, Cote d’Ivoire, Liberia, Madagascar, Sao Tome, Senegal, Somalia, and Togo.

The consequences of Africa’s healthcare shortages were spelled out at the international AIDS conference in Mexico City last month. Those attending the event were reminded that 54 percent of nursing positions in Lesotho’s public clinics are vacant. Malawi, meanwhile, has less than 100 doctors trained to treat people with AIDS. As a result 140,000 people who are HIV positive are not receiving any treatment; that amounts to roughly half of all carriers of the virus who require vital drugs to survive.

One major problem identified by the Commission is that the short-term nature of development aid means it does not help countries to meet recurring costs such as the salaries of health workers.

To remedy this situation, the Commission is proposing that some of the EU’s aid should be given in the form of a ‘contract’ designed to help the realisation of the United Nations’ Millennium Development Goals (MDGs). Many of the eight objectives have a health component such as reducing the incidence of major diseases, improving nutrition and allowing mothers to give birth safely.

The ‘MDG contract’ advocated by the Commission is aimed at providing reliable finance over a six-year period. That would be twice as long as the duration of most ‘budget support’ accords, under which the EU executive provides aid directly into the national coffers of recipients.

The Commission had hoped to finalise work on the MDG contract proposal during 2007 but it has still not been completed.

An EU official working on development aid issues said the delays can be attributed to the innovative nature of the concept. “This is flagship stuff,” the official said. “Europe is the first to come up with this idea, although you would think it would have been invented earlier. It is not an easy thing to put together.”

Although anti-poverty activists have welcomed the principle of providing durable support, they have expressed misgivings about some of the small print in internal Commission documents outlining how the contract should work. Because these say that it would not be limited to health and education but that it could be used to improve the investment climate in poor countries or boost their macroeconomic stability, some campaigners fear that the needs of healthcare systems could be overlooked.

Mirjam van Reisen, director of Europe External Policy Advisors, an organisation monitoring the EU’s contribution to the fight against poverty, said that indicators should be drawn up to show that the contract will actually benefit hospitals and clinics. “To claim that the MDG contract will contribute to having more health workers and teachers is a long shot,” she said.

One of the central reasons why Africa has a dearth of doctors and nurses is that medical graduates have had to emigrate in order to earn a decent salary. In Malawi, nurses typically earn a mere three dollars a day.

Manto Tshabalala-Msimang, the South African health minister, last year accused the EU of depriving her continent of doctors through its ‘Blue Card’ scheme for attracting highly-skilled migrant workers.

The Commission responded by saying that the scheme, which would apply to all EU countries apart from Denmark, Ireland and Britain, contains a clause requiring ‘ethical recruitment’ in the health sector.

Nearly all of the EU’s governments indicated that they were in favour of the Blue Card system when it was discussed by the bloc’s justice and interior ministers Sep. 25. The exception was the Czech Republic, which decided to block formal adoption of the measure because a number of other EU states do not allow its nationals to work on their territory.

France, the current holder of the EU’s presidency, said it regarded the Czech opposition as a temporary obstacle, relating to domestic politics. According to Brice Hortefeux, the French interior minister, the issue could be resolved “very soon.”

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