Health Development versus Medical Relief: The Illusion versus the Irrelevance of Sustainability

D evelopment agencies want their interventions to be sustainable. The Offi ce of Sustainable Development of the Bureau for Africa of the United States Agency for International Development defi nes sustainability as " the ability of host country entities (community, public and/or private) to assume responsibility for programs and/or outcomes without adversely affecting the ability to maintain or continue program objectives or outcomes ". It defi nes fi nancial sustainability as " having enough reliable funding " , meaning funding " generated from a country's own resources " [1]. Exceptionally, in times of emergencies, development agencies are willing to support relief interventions that are beyond the capacity of the benefi ciaries. In such circumstances, sustainability is irrelevant, as the crisis is by defi nition temporary and the need for relief will ebb with the crisis. In the fi eld of health care, the issue of sustainability creates a dichotomy between medical relief and health development, because relief is unaffected by the condition of self-reliance. This dichotomy results in turf battles between the advocates of medical relief and the advocates of health development. This essay explores the causes of this dichotomy and highlights the senselessness of turf battles. All trendy development approaches point out that sustainable health care—narrowly defi ned as independent from international aid—is illusionary in the world's poorest countries. Public health budgets in these countries must be increased and require stronger national and international fi nancial commitments. If public health budgets were increased, the level of health care within the capacity of the benefi ciaries would be higher, and the dichotomy would dissolve to a certain extent. However, health development advocates assume that public health budgets will not be increased and base their sustainability estimations on this assumption. In doing so, they contribute to the status quo of insuffi cient public health budgets. Funding of HIV medicines. In February 2000, exceptional rainfall inundated a part of southern Mozambique. Many people were rescued by helicopters. Providing helicopters was an unsustainable intervention, but many development agencies were willing to support it. Mozambique is also a country highly affected by HIV/AIDS. Many people rescued with helicopters were HIV positive, and needed antiretroviral therapy (ART). Providing ART in Mozambique is also unsustainable. But Médecins Sans Frontières (MSF) considers the HIV/AIDS epidemic an emergency: MSF used helicopters to rescue people and planned to provide ART. Development agencies initially refused to support the provision of …