Thursday, February 27, 2014

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foreign aid infographic



In Fernando Meirelles' 2005 drama thriller The Constant Gardener, Tessa Quayle loses her life in a struggle to uncover and expose the behavior of KDH, a pharmaceutical company that is conducting secret clinical trials for a dangerous experimental drug called Dypraxa. Since the trials would be massively expensive and difficult to get approved in the U.K., the company instead opts to give the experimental drug to unsuspecting villagers using free health clinics in rural areas of Kenya. They induce local doctors to enroll patients in trials of the potentially dangerous drug without any prior consent, and they collude with the British government to keep it all under wraps.

You might assume that a story like that could only be found in a Hollywood script, but the sad reality is that drug companies (and governments) defend very similar behavior in real life. Often, under the guise of 'development aid' companies and governments dump unwanted or dangerous products on rural villages, or game governments into unfavorable trade deals or infrastructure projects. 

How can it be that we have a system that allows a company to promote a ‘development aid’ project that employs a standard of ethics which puts the lives of thousands of people at risk? In The Elements of Bioethics, Gregory Pence points out that the standards set by the Nuremberg Code and guideline number 15 of the International Ethical Guidelines for Biomedical Research Involving Human Subjects, as well as the Declaration of Helsinki, all require that individuals in developing countries be provided not just with the best care available in their particular country, but the best care available anywhere. In light of these agreements, the behavior of real life KDHs of the world seem shockingly brazen, perhaps even evil, but I would suggest that they can only be understood in the context of the overriding influence and nature of the world’s socio-economic structure, and the attitude towards development aid that it has produced.

Giving with one hand, while taking with the other

The process of becoming a developed ‘first world’ country largely involves the development or procurement of a vast accumulation of resources. Financial advantage, intellectual property, favorable trade relationships, and human capital are all key. Through this process an entire population's living standards can be elevated, but in a world of finite resources, maintaining an ever growing economy to meet the needs and expectations of the populace means extracting value elsewhere. There must necessarily exist other nations and peoples from whom the value extracted is greater than that gained. Today, these nations are collectively referred to as the ‘Third World’, and every country in this group can be tied by one common denominator; while their resources are massively exploited to support developed countries, their economies chronically lag behind. In these countries, the expectations and aspirations of those in the first world are all but an impossible pipe dream. Consider, for example, the expectation of many people in Europe and America that universal healthcare should be a standard that is pursued in good faith by the government.
  These populations are referred to as the ‘Third World’, and every country in this group has a commonality; their resources are massively exploited to support developed countries.
 In a third world country this idea is ludicrous, as the government (if it is not rife with corruption) probably struggles to contend with the need to build a viable infrastructure for the country, and provide basic necessities such as food and water. Many people in developed countries like the U.S. may not even realize how their lifestyle is predicated upon a ubiquitous and dependable infrastructure, only catastrophic events like natural disasters reveal the absolute necessity for their stability. 

In this context, it may be easier to understand why governments and corporations justify, and officials in third world countries except, the lower standards and 'unethical' procedures displayed in cases that reflect the story of The Constant Gardener. Essentially the attitude is that no one is worse for the wear; if a poor Kenyan or Ugandan is given sub-standard food from a relief group or experimental medicine from a free clinic, they're still better off than before.

This line of argument may seem plausible, but the reality is that it's nothing more than a convenient excuse.  Just as in The Constant Gardener , in real life the profit motive is the true primary driver for many of the decisions being made by the companies and governments. KDH, like all major corporations, must turn a large and consistent profit in order to be viable on the market. This basic fact, which ultimately is an expression of the larger necessity to accumulate resources,  inevitably leads to a conflict of interest in any international dealings based on 'aid'. In the case of a pharmaceutical company, the need to cheaply test experimental drugs becomes a foreign aid campaign promoting health and well-being. The complicity of governments is almost a given, since they are always keenly aware that any 'aid' they extend to third world countries must be carefully balanced with the need to maintain their own economic advantage.

