Global Health Ideas

Finding global health solutions through innovation and technology

Archive for February 2007

Event Today: Alternative Health Financing

I attended a very interesting event yesterday at the Woodrow Wilson International Center for Scholars on nanotechnology and global health. I will blog on that later this week/weekend. Today they have another event that might be of interest to those in the DC area. They also have a free live webcast (that can also be viewed later):

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February 28 2007, 12:00 p.m. – 2:00 p.m. (FREE)
Alternative Health Financing in Low- and Middle-Income Countries
Woodrow Wilson International Center for Scholars

Pablo Gottret, Senior Health Economist, World Bank;
Marty Makinen, Vice-President, International Health, Abt Associates; and
Hugh Waters, Assistant Professor, Johns Hopkins Bloomberg School of Public Health

Due to the generally unpredictable nature of illness and the burden of high health care costs, risk-pooling is beneficial to cover the needs of those who become ill. It allows populations to make contributions to a central fund in times of good health and/or relative resource abundance in order to cover the health needs of the community-whether that entails preventive medicine, maternal healthcare, sick visits, or catastrophic coverage. Ideally, these central pools would finance services for the poorest and provide the entire group with financial protection and improved health care. However, many different health financing schemes have been used in developing countries, with varying degrees of success.

Written by Aman

February 28, 2007 at 6:52 am

Geekcorps’ and former Peace Corps Volunteer Wayan Vota in San Francisco Tuesday Feb 27

Wayan Vota, director of Geekcorps, is in town and will be talking informally about Technology and the Developing World – from the Peace Corps, Geekcorps, to the One Laptop.

Date – Tuesday, Feb 27, 2007
Time – 6:30 PM
Place – 21st Amendment, at 563 2nd St, San Francisco.

Come on by, have a drink, and chat with Wayan.


In Guyana, Peace Corps volunteer Pam Kingpetcharat teaches computer repair.

Written by Ben

February 26, 2007 at 6:30 pm

DC International Private Enterprise Group (IPEG) Meeting

On Thursday (2/22/07) I had the pleasure of attending the newly formed IPEG DC chapter meeting. IPEG is the International Private Enterprise Group started by a couple of Columbia students. The DC chapter is hosted by NextBillion and they do a fantastic job of putting it together. IPEG is an opportunity for professionals interested in business and development to network and exchange ideas. You can read more here.

This meeting was focused on success in the health sector. Beth Boomgard from AED discussed her group’s work (Private Sector Health Initiatives) in the area of anti-malarial bed nets. Unfortunately I did not get to hear her full discussion, but you can read more about the NetMark project here.

Based on the case study we wrote, I was able to share my ideas about Aurolab and the Aravind Eye Care System. Both are phenomenal organizations that offer many lessons. The Aravind clinic started in 1976 in a 11 bed rented house and today is probably the largest eye care system in the world. Their mission is to eradicate blindness in developing regions, which is primarily due to catarcts. Aurolab is the non-profit medical device and pharmaceutical manufacturing arm of Aravind. For a quick overview on Aravind see this Wall Street Journal piece or this Fast Company article and/or check out this video if you have time (35 min, Link). Basic facts about Aravind & Aurolab:

Aravind
– 2/3rds of patients receive some sort of charity care, 1/3 pay above cost
– 250,000 cataract surgeries per year
– 5 hospitals across the state of Tamil Nadu, over 1000 beds
– 1300 community eye camps
– 2 Million outpatient visits

Aurolab
– Export products to over 120 nations
– Reduced price of synthetic lenses (IOL) for cataract surgery to under $10
– FDA compliant facility
– IOL, suture, pharmaceutical, spectacle and hearing aid divisions
– Globally unique due to scale and non profit status

Blindness due to cataracts is a substantial problem in developing countries. Aravind and Aurolab managed to build infrastructure, systems and manufacture core medical technologies at the local level that allowed them to chart their own course. Instead of relying on a non-sustainable donor model, they decided to build their own system and self-manufacture their own technologies and still manage to make a substantial profit. Some of the questions I received Thursday night revolved around replicating and expanding the model:

1) What other disease categories can Aurolab tackle – what other low cost medical technologies can they make?

2) How did they achieve remarkable success? How do we replicate this model?

