Real-World Dynamics of Development Assistance for Health

Development Assistance for Health (DAH) is premised on a net flow of knowledge, know-how, and financial resources from the Global North to the Global South. Implicit in that construct are assumptions of a net superiority of the Global North in the production of better health for the Global South. Those assumptions have damaging implications in practice. The dynamics play out through multiple transactions and bargaining among the centers of influence, power, and perceived powerlessness in global health. There is much that is positive in DAH. However, there are vast areas of dysfunction, including the absurdity of self-serving announceables by powerful entities in the Global North, and devotion to fads that are presumed to be magic solutions to complex problems. The prevailing practice in much of the Global South fosters neo-dependency on the Global North; this is contrary to increasingly trendy notions that the problem of global health is that of neo-colonialism. There is a pressing need to do better. A break from ossified narratives and practices of DAH is central to such improvements.