Shadow Chancellor George Osborne has announced that the Conservatives would spend at least £500 million a year on fighting malaria. He also confirmed that the Conservatives will increase aid spending to 0.7% of GDP by 2013.
This is a welcome announcement in a number of respects. It affirms that there is a cross-party consensus that, when properly spent, aid can make an important contribution to the fight against poverty. Second, it draws attention to an underfunded area – the fight against malaria – for which we have good evidence of the effectiveness of the interventions, but which remains underfunded. Third, it highlights the need to work with and through other donors.
But I do have some quibbles. There are presentational advantages to singling out particular diseases that we will tackle. But the only cost-effective, sustainable, long-run solution is to build basic health systems – training nurses, building clinics, reforming procurement – which can deliver the full range of basic health services, from anti-malaria bed-nets to immunisation against measles. The increasing focus of funding on specific deseases has over time led to more and more investment in drugs and facilities that focus on one particular condition, with a corresponding 50% fall in investment in basic health systems. So while it is right to identify malaria as a condition we can address by increasing resources, we must ensure that the additional funding is delivered in the form of support to those health systems. (To be fair, nothing in the announcement contradicts this point; but I would have liked to see it made explicitly.)
My second quibble is not with George Osborne's announcement but with Jeff Sach's article yesterday in which he denounces the use of social marketing. Social marketing is a method of increasing access to essential goods and services – such as anti-malaria bednets or condoms – by encouraging the private sector to provide those services on a commericial basis, sometimes with a subsidy. Sachs says:
This policy reflects a shortsighted ambition to promote markets rather than the overriding goals of saving lives and removing bottlenecks to long-term economic development.
That is not an accurate description of the objective of social marketing, because it takes no account of the evidence (summarized here) that small firms incentivized by profits may be rather better at getting these goods and services to people than public sector organizations. If so, then using social marketing may save more lives quicker. It would be ironic if, in listening to Jeff Sachs's very persuasive views about the need to invest more in proven ways to reduce poverty, such as the fight against malaria, the Conservatives were also to adopt his anti-market prejudices about the best way to achieve those goals.