This argument paints a bleak picture of the overall prospects for development aid in third-world countries, and it is important to note that the failure here is systemic. The good news is that alternatives do exist; reform works, and modest attempts to reorient the overall approach to aid have shown huge promise in many cases.

To maintain ethical standards, regulation is key

                       

It seems obvious that some boundaries need to be set. Pharmaceutical companies should be expected to follow basic ethical guidelines if they intend to use aid recipients in clinical research trials. They should provide the 'standard' treatment as a control in any trial, and separate 'charitable' operations entirely from research-provided care (i.e. not tying peoples overall care to the stipulation that they participate in research trials). In addition, every company should seek fully informed consent from any person participating in a study. The deceptive practice of inducing doctors in third world countries to enroll people in trials without informing them should be done away with entirely. These are changes that can be accomplished within the current system and without major alterations in the overall structure that currently exists.

Investment is needed, not 'aid'




Capitalism is great at taking potential opportunity, investing in it, and reaping the benefits of of its growth. Its great, so why not apply it to the development aid sector? Rather than simply giving countries huge loans to build infrastructure, or sending crates of emergency food aid to villages affected by chronic drought why not invite investment into entrepreneurs leveraging local resources to provide for immediate infrastructure needs, and innovative companies trying to solve underlying environmental or societal issues.


There has been an investment explosion into African economies in the last decade, but Healthcare investment in Africa continues to lag well behind other sectors. Of the $12.8 billion the World Bank spent globally on health between 1997 and 2007, only $600 million was available for the private sector, and out of that, just $12 million was available specifically for Sub-Saharan Africa. While those numbers do not represent healthcare investment in the private sector as a whole, they do provide context for the investment imbalance at hand. There is little private investment and/or risk capital available for most of Africa, and this problem can only be address through the adoption of a new investment model for the region.

What sort of companies should investors take a look at? Well they could start with the efforts of Dr. Earnest Madu, a world renowned Cardiologist who has pioneered the establishment of world-class medical facilities in Jamaica and West Africa. Madu, CEO of the Heart Institute of the Caribbean (HIC) founded the company four years ago to prove it’s possible to provide high-quality health care in a poor country like Jamaica.Before the HIC opened in Jamaica, there was no chance of receiving routine cardiology procedures like stress tests, electrocardiograms (ECGs or EKGs) or angioplasty.The hospital treats many poor patients, with a policy of not turning away anyone who needs help. “We charge only what they can afford to pay,” Madu says. Skepticism was high in Jamaica about the possibility of receiving first-class cardiac care at home, but in just three years, the HIC has won a steady clientele of middle-class Jamaicans who don’t want to travel to Miami for medical services, and poor ones who can’t afford it. The HIC offers cardiovascular treatment for 5,000 to 12,000 patients a year at a fraction of what it costs in the U.S., due to lower expenses. The HIC does not yet have the capacity for pediatric cardiac operations, such as replacing faulty valves, but Madu estimates that with the proper equipment and medical expertise, such an operation could be performed in Jamaica for less than $10,000.



Another example of smart investment is a company like Ushahidi, the company behind the BRCK, a multi-input/multi-output backup generator/network hub that overcomes the lack of adequate network infrastructure in rural areas, potentially allowing millions of African’s to utilize the internet. Products like the BRCK, designed to withstand the pressures of the African Desert and Jungle, offer what could become a new 'African Certified' standard for rugged, dependable and innovative products in the future. All kinds of jobs require steady connectivity, even when infrastructure is spotty due to wireless connections, intermittent power, or devices that can’t share connections. For the keen eyed investor, companies like this should be highly attractive.

With a fresh approach to development aid that applies ambitious investment with creative solutions, the idea of 'aid' itself could become a concept applicable only in disaster situations and never to address the long term growth and development of any nation. There's profit in potential, so why not invest?

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