Bilateral funding a plus for cross-border projects

Trio of projects wins U.S./Mexican commitment

An unfortunate characteristic of most cross-border projects is that all the money comes from the American side, says Kathleen Moser, MD, TB control officer of San Diego County.

"Because most cross-border projects are totally U.S.-funded, the balance of power is unequal," she explains. "Partly, it’s an issue of whether or not you’re truly partners, and whether or not both sides own’ the project. And part of it’s an issue of power — since if one country has all the power to give, they also have the power to take back."

another disadvantage to unilaterally funded projects is purely pragmatic: Many American donor agencies are reluctant, or simply restricted by terms of their own charter, to participate in projects that are funded unilaterally.

For all these reasons, Moser is proud of having helped establish a series of projects that will enjoy bilateral funding from the United States and Mexico. The projects will target three kinds of public health problems: TB control, the spread of HIV infection, and substance abuse issues.

"Each of the projects will look a little bit different, since the issues are different," she says. "The HIV project will be mostly educational and preventive; the substance abuse project will address problem drinking in border areas; and the TB project will address outreach, directly observed therapy, and cross-border communication." One TB project that’s already come to fruition is CURE-TB, which employs a 1-800 number and bilingual interpreters to help refer patients to providers on either side of the border. (See related story, p. 17.)

Models more similar than people think

Except for linguistic barriers, cross-border projects involving TB control are not as inherently difficult to manage as people often think, Moser says. "The model for TB control there is very similar to what we have here in the U.S. Their TB programs are run by the government, so that almost all the care for TB patients is provided by people who work for the government, and that’s it, period."

In the past, the infrastructure in Mexico was more centralized than that in the United States, with various state programs tied tightly to Mexico City. ("It would be as if we here in San Diego couldn’t make a move without consulting the Centers for Disease Control and Prevention first," Moser explains.)

That’s changed, however. "Now, all the states in Mexico are decentralized," she adds, with Baja, to the south of California, being the last to decentralize, so "now they have their own resources and are pretty much in charge of what they do with them."

For the new trio of cross-border projects, grant applications and fundraising were spearheaded and directed by San Diego TB control, working in partnership with Project Concern International, a nonprofit organization based in San Diego that tries to arrange international projects devoted to improving public health.

"I think in any country, there’s a strongly developed sense of sovereignty and pride," she says. "No one ever tells you to take your money and go home, because generally, they need it too much to do that. But I think everyone will like this arrangement a lot more."