Regarding the second set of questions – in a nutshell, it comes down to solid management, charismatic leadership, clear socially driven mission and unwavering persistence. Of course there are many other factors, see our case study for more information on how they built partnerships, transferred technology and charted their own direction. Finally, one very important ingredient, is that it takes time (see historical milestones). Aravind was started in the mid 1970s and Aurolab was founded in 1992. They faced various challenges, learned from their mistakes and over the course of 3 decades built a world renowned system. As far as replication, I argued that you do not need a non profit manufacturing facility in every country – for example, Aurolab through NGO partners distribute their synthetic lenses (intraocular lenses) to over 100 countries and have 5-10% of the global market. On the hospital side, Aravind has consulted with over 100 hospitals worldwide to set up clinics and systems to improve their capacity to offer care. For more on that see their “consulting” arm – LAICO. The last thing I will say is that there is not a one size fits all solution, but people really should study the Aravind Eye Care System to see what lessons they can apply to their particular case. As far as the first question, I will have to tackle that in another post.

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Written by Aman

February 26, 2007 at 7:30 am

Posted in Global Health

“Meet the World” Flag Art a Hoax?

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A couple of days ago I posted on the “flags as social art” exhibit. I did say in that post that I was unable to verify the numbers or sources of data, even though the official website for the art states “We used real data taken from the websites of Amnesty International and the UNO.

I apologize for being in a rush with that post because I did go back and take a look at the stats for one flag which seemed a bit far off. Somemone may also want to let WorldChanging know that some of these representations seem inaccurate (see their post from Jan 5, 2007 which I just spotted).

The Angolan flag indicates that half the people in Angola are infected with HIV and half with malaria. Two separate sources indicate this is not true:

1) Malaria in Angola – 1.2 Million (USAID report of malaria in 2002 – Link)
2) HIV in Angola – roughly 240,000 (CDC – Link, KFF report)

When looking specficially at Somalia, the flag may be accurate – UNICEF says that in the country – “Female Genital Mutilation (FGM) has a prevalence of about 95 per cent” (Link). So I am not sure what data was used to make the flags or how the artist arrived at these conclusions. I have not had time to check stats on the other flags and there may be something I mis-interpreted, but perhaps the artist should be more transparent. This concept is a very interesting way of getting across ideas, its a shame that some of the flags may be inaccurate.

Written by Aman

February 23, 2007 at 7:06 am

Lessons from Cuba: Healthcare Infrastructure and Information Systems

cuba_system_bbc.gifI watched a fantastic presentation by the folks at the Department of Medical Informatics & Clinical Epidemiology at Oregon Health & Science University (OHSU). They have an online journal “On Informatics” where they have a recent video presentation titled “Cuba’s Medical System: A Public Health Paradox?” (The video is below)

If you want to learn something about a very interesting health system and how they are using ICTs/medical infomatics I highly recommend watching it. The focus of the video is on Cuba’s national health information portal, INFOMED, which on paper sounds amazing. I have posted some bullet points directly from the video below in case you want the “cliff notes” version. Additionally last week there was a major conference on medical informatics in Cuba. Check the posts on this blog from 2/13/07 – 2/16/07 for their notes directly from the conference. If you are not familiar with Cuba’s healthcare system, it is a fascinating case of what happens when a country devotes massive investment in health. To be sure there are some criticsims, but you can get a general idea of how well Cuba seems to have done with population health under extreme political and economic duress. The graphs give you some basic aggregate facts (figure credit: BBC News) on Cuba’s health system, which speak for themselves.

Cuba has made investment in their primary healthcare a system a top priority (funded in part by gutting their defense budget). So when they had a severe economic crisis in the 1990s, population health did not plummet as much as would be expected. They are not allowed to import US made medicines and medical supplies (such as pace makers, mammogram film and medical textbooks) due to the economic embargo, consequently they have had to innovate to take care of their population. One other noteworthy fact is their susbstantial biotechnology sector.

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This video is a presentation of their health system, the major challenges they face, and the phenomenal informatics infrastructure they have. Here are some highlights and thoughts from the video:

1) There is a doctor and sometimes an associated nurse living in every neighoborhood/local area (known as a Consultorio) which is the base of their health system. The implications include a strong infrastructure and systems in place (exactly what Laurie Garrett is advocating) along with:

  • Quick determination of an outbreak because there is a medically trained person in every neighborhood
  • Strong knowledge of available resources AND local habits that may have caused outbreaks
  • Years of excellent medical records that can be mined and tracked
  • Consultorios have strong communtiy civil groups for education, women’s groups, etc. and the doctor is involved in these groups

2) Availability of longitudinal medical history with consolidated information systems. Cuba doesn’t have much in the way of EMR’s due to economics and patient privacy issues, however, the have INFOMED:

  • Serves as center and backbone of national medical informatics
  • Is a central repository for clinical practice guidelines, link to the cochrane collaboration, virtual library, and more
  • Every neighborhood clinic is supposed to have a computer with access to INFOMED
  • Used for telemedince and continuing education

For more information on INFOMED see this 2006 article: A Case Analysis of INFOMED: The Cuban National Health Care Telecommunications Network and Portal by Ann C Séror, PhD. LINK

As I commented at the OHSU On Informatics online journal, it might be difficult for other developing countries to learn from Cuba’s experience precisely because they do not have such an organized model, infrastructure, or I am assuming a similar investment in health. However, on a community or hospital system scale, perhaps lessons can be applied. The Aravind Eye Care System in Tamil Nadu, India has developed an excellent health system and this has allowed them to utilize the power of ICT in several ways. So perhaps best practices can be developed and then shared on a case by case basis.

Last reference, check Steven Mansour’s site for someone who works on ICT in Latin America and has been to Cuba.

Written by Aman

February 21, 2007 at 7:12 am

Indonesia, Avian Influenza & Global Inequities in Technology Access

Two weeks ago Indonesia announced that it would no longer provide samples of the H5N1 (Avian Influenza) virus to the World Health Organization (WHO). The decision by Indonesian Health Minister Siti Fadilah Supari was based on reasoning that commercial entities would use information derived from freely donated Indonesian samples to develop vaccines that would not be accessible to most Indonesians.

Indonesia is faced with with various challenges (world’s 4th most populous nation, 6000 inhabited islands) to dealing with a human epidemic, should one occur. And should one occur, Indonesia is a likely to be hit hard – currently 38% of mortalities worldwide (63 out of 167) have been identified in Indonesia (source: Wikipedia).

Instead of providing the viral samples with the WHO, Indonesia’s plan was to share exclusively with Baxter HealthCare (USA) in exchange for technology to develop the vaccine domestically. This arrangement has met with considerable sympathy (The Lancet), but the WHO was of course very interested in continuing to receive samples.

More recently, Indonesia has agreed to “resume sending avian flu virus samples to the [WHO] as soon as it is guaranteed access to affordable vaccines against the disease” (source: Indonesia Offering Samples of Bird Flu, NY Times).

One Indonesian reporter’s view is in agreement with Indonesia’s position, but in more direct language (source: RI must stay angry, but temper its anger with wisdom, The Jakarta Post):

Treating poor countries as Petri dishes for the robust growth of diseases so pharmaceutical companies can produce vaccines, and perhaps life-saving drugs, only for countries able to afford them is obliviously discriminative.

There is a local saying cacing pun marah ketika diinjak, literally translated as even a worm gets upset when stepped upon. This must seriously be pondered upon by those with greater power to review their initial righteous intentions of creating a better world.

Indonesia has made a bold, but necessary, move on behalf of itself and other developing countries. Upcoming developments will tell how much of an impact such an action can have.

Written by Jaspal

February 20, 2007 at 7:05 am

Visual Demographics – Meet the World

UPDATE – There is something a bit funny about the use of stats in these flags, see latest post. What a shame because it is an interesting idea.

An artist friend just sent me this site of flags. Apparently these flags as social art made their debut a couple of years ago, but now they are making the rounds again. The flags use real data to “populate” the colors, however I was unable to verify this. It is never-the-less a very interesting concept, enjoy:

Icaro Doria, Brazilian author/artist: “We started to research relevant, global, and current facts and, thus, came up with the idea to put new meanings to the colours of the flags. We used real data taken from the websites of Amnesty International and the UNO. The idea was to bring across the concept that the magazine offers profound journalism about topics of real importance to the world of today.” More flags here.

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  Read the rest of this entry »

Written by Aman

February 19, 2007 at 6:17 pm

You too can “Have It All”…drug ad spoof taken for real

havidol.jpg“A media exhibit featuring a campaign for a fake drug to treat a fictitious illness is causing a stir because some people think the illness is real. The thing that amazes me is that it has been folded into real Web sites for panic and anxiety disorder. It’s been folded into a Web site for depression. It’s been folded into hundreds of art blogs”.

Full Story – link

About the exhibit – link

Written by Aman

February 19, 2007 at 11:01 am

Posted in Global Health

About Us & Link Drop: CK Prahalad Interview, Green Tech 4 Malaria, “Slum Tourism”, Philanthropy Vacations

I have finally updated the “About Us” page to include bios. Also you can subscribe to our blog on the subscribe/feed page. Enjoy the links below.

