Global health takes on big issues that are often complex and multifaceted. To tackle these issues, more than simply money is required, as Laurie Garrett’s The Challenge of Global Health explains.
Garrett’s article discusses several issues that prevent global health efforts from being effective. To begin, she talks about aid being “tied to short-term numerical targets,” which means that aid often focuses more on particular diseases than on broad measures that would address general well-being. Garrett argues that narrowly focused programs are unsustainable, and that agencies/donors should “integrate their infectious-disease programs into general public health systems.” Such integration would allow for treatment and prevention to be addressed, making aid programs more effective.
But how would one distinguish the effectiveness of healthcare systems? Garrett proposes two important markers that are telling: maternal mortality and life expectancy. Maternal mortality data would reflect the “overall status of healthcare systems:” the conditions of facilities, along with the training and amount of personnel. Life expectancy data tells about “child survival and essential public health services,” essentially the broad-spectrum services that allow for survival through childhood (e.g. safe water, mosquito control and immunization). These markers are critical because they can contribute to a feedback loop where weaknesses of systems (issues that a system doesn’t address) are identified and improved upon.
Garrett also argues that despite the enormous monetary aid, global health continues to decline. There are several reasons including narrow spending and corruption and bureaucracy trapping money. Corruption and bureaucracy seem to be common among developing countries. The World Bank estimated that “about half of all funds” for sub-Saharan Africa never reached the clinics and hospitals they were intended for. Instead, the funds were misspent and even involved in the black market and sale of counterfeit medications. But even following legal routes, funding still gets lost in the maze of “financing bureaucracy,” severely hampering health-delivery systems by a least 15%. However, even if aid does reach a program, the narrowly defined goals can prove detrimental to global health.
Referred to as “stovepiping,” these goals tend to reflect the interests of the donors instead of those of the recipients- the people in need of help. This causes phenomena that we see every month: a disaster or epidemic breaks out, and massive donations are made. These diseases and health conditions bask in “a temporary spotlight,” which draws attention away from other broader and more statistically important killers (i.e. maternal death during childbirth and pediatric respiratory and intestinal infections.) Garrett points out that stovepiping also causes a shift in the interests of health-care workers, as more move towards the money and abandon other programs that “lack activist constituencies.”
Therefore, there is a strong need for integrated programs that can “prevent, recognize, control, and treat infectious diseases.” The beauty of such a model, as Garrett proposes, is that the ideal model can be generalized to include chronic diseases. Initially, steady funding and lasting support are needed, but attention to execution is also important.
Current donor practices need to be improved; faulty programs that lack effectiveness and sustainability are likely to be detrimental to public health. For example, failed tuberculosis programs that poorly handled tuberculosis treatment (the majority of patients did not complete antibiotic therapy) led to the emergence of XDR-TB. Other examples include mass vaccination campaigns gone wrong when lack of funding forced health-care workers to reuse needles, leading to a spread of HIV.
There’s enormous opportunity in this era to make a difference in global health, and Garrett’s got the right idea. If we can make smart programs that provide local infrastructure and address the big picture, instead of focusing on narrow goals and relying on donor support, then we can make sustainable programs.
Eric Wan
Eric- great job answering the questions and hitting on the important points of the article!
ReplyDeleteOne thing this article made me think about was that we have a similar problem in the US (to a lesser extent obviously, as our life expectancy and maternal mortality rates are very good compared to the developing world)- our medical system here is becoming more and more specialized while we still have a large number of people who don't have access to the most basic services and medications. While many donors are interested in giving money to research on rare cancers, few are interested in investing in development of primary care system or working to establish a basic level of care that everyone can access.