Partnership As a Sustainable Model for International Aid
As the world comes to grips with the recent decision by the United States to cut its aid funding by as much as 80% this year, urgent questions are arising about how the world can continue making progress against the UN’s Sustainable Development Goals and ensuring global security in the context of the biggest reduction in foreign aid since the emergence of the modern international order.
A shifting landscape for global aid
Much attention has understandably been given to these sudden and dramatic aid cuts made by the United States this year. In reality, these reductions in investment are remarkable for the scale and rapid implementation of the cuts rather than the fact that funding is being reduced. The last two years have seen cuts in international aid by Switzerland, Germany, France, the Netherlands and Belgium, among others. The United Kingdom has announced a similar retrenchment to follow from 2027, motivated by rising defence costs and the need to invest more in domestic security.
Democratically elected governments are entitled to make decisions about spending priorities in line with what they believe is in the best interests of their nations and citizens. Around the world, they are under pressure to use funds in more effective and efficient ways at a time of economic uncertainty and rising political instability. There are also legitimate and long standing concerns about how effective existing international aid structures and methods of funding are.
But international aid also has an irrefutably vital role to play in promoting human health and dignity around the world; in the countries that receive it through strengthening health systems, and in high-income donor states by managing threats to global public health and international security.
Without more coordinated global action, for example, antimicrobial resistance will be a contributing factor to almost 200 million fatalities — a figure equivalent to the population of Brazil. Covid-19, HIV and the Spanish Flu have all demonstrated in the last century how disease and infection do not care for national borders or geopolitical concerns.
With the wealthiest governments unlikely to feel able to change their decisions about funding priorities in the near future, new approaches to tackling urgent global health crises must be found. There is a need to develop a model of international aid that makes better use of funding still available and in ways that can have a definitive, lasting impact on a multitude of health and social care issues. Aid must be delivered in ways that are more impactful, cost-effective and sustainable.
The need for sustainable and innovative partnerships
Almost twenty years ago, the Nigerian economist Ngozi Okonjo-Iweala – now Director-General of the World Trade Organisation and a two-time Nigerian Finance Minister – came to prominence around the world for her advocacy of the principle of ‘trade, not aid’. Okonjo-Iweala was and is not opposed to humanitarian and development aid; rather, she advocates that investment ought to be deployed in ways that invest in the ability of lower- to-middle-income countries (LMICs) to generate their own gains in development. In the long run, the goal of effective aid should be to reduce the future demand for it in LMICs.
In the sphere of healthcare, even more than financial constraints, research has identified that investment in training and capacity building is the single most critical intervention needed to strengthen healthcare systems in Africa – even more pressing than lack of domestic funding for health infrastructure (though this too is vital). The single best investment the Global North and higher-income countries (HICs) can make in global health is equipping the workforce of LMICs with the skills, knowledge, expertise, experience or equipment that they need to strengthen their own health systems.
One of the most cost-effective yet impactful ways to deliver this kind of investment is through the carefully structured partnerships between nations, communities and sectors that enable the easy exchange of ideas, skills and expertise between participants.
At the international level, partnerships between nations (whether between Health Ministries or between hospital sites in different parts of the world) can allow staff in LMICs to benefit from insight, training, growth opportunities and expertise not available in their home countries. Partnerships within LMICs between different sites and organisations can enable the wider dissemination of these benefits. Skills and expertise, once developed, outlast the life of original programmes by years or decades through the careers of beneficiaries, and can be shared with others through in-country networks.
For example, many healthcare professionals in LMICs lack training in the effective use of antibiotics, mistakenly believing that second or third-line antibiotics must be better for treating infection; often, those who do have training work in environments where there is a lack of investment in technical skills to identify the cause of an infection through testing. But in order to avoid antibiotic resistance and the threat of deadlier pathogens evolving, it is vital that some antibiotics are used sparingly — minimising the exposure bacteria have to them dramatically reduces the risk of resistant strains evolving.
CPA has pioneered programmes like Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) to help tackle this threat. By pairing hospitals and community sites with counterparts in the UK, we support healthcare workers in eight African countries to develop their expertise in good antimicrobial stewardship (AMS) – the proper use of drugs like antibiotics. In some places, this means strengthening the confidence of pharmacists to guide other clinicians in good prescribing practice; in others, it can involve equipping personnel with the data skills to monitor, evaluate and make informed decisions about how antibiotics are used across a whole hospital site or community.
The gains made from this kind of upskilling can lead to efficiencies and savings that free up resources for further development elsewhere. At Lira Regional Referral Hospital (LRRH) in Uganda for example, a pharmacy leader trained by CwPAMS’ Africa Leadership Fellowship – AMS initiative was able to implement improvements in monitoring, lab testing and adherence to prescribing best practice that saw the hospital reduce its demand for Piperacillin-Tazobactam and Meropenem – two potent antibiotics – by a whopping 75%. LRRH now places an order for these drugs every two months, compared to two weeks before the CwPAMS-supported intervention.
HICs stand to benefit from these exchanges as well. Working closely with colleagues and organisations from LMICs can lead to advances in the understanding of pathology and patient care based on experience with different diseases, care approaches or unique challenges. Personnel in LMICs are often experts in conditions and pathologies that, whilst rare or unheard of in many HICs, nonetheless offer lessons relevant to the treatment of conditions that are. As climate change and globalisation increasingly see diseases like malaria move into new parts of the world this, expertise can also help strengthen health systems in the Global North.
Making the case for sustainable, cost-effective and innovative ways of working
CPA’s programmes have been offering a model for how aid can be done differently for decades. Hundreds of thousands of pharmacists around the world have been upskilled by our PharmAid programme, which provides pharmacists in LMICs with access to an expert prescribing guidebook produced every year in the UK (the British National Formulary or BNF). CwPAMS has helped drive sustainable improvements in patient care by training thousands of healthcare workers at dozens of hospitals around the globe.
Other innovative initiatives like our SPARC (Surveillance and Prescribing Support for AMS Resource Capacity Building) programme have been working to equip staff in LMICs with skills to generate better data on antimicrobial use and make informed decisions about prescribing. SPARC has created the Prescribing Companion App, a comprehensive and offline-ready digital resource hub that gives clinicians up-to-date, authorised prescribing guidelines and useful resources tailored to twenty-two countries in Africa and Asia.
The UK’s new Minister for International Development, The Baroness Chapman of Darlington, has said that the UK’s aid cuts create the opportunity for the UK to position itself as “an investor, not just a donor” and “focus […] on partnering” that draws upon “all the expertise the UK has to offer”. This is the way forward for the development of a truly sustainable approach to global health that, in the long term, will help close the gap between health systems in LMICs and HICs whilst providing benefits to both.
About CPA and the Fleming Fund
The Department of Health and Social Care’s Fleming Fund is a UK aid programme supporting up to 25 countries across Africa and Asia to tackle antimicrobial resistance (AMR), a leading public health threat across the world. The Fleming Fund invests in strengthening data surveillance systems through a portfolio of country grants, regional grants and fellowships managed by Mott MacDonald, and global projects managed by partners.