Discussion about this post

User's avatar
J Chicago's avatar

What a disaster, thank you for reporting it so thoroughly!

Expand full comment
Elizabeth Fama's avatar

I would like all Africans to have access to the education and medications that are necessary to prevent and treat HIV. I'm just not sure whether the best way to achieve that is for the US to pay for it. I worry that so many years of aid has set up a poor incentive structure for the individual countries to take responsibility for the health and well-being of their citizens. I'm concerned that long-distance funding discourages NGOs from doing their work as cost-effectively as possible. As you point out, this program has been in force for twenty years, and yet we're still paying rent on the buildings they use to run their clinics.

The entire African continent has a GDP of about three trillion, which is three thousand billion dollars. Per your article, the US expenditure on PEPFAR is six billion a year. It doesn't seem unreasonable to ask these countries to allocate 0.2% of their own spending to continue lifesaving services. By gifting this funding, we are also effectively relieving their governments of other budgetary items--items that we aren't aware of and may not even approve of. There are so many reasons it's better to teach a man to fish, rather than feed him a fish.

Perhaps phasing out the aid over Trump's four years would have been a more gradual way of nudging the programs in these countries toward other sources of funding, but that's different conversation.

Expand full comment
13 more comments...

No posts