Do We Get Our Money's Worth in Global Health?

Two carefully researched reports in the Lancet argue that the world is not getting its money's worth in global health.

The first, from the World Health Organization, says that a focus on making improvements in individual diseases--like AIDS--has come at the expense of comprehensive programs that offer treatment for all the most pressing health problems.

The other, from Institute for Health Metrics and Evaluation in Seattle, documents a quadrupling of funds for global health since 1990 but shows that some of the poorest countries with the highest disease burdens have actually received less help than somewhat healthier and wealthier countries. In addition, the IHME paper documents the shift in power and influence from government and public agencies to private foundations--like the Gates Foundation, which funded the study--and individuals.

Both research articles--and the accompanying comments and editorials--are well worth reading at length and at leisure (which I plan to do this weekend). I do not know if these articles will spur any changes in direction or action on the ground but I have a feeling we will be hearing about these pieces for some time to come.

Several of the blog posts I have read so far about these studies are rehashes of the press releases that accompanied them. Given the nuances of the arguments and the complexity of the data, it may take a while for more thoughtful reviews to appear.

Maria Cheng's article for the Associated Press is a good, if basic, introduction to the papers. Kaiser Health News says they will post an aggregation soon--and here it is.

Health-Eight Meet in Seattle

Sandi Doughton of the Seattle Times lifts the lid a bit on one of the more exclusive clubs in global health--the Health-8 or H8--meeting this week in Seattle.

Her report documents one more step in the ongoing privatization of global health as power and influence drain away from public groups--like the World Health Organization--to private foundations and non-profit organizations.

Given the reactions in Doughton's article, folks don't seem too concerned about the lack of transparency. After all, it's not like Hilary Clinton having secret talks about health care during her husband's administration or Dick Cheney chatting about energy policy with petroleum execs--right?

Related Post:
Who are the Health 8 (or H8)?

Malawi Project Featured in American Journal of Nursing

I am happy to report that a photo-essay about my Malawi project is the cover story for the June issue of the American Journal of Nursing. That great cover photo of Mphatso Nguluwe was taken by my friend Eileen Hohmuth-Lemonick who joined me on my three-month Malawi trip last year.

Mphatso is a great story-teller, who likes to tell her fellow Christians that she is the mother of nine children by eight different fathers. It's a great teachable moment that I wrote about last July.

My project focused on the nursing shortage in Malawi as a kind of a kind of window into how health systems function in poorer parts of the world. Malawi is in the midst of a six-year program to address its nursing shortage by paying nurses more and supporting more nursing education and training.

Part of what I learned in Malawi is how fragmented and overly narrow most efforts at improving health turn out to be. We think that having more drugs or more nurses and doctors will automatically improve conditions without considering the need for better roads, clean running water or functioning secondary schools to make sure those efforts succeed.

Because it's easier to raise money for a single issue--like AIDS or polio vaccines or girls' education, we continue to maintain (and tell stories about) siloed efforts that don't intentionally contribute to broader, more long-term needs like primary care. There was a study about that from the Institute of Tropical Medicine in Antwerp just yesterday in the Public Library of Science.

I don't understand why--if it took me only three months to figure this out--the professionals who do this for a living still can't seem to adjust their efforts accordingly. As the PLOS study suggests, they must already know this. But then, as the saying goes, "It is difficult to get a man to understand something when his salary depends on his not understanding it."

I tried to get at some of these themes with the photos and captions that are part of the AJN essay as well as the supplemental material that is available online. When I suggested to Diana Mason, the outgoing editor-in-chief, that both be made available for free to non-subscribers as well since they reflect on health in the developing world, she readily agreed. Well, as another saying goes (two aphorisms in one post--that probably exceeds the limit), "it is better to strike even a tiny light than to curse the darkness."

Related posts:
Hiding Broken Practices Behind New Catchphrases
At Work with Malawi's Nurses

Update: Related 10-minute podcast with Christine Gorman on the AJN site

Hiding Broken Practices Behind New Catchphrases

Here is another example of why we need more independent reporting on global health and development. A study from the Public Library of Science found that many global health initiatives are still effectively siloed efforts that focus on single diseases or institutions and do not, despite claims to the contrary, support overall health systems.

And yet, as I have seen in my own travels through Malawi, Lesotho, South Africa and Zambia, improving health systems is precisely what is needed in many poor countries and impoverished areas. "Health system strengthening" has become the new catchphrase but, according to the PLOS report and the lived experience of many in the global health field, there has been no real change in action to support this goal.

One positive trend: the researchers note that while their funding came from the Institute of Tropical Medicine, Antwerp, "the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." This slightly more detailed conflict-of-interest statement should be adopted more widely when reporting or writing about global health.

Related post:
Who Pays for Global Health News and Why?