  • Green technology to boost production of malaria ‘wonder drug’ Link
  • The New Yorker Conference on innovation (via Endless Innovation) Link
  • “Slum Tourism” @ Foreign Policy Passport Link
  • WSJ article – Seeds of Reform: In China, Farmers Become Health-Care Monitors Link (via)
  • The upcoming issue of Fast Company has three very short pieces:
    • Changing the World, One Luxury Vacation at a Time Link
    • Q&A: C.K. Prahalad – Pyramid Schemer Link
    • Pierre Omidyar’s network funds both nonprofits and for-profits Link
  • Science needs entrepreneurs, Google founder says Link

Now all Larry Page has to do is visit schools of public health and hammer home the same message -public health needs more *business minded* entrepreneurs. Of course I have a bias, but being involved in public health for almost a decade I found his words of wisdom to be applicable especially to the discipline of public health…Page told hundreds of scientists, meeting in San Francisco. “You need to think that business and entrepreneurship is a good thing.”

My colleagues and friends (some of who disagree with me and have provided some valid arguments) have heard me whale against the public health establishment for often being late to the game and failing to incorporate cutting edge applied work… I think schools of public health could use improvement in the educational process and dialogue with their students.

Written by Aman

February 19, 2007 at 7:08 am

Posted in Global Health

Video: “Green” Wheelchairs

KarmaTube’s video of the week is about wheelchairs which are made from recycled parts. The chairs are made by Wheels for Humanity where, “staff and volunteers at Wheels collect and refurbish used wheelchairs and deliver and individually fit them to impoverished children and adults in developing countries.” It looks like the organization has some important friends. Last Fall, first lady, Maria Shriver joined Wheels in Chiapias to deliver wheelchairs (photos here).

An excerpt from the video – “we take equipment that people consider trash…the wheelchairs we refurbish would normally go into a landfill”. Time: 5:42, Enjoy.

Written by Aman

February 17, 2007 at 11:57 am

Advance Market Commitment for Vaccines Takes Off: A Partial Solution

by Dweep Chanana

CGDev reported on Monday (also covered in BW) that some G7 nations, together with the Bill and Melinda Gates Foundation have agreed to provide an advance market commitment of $1.5 billion for purchase of vaccines against pneumococcal disease. Why is this commitment important?

By promising in advance to pay for life-saving vaccines once they are produced, these countries are creating incentives for biotechnology and pharmaceutical companies to produce vaccines appropriate for use in poor countries, and to sell them at affordable prices.

The reports bring up some interesting points. First, who contributed – in addition to 5 nations, the Gates Foundation contributes $50 million – and who did not – the U.S. refrained due to ‘budgetary restrains

Second, while the AMC is hailed as a big step forward, as a pilot it targets only the low hanging fruit of vaccine research. After all, a vaccine for pneumococcal disease exists already, and costs about $60 in the U.S. Further, other vaccines are in development, for instance by GlaxoSmithKline, which heralded the agreement as an “innovative financing mechanism” (what else will they say, as an interested party?).

More information came from Owen (thanks to Aman for the reference), who writes on his blog about the genesis and evolution of the AMC. He also provided the GAVI presentation on the subject, slides 10 and 11 of which explain the AMC pricing mechanism. So, we now know that the AMC will work by guaranteeing to (any) manufacturers, a certain price. A small part of the price would be paid by the recipient developing country, while the rest by the AMC, till such time as costs come down.

Problem One: Where are the numbers?

So, now I know how the mechanism works. But what I do not know is significantly more important. Have the numbers been worked out? For instance, what is the target cost to a developing country? What is the mark-up the AMC will pay? In essence, how many vaccines will this $1.5 billion pay for, under various scenarios?

It may not be obvious, but these questions are important to understand just how useful the AMC really is. I realize that it targets vaccines that are currently under development, but that would take years to become available in developing countries. But $1.5 billion is a lot of money for research that has already been mostly done. Besides, what if a vaccine is not being developed for a particular strain?

Problem Two: An Unsustainable AMC Model
Read the rest of this entry »

Written by Guest Contributor

February 15, 2007 at 7:20 pm

Success story: Saving the world one multivitamin at a time

ode93_int_klein.jpgCool story below from the latest issue of Ode Magazine (an independent magazine about the people and ideas that are changing the world). There are two other stories of general interest –

1. This little light of mine: A revolutionary new light bulb uses so little energy it can last decades. (Article)

2. Pulling themselves up by their keyboards: By bringing computers into slums, an Indian physicist shows that illiterate children can educate themselves—and help their country progress. (Article)

Supplementing Global Health:
Howard Schiffer and Vitamin Angels are saving the world one multivitamin at a time (Article)
Read the rest of this entry »

Written by Aman

February 15, 2007 at 12:30 am

Phones 4 Health Partnership with PEPFAR

At the 3GSM World Congress just this morning in Barcelona, a new public-private partnership was announced between Motorola, MTN (a leading African mobile operator), Voxiva, and PEPFAR.

