Opinions: Doctors in developing nations; foreign aid

Dec 24 2009

Boosting Number Of Medical Residents In U.S. Could Negatively Impact Developing Nations

In a New York Times opinion piece that focuses on health reform in the U.S., Shannon Brownlee, a senior research fellow at the New America Foundation and David Goodman, a professor at the Dartmouth Institute for Health Policy and Clinical Practice, discuss an amendment that teaching hospitals in the U.S. hope will make it into final health care legislation. The amendement would add 15,000 residency slots to the 100,000 residencies supported by the federal government.

In addition to issues this presents for domestic health care, the writers note how an increase in the number of residency slots in the U.S. could impact other countries. "More than a quarter of American residencies are filled by graduates of foreign medical schools, more than half of them from poor countries. After training here, many stay, leaving the people of their own countries holding the bill for their training. In a kind of reverse foreign aid, the president's Global Health Initiative is poised to invest millions in medical education in Africa and elsewhere, while American academic institutions expect to employ more of their medical school graduates," they write (12/23).

'Policy Reforms' Needed To Fight Poverty

Foreign Affairs features a review of Zambian-born economist Dambisa Moyo's book on foreign aid. Agdish Bhagwati, a senior fellow in international economics at the Council on Foreign Relations, examines Moyo's argument that "the concept of foreign aid is flawed - not just because corrupt dictators divert aid for nefarious or selfish purposes but also because even in reasonably democratic countries, aid creates perverse incentives and unintended consequences." Bhagwati also reviews the history of foreign aid, noting that "[s]imilar problems involving the mismatch between intentions and realities are present in today's battles over aid. Now, as before, the real question is not who favors helping the poor or spurring development - since despite the slurs of aid proponents, all serious parties to the debate share these goals - but rather how this can be done."

"If history is any guide, therefore, the chief weapon in the 'war on poverty' should be not aid but liberal policy reforms. Aid may assist poor nations if it is effectively tied to the adoption of sound development policies and carefully channeled to countries that are prepared to use it properly (as President George W. Bush's Millennium Challenge program recently sought to do). Political reform is important, too, as has been recognized by the enlightened African leaders who have put their energies into the New Partnership for Africa's Development (NEPAD), which aims to check the continent's worst political abuses," writes Bhagwati (January/February, 2010).