In the next issue of DEVELOPING WORLD BIOETHICS (a journal of which I am a co-editor) we will publish a paper arguing that tsunami related international aid was disproportionate if one looks at the number of people affected compared with other disease and disaster related deaths in the world. The authors alert us to the fact that if numbers alone mattered international aid should be spending arguably substantially higher for HIV/AIDS than on the tsunamis disaster in the end of 2004. Their contribution should perhaps be seen in the context of a larger debate about proper priority setting in international health related aids programmes. Laurie Garrett, of the US Council on Foreign Relations, argues in a thoughtful recent article that current funding priorities are all too often too narrow-mindedly focused on targets such as a certain number of HIV positive people in a given developing country on antiretroviral therapy at a certain point in time.[1] This, he rightly points out, often comes at too high a price as local resources are re-routed to achieve that particular objective. Healthcare professionals go for better-paid jobs in such programmes, and as a consequence developing nations’ health delivery systems begin to crumble. Moreover, given that such targets are usually donor-driven (eg by the Gates Foundation) there is a very serious risk that once the funding dries up the programmes become unsustainable. Garrett suggests that we should no longer focus on such narrow objectives but that instead we ought to shoot for public health outcomes, such as overall life-expectancy and increased maternal survival.
