ETHICS OF DEVELOPMENT ASSISTANCE FOR HEALTH

Developing countries, home to 84% of the world’s population and 92% of the burden of disease, have only 29% of global gross domestic product and 16% of health spending. In the past three decades, levels of and contributors to global health aid have increased at an unprecedented pace, with an emphasis on funds for HIV/AIDS; maternal, newborn, and child health; malaria; and tuberculosis.

While increased development assistance for health (DAH) is essential and welcome, these system developments raise numerous ethical questions. To expand global health equity, the DAH system should abandon the power-based donor-recipient dichotomy and replace it with the principle of equal respect for all people’s capabilities.

The global justice theory of provincial globalism and its shared health governance (SHG) framework offer an alternative and much better approach to DAH. A shared health governance approach rejects global justice views that rely on individual or social contracts purporting to be mutually beneficial. With shared health governance, donors and global, national, and subnational agencies and communities can jointly re-form the current foreign aid scheme of DAH.

The dual focus on health agency and health functioning provides a more equitable foundation for collaboration among equal partners who share health governance. From this perspective, the current system is ineffective, inefficient, and inadequate for addressing global health needs.

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