{"id":50446,"date":"2021-06-11T17:07:41","date_gmt":"2021-06-11T16:07:41","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=50446"},"modified":"2021-06-16T18:00:33","modified_gmt":"2021-06-16T17:00:33","slug":"uk-aid-cuts-will-put-global-health-systems-at-risk","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2021\/06\/11\/uk-aid-cuts-will-put-global-health-systems-at-risk\/","title":{"rendered":"UK aid cuts will put global health systems at risk"},"content":{"rendered":"<p><span style=\"font-weight: 400\">The United Kingdom is a major provider of foreign aid, and is the world\u2019s second largest bilateral health aid donor after the United States. The UK is also a <\/span><a href=\"https:\/\/www.gavi.org\/news\/media-room\/gavi-welcomes-uk-funding-pledge\"><span style=\"font-weight: 400\">major<\/span><\/a><span style=\"font-weight: 400\"> donor to the global health multilateral agencies. However, the UK government recently announced it will only supply bilateral aid to 34 countries, thereby eliminating the aid budget for 102 previously supported countries. The consequences of this sudden departure will affect health systems globally.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">On 7 June 2021, the UK\u2019s foreign secretary Dominic Raab wrote a <\/span><a href=\"https:\/\/committees.parliament.uk\/publications\/6155\/documents\/68757\/default\/\"><span style=\"font-weight: 400\">letter<\/span><\/a><span style=\"font-weight: 400\"> to the <\/span><a href=\"https:\/\/committees.parliament.uk\/committee\/98\/international-development-committee\"><span style=\"font-weight: 400\">International Development Committee\u2014<\/span><\/a><span style=\"font-weight: 400\">a parliamentary committee that scrutinizes the use of UK foreign aid<\/span><a href=\"https:\/\/committees.parliament.uk\/committee\/98\/international-development-committee\"><span style=\"font-weight: 400\">\u2014<\/span><\/a><span style=\"font-weight: 400\">announcing that only 34 countries would receive UK bilateral foreign aid in 2021-2022. This means that <\/span><a href=\"https:\/\/www.devex.com\/news\/uk-ends-bilateral-aid-to-more-than-100-countries-territories-100087?access_key=&amp;utm_source=nl_newswire&amp;utm_medium=article&amp;utm_content=text&amp;mkt_tok=Njg1LUtCTC03NjUAAAF9ikMiRfEVs9Xsk6Nq7Jf51cupW7H5rlTxAb07VDZTRVy8bL59YgKevnC1NBFw-y36J15KW9l5c4eJjFcd-Y2NQmmJcNYie1oxdapwDOtCatQLHvA\"><span style=\"font-weight: 400\">102 countries or territories<\/span><\/a><span style=\"font-weight: 400\"> that received aid in the previous year will no longer receive bilateral UK aid.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The UK has recently implemented major changes to the way it organizes and manages its aid portfolio. In 2020, the Department for International Development (DFID), the primary agency responsible for overseeing and disbursing foreign aid, <\/span><a href=\"https:\/\/www.gov.uk\/government\/news\/prime-minister-announces-merger-of-department-for-international-development-and-foreign-office#:~:text=Prime%20Minister%20Boris%20Johnson%20announces,International%20Development%20and%20Foreign%20Office.&amp;text=The%20Prime%20Minister%20has%20announced,brings%20together%20Britain's%20international%20effort.\"><span style=\"font-weight: 400\">merged<\/span><\/a><span style=\"font-weight: 400\"> with the Foreign &amp; Commonwealth Office (FCO) to create a new agency called the Foreign Commonwealth &amp; Development Office (FCDO). This move aligns with the UK prime minister Boris Johnson\u2019s vision for spending aid in the national interest.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Academics <\/span><a href=\"https:\/\/devinit.org\/resources\/merging-dfid-and-fco-implications-uk-aid\/\"><span style=\"font-weight: 400\">warned<\/span><\/a><span style=\"font-weight: 400\"> of the risks of this merger. Specifically, scholars flagged that a new agency may favour countries with strategic interests over the neediest (i.e., the poorest and most fragile.) Unfortunately, it seems that these concerns have been realized.