An Advocate’s Dilemma: Defending Official Development Assistance or Reducing Aid Dependency? [Guest Essay]
Newsletter Edition #259 [The Files In-Depth]
Hi,
The ongoing tumultuous changes in the international aid sector has set off deep soul searching among those in the field, not only in the communities affected by abrupt policy shifts, but also in organizations and intermediaries who work in the aid supply chain.
Today’s guest essay by Katri Bertram, an aid expert, lays out the predicament in striking clarity and discusses in plain terms, the choices facing aid professionals.
Thank you for reading.
If you find our work valuable, become a paying subscriber. Tracking global health policy-making in Geneva is tough and expensive. Help us in raising important questions, and in keeping an ear to the ground. Readers paying for our work helps us meet our costs.
Our gratitude to our subscribers who ensure we are able to pursue public interest journalism.
Best,
Priti
Feel free to write to us: genevahealthfiles@gmail.com
Find us on BlueSky: https://bsky.app/profile/genevahealthfiles.bsky.social
I. GUEST ESSAY
An Advocate’s Dilemma: Defending Official Development Assistance or Reducing Aid Dependency?
By Katri Bertram
Bertram has worked in global health and development for over 20 years and is currently International Director of an NGO. This article is in her personal capacity. She can be reached at katri.bertram@gmail.com
Many global health advocates currently face a dilemma: Should we rally to defend ODA and the status quo – or advocate for reducing aid dependency to ‘build back better’?
In April 2024, I wrote about a dilemma I and other global health advocates faced:
Half of the colleagues I work with and admire are calling for an end to aid dependency, and the other half are calling for increases in development aid (ODA). Are these two positions compatible, and what should we – as global health advocates in the Global North – do about this dilemma?
This dilemma has become more real following large scale cancelling of funding grants across many countries.
Making sense of what’s happening
Today aid dependency has fallen, but not for the reasons many of us hoped for: ODA has simply been slashed, and not just by the largest donors in the OECD Development Assistance Committee (DAC), news that is currently dominating most media (USA).
The UK, the Netherlands, and Belgium have announced the largest cuts in ODA history, and the European Commission, France and Germany are expected to follow soon. These cuts are not just minor shifts, but cliffs: at least USD 60 billion by USA and GBP 6 billion by the UK, EUR 8 billion over four years (2025-2028) by the Netherlands, and a possible EUR 20 billion by Germany.
Most cuts have been linked to shifts to the (far) political right. Domestic anti-migration narratives have spilled over into ODA narratives and budgets. Governments, increasingly overwhelmed with stagnating growth or recession combined with epidemic outbreaks or the climate crisis, are simply giving up on crisis prevention – even the existential kind. Most acutely, geopolitical tensions are leading to remilitarization, requiring huge budget shifts and investments. For all the talk about aid rivalry, and how countries like China will now take over: China only provided between USD 5 and 7.9 billion in aid in 2022, and only a small share of this was multilateral in nature.
After what has felt like a long, stunned silence (or naïve hope that cuts could be reversed through some behind-the-scenes lobbying and calls), most advocates – led most vocally by the AIDS community, scientists and health journalists – have rallied to defend ODA. The facts are compelling: US cuts alone could lead to 500,000 additional AIDS deaths, place the TB response at threat, risk a new uncontrollable pandemic, and lead to millions of child deaths due to the abrupt end of vaccination programs and emergency food aid.
As many other advocates, I have added my voice to criticise these senseless cuts, not just because of what is being cut, but also because of the how: in an utterly cruel manner that undermines dignity, democracy, science, civic space, and millions of lives.
Yet, in my vocal defence of ODA, I feel discomfort – even hypocritical. For many years, I have publicly questioned the incentives and impact of the sector I work in. In my 2024, I wrote:
The movement criticizing our current ODA and aid models has framed their criticism around power imbalances, colonialism and outright racism, and economic dependency. In a paraphrased nutshell: “It’s not aiding, it’s harming the Global South.”
Should I, and other advocates who want to see transformational change that leads to more impact and true power shifts, not be celebrating this moment of dismantling the status quo and as an opportunity to build back better? Should we not, as Olusoji Adeyi in his recent article stated, continue to call for the “overhauling and reinventing [of] global health.” Or as The Economist put it this week, are aid cuts possibly an opportunity?
Navigating the way forward
I believe that as global health advocates, we must be intentional about our advocacy. For too long, health advocacy has been tied to single issues and highly fragmented, mainly because it has been funded to act as a campaigning force for specific organisations or products from the Global North.
We can see the result in this current crisis.
Most advocates and campaigners refused to engage on political issues and became vocal only after specific cuts were made. Instead of engaging in public debates (over the past years or perhaps even decades) on what needs to change and how we can mitigate against the risks of ODA dependency – not to mention reduce it, most advocates are (funded to be) active and vocal only ahead of budget decisions (and replenishments). Reading the (public) room and mobilising civil society at large was dismissed as irrelevant, because a few top-level phone calls, side-meetings in Davos at WEF (or these days rather the Munich Security Conference) would do the job.
