Billions of dollars are being spent on disease-specific aid programmes in developing countries. But in this week's BMJ, Roger England, Chairman of Health Systems Workshop, argues that these programmes distort countries' efforts to deal with their problems.
His views follow the launch of a new International Health Partnership that Prime Minister Gordon Brown hopes will accelerate progress towards achieving the United Nations' millennium development goals for health.
Will the partnership make a difference, he asks?
Money for combating HIV and AIDS is the worst. It distorts countries' efforts to deal with their problems, because most of this new aid is delivered 'off budget,' resulting in separate plans, operations, and monitoring - all in parallel with government systems.
What is missing, he says, is strengthened national healthcare systems that can deliver the range of services that countries need, according to their own priorities, not those of international lobby groups.
No one is funding this adequately, and no international body is equipped to provide the technical support countries need. The obvious candidate, the World Health Organization, suffers from serious constitutional and institutional flaws and is chronically under funded.
So what can Mr Brown's new International Health Partnership do to redress this?
He suggests several actions, including stopping funding for global programmes that do not put their money through recipient countries' planning and budgeting processes and providing real support to countries that are seriously reforming their systems.
Finally, he believes the partnership can lead a complete rethink of the millennium development goals, not because we are not going to meet them, but because they are more trouble than they are worth - and always were.
We will not achieve better health care for the world's poor without better national health systems to fund and deliver it, he says, and we will not achieve that without a better international system for aid. Disease specific programmes do a disservice to this ambition, and the International Health Partnership must not only recognise this but be bold enough to act.