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Despite Raab\u2019s <\/span><a href=\"https:\/\/www.devex.com\/news\/uk-will-maintain-aid-spending-levels-in-poorest-countries-after-merger-raab-says-97517\"><span style=\"font-weight: 400\">previous statement<\/span><\/a><span style=\"font-weight: 400\"> that the newly formed agency would continue spending UK aid in the world\u2019s poorest countries, less than half of the 34 countries who will continue to receive foreign aid are considered <\/span><a href=\"https:\/\/datahelpdesk.worldbank.org\/knowledgebase\/articles\/906519-world-bank-country-and-lending-groups\"><span style=\"font-weight: 400\">low-income<\/span><\/a><span style=\"font-weight: 400\">. Wealthier countries, for examples China and Brazil, make up nearly a quarter of the countries. More than half of the 34 countries are in Sub-Saharan Africa (54%) followed by South and East Asia (23%), a clear reflection of the new agency\u2019s geographic focus on the Indo-Pacific and East Africa. Although the letter clearly articulated FCDO\u2019s geostrategic priorities, it is surprising to see five countries back on the recipient list (Burundi, China, India, Indonesia, South Africa) despite DFID previously <\/span><a href=\"https:\/\/icai.independent.gov.uk\/wp-content\/uploads\/ICAI-Review-When-aid-relationships-change-DFIDs-approach-to-managing-exit-and-transition-in-its-development-partnerships-1.pdf\"><span style=\"font-weight: 400\">withdrawing<\/span><\/a><span style=\"font-weight: 400\"> its bilateral support.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">In contrast, more than half of the 102 countries whose aid has been cut are either low- or lower-middle income and nearly a quarter are fragile or conflict-affected, a previously prioritized demographic for DFID. But there could be good reason for cutting many of these countries: they simply were not receiving much UK money in the first place. An analysis of UK <\/span><a href=\"https:\/\/stats.oecd.org\/Index.aspx?DataSetCode=crs1\"><span style=\"font-weight: 400\">official development assistance<\/span><\/a><span style=\"font-weight: 400\"> (ODA) data shows that in 2019, the 34 \u201cbudget safe\u201d countries received nearly five times as much ODA as the 102 being cut. That proportion dramatically increases when we look at health aid: budget safe countries received over fifteen times as much ODA than the cut countries combined.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">While the loss of UK aid may not be felt strongly for some of the 102 countries or territories nixed from the UK budget, it will in others. For example, the Gambia, a low-income country in western Africa, received more than half (55%) of its health aid in 2019 from the UK.\u00a0 This phenomenon of a country receiving most aid from one or a few donors, also referred to as <\/span><a href=\"https:\/\/centerforpolicyimpact.org\/our-work\/transition-donor-dependency-kenyas-health\/\"><span style=\"font-weight: 400\">donor concentration<\/span><\/a><span style=\"font-weight: 400\">, leaves countries vulnerable in the face of sudden donor policy shifts. Not only is the Gambia\u2019s donor environment very concentrated, but external aid makes up more than <\/span><a href=\"https:\/\/apps.who.int\/nha\/database\/ViewData\/Indicators\/en\"><span style=\"font-weight: 400\">one-third<\/span><\/a><span style=\"font-weight: 400\"> of all health expenditures in the country, signalling <\/span><a href=\"https:\/\/centerforpolicyimpact.org\/our-work\/transition-donor-dependency-kenyas-health\/\"><span style=\"font-weight: 400\">donor dependency<\/span><\/a><span style=\"font-weight: 400\"> in its health sector.<\/span><\/p>\n<p><span style=\"font-weight: 400\">When donors make sudden and unilateral <\/span><a href=\"https:\/\/www.healthaffairs.org\/do\/10.1377\/hblog20210303.137565\/full\/\"><span style=\"font-weight: 400\">decisions<\/span><\/a><span style=\"font-weight: 400\"> to cease funding to recipient countries, there is no opportunity to sustainably wind down aid programmes. <\/span><a href=\"https:\/\/icai.independent.gov.uk\/wp-content\/uploads\/ICAI-Review-When-aid-relationships-change-DFIDs-approach-to-managing-exit-and-transition-in-its-development-partnerships-1.pdf\"><span style=\"font-weight: 400\">An evaluation<\/span><\/a><span style=\"font-weight: 400\"> by the Independent Commission for Aid Impact found that even in countries where DFID began its transition out of aid in an intentional manner, they did not do so in a way that would \u201cminimize the risk of development reversals and protect its past aid investments.