Devex: Does epidemic control inadvertently reinforce inequality?
Patrick Fine, chief executive officer of FHI 360

“…There is an irrefutable logic to concentrating resources on the areas where a problem is worst. … But does this logical approach inadvertently reinforce social and economic inequality by allocating scarce health resources to areas and communities that are already economically better off? … Since HIV/AIDS funding makes up the lion’s share of external resources available to the health sector, there seems little doubt that the move away from integrated service delivery towards vertical interventions that concentrate resources in urban areas has reduced funding available to meet the health care needs of rural communities. If this is indeed occurring it poses a dilemma for both U.S. and developing country policymakers. In 2014, USAID made ending extreme poverty the mission statement for U.S. foreign assistance. … While refocusing HIV/AIDS funding on epidemic control has the advantage of being a straightforward proposition [to ending the AIDS epidemic by 2030] …, it is likely to undermine the success health ministries have had leveraging HIV/AIDS resources to strengthen health systems to meet a broad range of health needs in rural areas, and thereby weaken efforts to end extreme poverty. … Combined with structural biases that favor urban spending, it may well be that epidemic control will inadvertently contribute to growing inequality and work against the objective of ending extreme poverty” (9/15).