A “key problem” in reaching the goal of polio elimination “may well be that organizers of the global anti-polio initiative, and of other global health programs, are not listening to the people they want to help — or to each other,” Thomas Abraham, an associate professor in the Journalism and Media Studies Center at the University of Hong Kong, writes in a New York Times opinion piece. “As a result, in many communities targeted by [polio immunization] programs, people perceive a gulf between global programs like polio eradication and more immediate local health needs,” he continues, adding, “It is cold comfort to save a child from polio if the child later succumbs to malaria or diarrhea from dirty drinking water.”

“This raises the question of why global health programs are fragmented along disease-specific lines, rather than addressing multiple diseases and helping to strengthen basic health services,” Abraham writes. Because most money “is earmarked for specific health issues” and programs “are required to meet specific targets,” it “makes integration, or even cooperation, difficult,” he continues. The “top-down” nature of global health programs, whereby donors “call the shots,” “is too often devoid of consultation or input from the people who are supposed to benefit from these programs,” he says, adding, “The fault largely lies with developing country governments that are often content to accept whatever donors propose rather than try to set their own agenda.” Abraham concludes, “Global health programs need to be rebuilt from the bottom up, responding to the most urgent needs of communities, rather than what donors feel they want to fund” (11/19).