LONDON — In the past two decades, the world has spent more than $196 billion trying to save people from death and disease in poor countries.
Millions of people are now protected against diseases like yellow fever, sleeping under anti-malaria bed nets and taking AIDS drugs.
But there isn't much proof that pricey programs led by the United Nations and its partners are responsible, according to two studies published today in the medical journal Lancet.
Trying to show health campaigns actually saved lives is "a very difficult scientific dilemma," said Tim Evans, a senior World Health Organization official who worked on one of the papers.
In one paper, WHO researchers examined the impact of various global health initiatives during the past 20 years.
They found some benefits, like increased diagnosis of tuberculosis cases and higher vaccination rates. But they also concluded some U.N. programs hurt health care in Africa by disrupting basic services and leading some countries to slash their health spending.
In another paper, Chris Murray of the University of Washington and colleagues tracked how much has been spent in public health in the past two decades — the figure jumped from $5.6 billion in 1990 to $21.8 billion in 2007 — and where it has gone. Much of that money is from taxpayers in the West. The U.S. government was the biggest donor, contributing more than $10 billion in 2007.
They found countries don't get more donations even if they're in worse shape. Ethiopia and Uganda both receive more money than Nigeria, Pakistan or Bangladesh, all of whom have bigger health crises.
Some experts were surprised how long it took simply to consider if the world's health investment paid off.
Richard Horton, editor of the Lancet, said it was "scandalous" and "reckless" that health officials haven't carefully measured how they used the world's money.
Experts said that in some cases, the U.N. was propping up dysfunctional health systems. "If you've got rotten governments, no amount of development aid is going to fix that," said Elizabeth Pisani, an AIDS expert who once worked for the U.N., citing Zimbabwe as a prime example.
The WHO acknowledged change was necessary, but insisted it needed more money, warning fewer donations would jeopardize children's lives.