\u201d Other aid recipient countries have seen severe deterioration of health outcomes when funders exited without a transition plan in place. When the <\/span><a href=\"https:\/\/centerforpolicyimpact.org\/wp-content\/uploads\/sites\/18\/2018\/12\/Donor-Transitions-from-HIV-Report_Final.pdf\"><span style=\"font-weight: 400\">Global Fund left Romania in 2010<\/span><\/a><span style=\"font-weight: 400\">,<\/span><span style=\"font-weight: 400\"> the HIV prevalence among people who inject drugs rose from only 1.1% at the time of exit to 53% by 2013.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The 34 countries that are safe (for now) may have cause for concern if the UK has another sudden policy shift. Many of these countries have concentrated and dependent donor environments, leaving them vulnerable to transitions from foreign aid. For example, South Sudan funds nearly two-thirds of its health system from external donors. A third of its health aid in 2019 came from the UK.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">While the decision to withdraw bilateral support has already been made, the FCDO should learn from the past mistakes of other donors that withdrew aid without taking appropriate measures. <\/span><a href=\"https:\/\/centerforpolicyimpact.org\/our-work\/the-4ds\/donor-profiles-health-aid-in-transition\/uk-approach-to-health-aid-transition\/\"><span style=\"font-weight: 400\">Learning<\/span><\/a><span style=\"font-weight: 400\"> from evaluations of DFID\u2019s approach is a worthwhile cause. Aid in the national interest should not be an excuse for irresponsible leadership.<\/span><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Kaci Kennedy McDade<\/strong>, <\/span><span style=\"font-weight: 400\">Policy Associate at the Center for Policy Impact in Global Health, Duke University. <\/span><\/em><\/p>\n<p><em><span style=\"font-weight: 400\">Twitter: <a href=\"https:\/\/twitter.com\/kennedy_kaci?lang=en\">@kennedy_kaci<\/a><\/span><\/em><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Wenhui Mao<\/strong>, <\/span><span style=\"font-weight: 400\">Senior Research and Policy Associate at the Center for Policy Impact in Global Health,\u00a0<\/span><span style=\"font-weight: 400\">Duke University\u00a0<\/span><\/em><\/p>\n<p><em><span style=\"font-weight: 400\">Twitter: <a href=\"https:\/\/twitter.com\/wenhuimao?lang=en\">@WenhuiMao<\/a><\/span><\/em><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Competing interests<\/strong>: none declared<\/span><\/em><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Acknowledgements<\/strong>: The authors would like to acknowledge Gavin Yamey and Osondu Ogbuoji for their feedback on early drafts of this piece.<\/span><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The United Kingdom is a major provider of foreign aid, and is the world\u2019s second largest bilateral health aid donor after the United States. The UK is also a major [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2021\/06\/11\/uk-aid-cuts-will-put-global-health-systems-at-risk\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":66,"featured_media":48174,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[263],"tags":[],"class_list":["post-50446","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-global-health"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>UK aid cuts will put global health systems at risk - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2021\/06\/11\/uk-aid-cuts-will-put-global-health-systems-at-risk\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"UK aid cuts will put global health systems at risk - The BMJ\" \/>\n<meta property=\"og:description\" content=\"The United Kingdom is a major provider of foreign aid, and is the world\u2019s second largest bilateral health aid donor after the United States. 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Ikutha, Kitui, Kenya. Women and children are the ones that carry water or firewood. Though Kenya is predominantly an agricultural country, fertile, arable land is scarce and competition for resources often leads to conflict and environmental damage as land is overused. More than half of Kenya's 30 million people still live below the poverty line. Northern Kenya is facing food shortages because of recent drought. Kenya\u2019s new government has promised economic reform and an end to corruption, giving many people hope for the future. Ikutha is a town from the Sub-Sahara Africa punished by whips of the AIDS, the lack of water and educative and sanitary resources. During years there is no development worked against zones more disadvantaged and the international aids have still not arrived at this zone. 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