In this era of global rise in charity spending, and dependence on donor aid particularly in the spheres of global health by developing countries, it is important to ask the pressing question of what the consequence of philanthropy in global health is. It is interesting to see how wealthy philanthropists continue to gain an incredible amount of influence, and basically purchase soft power through mega donations that have steadily multiplied on many levels, sometimes even superseding the place of domestic governments. A case in point is the Bill and Melinda Gates Foundation; who are currently the main foreign aid donors in global health today. (McGoey 2013) describes the foundation as a powerhouse that plays an incredibly solid role in structuring and governing policies at apical levels of international decision-making in the spheres of global health. One cannot help but wonder how a privately owned organization attained such magnitude of power that allows it actually dabble into the affairs of global health governance.Reflecting back to the early and mid 20th Century when government bodies were really in charge of global health and public goods, it is flabbergasting to see the turn around in events particularly in low and lower middle income countries where wealthy donors tend to replace public means of solving nation states problem with private ones, rather than stepping into the shoes that serve as motivation to governments to better tackle global health affairs. In analysing the concept of Philanthrocapitalism, it is important to flash back to the advent of global health, and the actual role of philanthropy.
(Packard 2014) writes that the practices and ideas of global health were born in the 1990’s with the global emergence of new public health challenges and disease threats. It became even more evident that the world is a global village, and thus fear of infectious diseases travelling across borders and through transportation routes toppled. Hence, the need, more than ever to tackle disease threats on a global scale. International donor agencies and governments also claimed that disease epidemics were further straining the economies of impoverished countries and therefore, the foundation for foreign donor aid was laid. These donations in all honesty, have gone a long way in creating innovative health system strengthening on many levels in impoverished nations as well as saving many lives.However, these aids, as crucial as they may be, are not without problems. You see, no one mostly holds philanthropists who dole out huge sums of capital and resources in donor aid accountable, and as (Nye 2014) argues, one’s ability to enact policies that are seen as legitimate or having moral authority and establishing preferences that tend to be associated with intangible assets such as personality, culture, and political values, make them likely to gain attraction and hence soft power. The dire consequences however, is that personal principles and philosophies of a few mega donors end up structuring and shaping societies to which they donate to, a proof that power lies in the potential to attractively influence the inclinations of an individual.
In my opinion, the central ideal of philanthrocapitalism in the realms of global health threatens health sovereignty; it achieves this through economic and persuasive influence. (Nye 2013) describes it as a soft dimension in power wield, and elaborates further saying that savvy CEOs do not depend on dishing out orders and commands to secure power, but also by leading by example and attracting others to buy in their personal ethics and principles.The use of donor aid to structure public institutions could result in unfavorable consequences such as the state directly or indirectly conceding significant parts of its health sovereignty rights to mega donors as, (and worthy of note is that) many organizations who donate to charity are part of intergovernmental bodies that are put in place by UN treaties, or other sorts of agreements and are consist mainly of sovereign nation states. Using my personal experience as example, in Nigeria where I practiced Infectious Diseases medicine in a position that required providing primary care for People Living with HIV, everyday we were faced with clear evidence of wealthy philanthropists working extensively in domestic governance issues especially relating to global health, and micromanaging affairs that should be prerogatives of the government. The big NGOs decide which Implementing Partner gets more funding, and who works in what region, what sorts of diseases to battle, what infrastructure to fund, etc. Evidenced with knowledge and exposure gained from my Global Health and International Affairs HSCI 870 classes, I argue that these are some of the reasons for extensive zones of abandonment and its resultant health effects particularly among people living with HIV/AIDS in Nigeria.
This is as a result of poor coordination due to inadequate knowledge of local norms and traditions, and not to mention the issue of internal brain drain. Philanthropy in my opinion weakens political commitment, and erodes encouragement for governmental spending on public services and I dare say that the extremes of Philanthrocapitalism indirectly reduce governments particularly in developing countries to mere placeholders. I imagine that when Joseph Nye Jr. first coined the term Soft Power in 1994, it was restricted to the context of world politics, state power, and desired policy effects. It is interesting to see how soft power now influences popular culture and goes well beyond the scope of Nye’s definition.
Today, soft power applies not only to nations and organizations such as the Gates Foundation, but even to personal relationships and transcend beyond the classic definition of one country’s influence over another but rather lean towards the ability to generate pliability in partnerships, transactions and relationships by clear convictions and proof of moral legitimacy.Corruption, unwillingness to research new grounds and step out of comfort zones are some of the major barriers leading to the governmental sector’s failure to thrive in many developing nations. Revitalizing credible government is a task that must not be taken for granted. It includes a need for developing countries to unanimously work hard as a people in order to create functional and effective national health care which I argue is the building block for establishing health sovereignty and a means to achieving sustained social welfare, good education and health care. In concluding this paper, I wish to reflect on what the stand of wealthy philanthropists would be assuming developing nations move towards achieving total health sovereignty, through channelling available resources appropriately, embracing their problems, working towards creating sustainable solutions, and only asking for aid when absolutely necessary.
Will the mega donors support or antagonize this movement?