The G8 should let Africans decide how to run their health services

By Jasmine Whitbread,  the chief executive of Save the Children (THE GUARDIAN, 04/05/07):

Larry Elliott's article included pronouncements from Tony Blair, Kofi Annan and Bob Geldof on the G8's shameful reneging on aid commitments (In 2005, G8 pledged $50bn for Africa. Now the reality, April 25). Annan describes the "sliding" effect since the Gleneagles summit two years ago, and Blair says "there's more that needs to be done"; we agree, much more.However, the article concentrates almost exclusively on aid volume and the flagship $50bn figure that the G8 had pledged. Quantity is undoubtedly important, as is the need to exert pressure on the G8 to stick to their financial commitments. But another concept that crops up in the article begs to be more fully explored: responsibility.

Blair talks about the need to take a "responsible and long-term view of Africa". But what does acting responsibly mean for the G8? The article implies that the responsibility for supporting African countries links back to the UK's self-interest. We would argue that real responsibility by the G8 means scrutinising the way in which it chooses to wield its enormous power.

The G8 is all but unaccountable. Left to its own devices, it has a tendency to overstretch its legitimate mandate and not respond to the actual needs of African governments. In 2005 the Africa Commission marked a high point in attempts to build a plan of action with, rather than for, African governments. It's essential that we don't let the G8 fall back into the trap of assuming that, just because they have all the money, they have all the answers.

At this year's summit, healthcare will be on the agenda. This is great: 800 children's lives could be saved each day if they received their healthcare for free. But instead of listening to African health ministers and sorting out the chaotic international health system, made up of almost 90 different initiatives, we are seeing a new proposal called Providing for Health, which attempts to dictate how national health systems should be ordered.

The G8 should be sorting out the international system so that governments in places such as Liberia, who are desperate for donor money, can build a free health system for all in their country and then be held accountable by their own people. Children in Liberia are today dying of illnesses such as diarrhoea simply because they can't afford to see a doctor. Meanwhile, the national debt remains uncancelled despite the strong leadership from the new president, Ellen Johnson-Sirleaf.

Tony Blair says: "There are still far too many Africans who die when their death is preventable with our help." He needs to know that, despite the fact that African health is on the G8 agenda, there was no German representation at the African health ministers' meeting in Johannesburg last month. How is this an example of the G8 taking a "responsible and long-term view of Africa"?

The G8 should support and advise, not dictate; provide good-quality, predictable aid; and get the international system fit for purpose. Only they have the collective power to do so. Perhaps then will we see more successes like the one in Zambia, where free healthcare is keeping children alive.