Review of “Unequal Worlds of Care: The Politics of Global Health in Malawi”

Unequal Worlds of Care analyzes healthcare in Malawi, where private and public foreign health aid focus overwhelmingly on HIV/AIDS care. Amy Zhou finds that contemporary assistance programs tend to be targeted and temporary. Certain problems, like mother-to-infant transmission of AIDS, receive considerable resources, while other serious problems, like neonatal mortality, do not. This type of dichotomy characterizes the "two worlds" of care. Zhou argues that each aid project in this piecemeal approach may do some good, but overall, the projects tend to have few lasting impacts because they do not invest in the overall healthcare system. She calls for a reimaging of healthcare and donor aid globally to create a broader and more integrated system. Zhou begins with a preface that places the study in the current context of substantially reduced US funding for global health concerns. If anything, the recent retrenchment in foreign aid to combat HIV makes the core themes of Unequal Worlds of Care even more relevant—the hypothetical situation Zhou uses as a foil throughout the book is now much closer to reality. Aid cuts could reignite a new AIDS crisis, a situation that was unimaginable to most healthcare workers while the study was being conducted. And in the pattern of cuts, the two worlds persist: experts estimate that, while funding for HIV has been cut about 20 percent, funding for maternal and child health, family planning, and reproductive health has been cut 90 percent (p. xv). The uncertain future underscores the problems that arise when every donor creates their own temporary structures of care, typically separate from the central health system.