Poor communities should decide their own priorities for aid

Allowing poor communities to decide their own health priorities avoids inappropriate aid, says a senior doctor in a letter to this week's BMJ.

He describes the case of a village that was asked by an aid agency what its priorities for development aid would be, the answer presumed to be a health centre, school or irrigation system. When the villages replied that they wanted a football pitch, the agency withdrew its offer. So the villages built their own football pitch, and this engendered such a feeling of community spirit that they built their own health centre the next year without outside help.

"During famine, we concentrate on nutritional supplementation for children under 5 years old, yet I have been challenged by villagers who argue that the older children should have priority as they have already survived the difficult years of early childhood and are now contributing to their family's potential," he writes. "Listening to communities and allowing them to decide on their priorities avoids inappropriate aid."

Health for All by the Year 2000 failed to meet its goals in many countries, he adds. Aid therefore needs to be widely targeted and supplied in response to priorities that are determined locally.

Click here to view letters