We need ODA and health advocacy that is authentic and linked not to an organisation in the Global North that we want to see funded, but rather expresses and shines a light on the needs and voices of civil society and strengthens the civic space – especially in the Global South. I continue to believe that:
If we engage in and finance ODA from the Global North, we have to listen to what people and countries say they need, and how they need it. It’s embarrassing, to the point of extremely distressing, to listen to proponents of ODA claim they “know what’s needed” (and then present a package of products to go with it). If this is what’s meant by defending ODA, not in my name, not with my voice.
At the same time, I believe ODA and humanitarian assistance are still needed and play an important role in specific circumstances (e.g. in a conflict zone or failed state, to provide access to a discriminated population group, or for multilateral cooperation to prevent pandemics). If a state fails in its responsibility to provide, then others should jump in, in my opinion. More than ever this past year, I have donated to NGOs. Yet here too, I try to be intentional and consider the longer-term consequences of my actions. Are the organisations I support really aligned with national systems, and co-creating with local communities and countries based on their needs? Is the sole goal to sell a product for someone’s profit, whereby a life saved is a secondary and helpful PR figure? Do words such as health workers, national health systems, domestic resources, accountability, and civil society feature anywhere?
Reducing dependency
Let’s face it: the ODA sector is being gut-punched in 2025. Those of us working in this sector are floored, reeling, and feeling numb and helpless. We are used to affluence and being celebrated as saviours. Yet something fundamentally shifted at the latest during the COVID-19 pandemic, when our ODA sector blatantly failed to share with the Global South.
We, those of us part or the Global North, were part of the nationalism problem.
We, those of us who had created debt-financing and donor pooling models, were party to creating the debt crisis and vaccine inequity.
We, ignoring national politics and geopolitics, failed to read the new room and state of the world.
We, in the Global North, paid some minor lip service to shifting power and local ownership, but didn’t walk even one step of our talk.
I can’t and won’t speak for people from the Global South but can imagine that’s where the brunt of the cost is being paid right now – in real lives. Most of us in the Global North are mainly wondering how to find a new job, or those of us with a job are wondering for how long.
I am part of this ODA sector, and my positionality, as Seye Abimbola calls it, in part explains my knee-jerk reaction to “defend ODA” even though I want to dismantle and fundamentally change (most of) it.
There’s no alternative to ‘building back better’. We must reduce ODA dependency. But we must do so in an intentional, humane and dignified way. Strong, authentic and independent global health advocacy is essential in this endeavour.
What’s next for advocates?
Silence is not an option in these times. As health advocates, our role is to defend and speak out for policies based on scientific and social evidence that lead to improved health outcomes. This includes women’s rights to bodily autonomy (including sexual health and abortion), vaccination, and epidemic and pandemic prevention and responses. This doesn’t always mean we have to defend the status quo and exact health governance and systems of dependency that we have kept in place for too long.
In my opinion, it’s our moral duty to speak for those who are discriminated against and silenced: we must be vocal advocates for health equity, and for health as a universal human right. I believe we should continue to support decolonization, power shifts, and efforts to reduce aid dependency.
In these times, we must not only speak for issues we believe in but also call out what we are against. In practice this means that we must stop tiptoeing around politics and power, which includes going along with whatever a billionaire may want. We can’t reduce aid dependency if we don’t tackle our own dependency as global health stakeholders and advocates.
Finally, and perhaps most importantly, we need to defend a strong, independent civic space. Many of our global health advocate colleagues face threats because they have courageously spoken out for science, human rights and equity. Their professional reputations and livelihoods are threatened and their personal safety and that of their families is under threat. Your support, your voice - our collective support - is our most important line of defence.
II. PODCAST CORNER
Dialogues: a conversation with Themrise Khan
In this episode of Dialogues, host Garry Aslanyan speaks with Themrise Khan, a Pakistani independent development professional and researcher with almost 30 years of experience in international development, aid effectiveness, gender and global migration. Themrise is also the co-editor of the book "Preventing the next pandemic, White saviorism in international development: theories, practices and lived experiences." In this dialogue, she shares her views on the origins of this concept and how it continues to influence national autonomy, global power imbalances and race relations.
Listen here
Garry Aslanyan is the host and executive producer the Global Health Matters podcast. You can contact him at: aslanyang@who.int.
This podcast promotion is sponsored by the Global Health Matters podcast.
If you wish to promote relevant information for readers of Geneva Health Files, for a modest fee, get in touch with us at patnaik.reporting@gmail.com.
Did a colleague forward this edition to you? Sign up to receive our newsletters & support Geneva Health Files!
Global health is everybody’s business. Help us probe the dynamics where science and politics interface with interests. Support investigative global health journalism.