[Who benefits from health programs aimed at the poorest? Successes and failures. 2008 SESPAS Report]

International aid health programs directed at the poorest play an undoubtedly constructive role in relieving acute human suffering. These programs may, however, be counterproductive and even harmful if they obscure the need to eliminate social inequities, which are the primary cause of health inequities. The present article reviews the effectiveness of two state programs that received support from international aid to (a) improve food security in rural households and vulnerable urban groups in Colombia (1996-2005) and (b) develop a local health system in the northern area of San Salvador, El Salvador (1992-1997). International aid supports successful healthcare programs, such as food programs, could generate dependency in its beneficiaries. Factors extrinsic to cooperation (political and economic factors of the context) may affect the programs and generate social conflicts. This is the case of the program to improve access to food by subsistence production in rural areas of Colombia, which failed to reach the small farmers and benefited agricultural export production owned by wealthier groups, or interventions designed to improve health among the poorest in El Salvador.