Debate
HIV/AIDS mitigation strategies and the State in sub-Saharan Africa – the missing link?
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* Corresponding author: Abdu Mohiddin abdumohiddin@doctors.org.uk
1 Division of Health and Social Care Research, Guy's, King's and St Thomas' School of Medicine, Kings College London, London SE1 3QD, UK
2 Department of Economics, School of Oriental & African Studies, London WC1H 0XG, UK
Globalization and Health 2006, 2:1 doi:10.1186/1744-8603-2-1
Published: 17 January 2006Abstract
Background
The HIV/AIDS pandemic in sub-Saharan Africa is widely recognised as a development disaster threatening poverty reduction, economic growth and not merely a health issue. Its mitigation includes the societal-wide adoption and implementation of specific health technologies, many of which depend on functional institutions and State.
Discussion
Donor and International Institutions' strategies to mitigate HIV/AIDS in sub-Saharan Africa are premised on a single optimal model of the State, one which focuses on the decentralised delivery of public goods alone (such as healthcare) – the service delivery state. The empirical evidence, though sparse, of "successful" and "unsuccessful" sub-Saharan Africa states' performance in mitigating HIV/AIDS does not support this model. Rather, the evidence suggests an alternative model that takes a country context specific approach – encompassing political power, institutional structures and the level of health technology needed. This model draws on the historical experience of East Asian countries' rapid development.
Summary
For international public health policies to be effective, they must consider a country tailored approach, one that advocates a coordinated strategy designed and led by the State with involvement of wider society specific to each country's particular history, culture, and level of development.