Excerpts from Earth Times, Feb 13, 2007:
“Leading players in the mobile phone industry and the U.S. Government have joined forces to fight HIV/AIDS and other health challenges in 10 African countries. Phones for Health is a cutting-edge US$10 million public-private partnership, which brings together mobile phone operators, handset manufacturers and technology companies – working in close collaboration with Ministries of Health, global health organizations, and other partners – to use the widespread and increasing mobile phone coverage in the developing world to strengthen health systems.”

“Health workers will also be able to use the system to order medicine, send alerts, download treatment guidelines, training materials and access other appropriate information,” said Paul Meyer, Chairman of Voxiva, the company that has designed the software. “Managers at the regional and national level can access information in real-time via a web based database.”
Read the rest of this entry »

Written by Aman

February 13, 2007 at 6:50 am

Controversy over WHO Compulsory Licensing Comments

Today we are lucky to have another guest blogger, Tim France, who brings a wealth of qualifications to the table. Tim is Technical Adviser at Health & Development Networks, and an active member of the HDN Key Correspondent Team. Tim obtained his PhD at the University of Wales College of Medicine (Cardiff, UK). In 1990, he switched careers to focus on promoting the public understanding of science and health. He has since held positions with the World Health Organization Global Programme on AIDS, the UN Joint Programme on AIDS, and various non-governmental organizations, mostly writing and editing HIV/AIDS-related technical guidelines and policy materials, as well as developing information dissemination strategies. He has also been Scientific Editor of two popular scientific journals: the British Journal of Hematology and the European Journal of Cancer. Tim’s blog is called Just a Minute.

Tim has written a piece on the recent controversy regarding Dr. Chan’s comments on compulsory licensing. This post is cross-listed on Tim’s blog and the HDN website listed above. Enjoy:

More Trust Needed on Shared Health Goals, by Tim France
Despite unprecedented investment in international health programmes, seven specific diseases still claim one in every four deaths worldwide. There has never been a more acute need or opportunity for the World Health Organization (WHO) to do its job. To do so, the agency must achieve an extraordinary partnership among diverse stakeholders. Hasty criticisms of WHO in the past week reveal some of the challenges working together presents.

With expectations rising about her leadership of WHO, Dr Margaret Chan’s recent unconsidered comments about compulsory licensing of essential drugs raise real concerns. But over-interpretation of her brief remarks by the media spawned a new analysis of WHO’s ‘position’ on compulsory licensing. AIDS organisations’ willing transformation of that analysis into an accepted truth appears increasingly like an unstrategic goal with each passing episode.

Chan was in Thailand to take part in a conference on neglected diseases. Her keynote speech praised drug companies for their donations of drugs against diseases such as trypanosomiasis, lymphatic filariasis and schistosomiasis. These are medicines that are otherwise impossible to obtain for most of the people who need them. Media reports later referred to Chan as having “praised the pharmaceutical industry lavishly in her address,” without referring to the specific context of the drug donation programmes.

Read the rest of this entry »

Written by Guest Contributor

February 12, 2007 at 9:42 am

Reality Check Interview: Siguida Keneyali – Promoting Health Change, Not Charity

It’s time for another reality check. From time to time, we will post stories from the field that get to the heart of global health work. We have had some previous posts that are stories from the field or that provide a reality check. As the interviewee says below: “Many people imagine international health as this fashionable, sexy, and fun job. Nope. Most of it is administration…Yet, it is remarkably rewarding.”

Britt Bravo has a great website (Have Fun Do Good) that focuses on remarkable women who are having a social impact. She recently interviewed a coordinator of Siguida Keneyali or “Health in Our Homes”. Read the rest of this entry »

Written by Aman

February 11, 2007 at 7:51 pm

Doc-in-a-Box/Rx Box – A Novel Idea by the Council on Foreign Relations?

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The solar-powered Doc-in-a-box is designed to be staffed by one medic and offer 1,800 people each year primary care and screening for HIV/AIDS, hepatitis, tuberculosis and malaria. The prototype cost $4,000 to build, but the council estimates that mass production could cut that price by half…Garrett has ambitious plans for Doc-in-a-Box. Adopted widely, she thinks such a system could help eliminate some of the wastefulness from international health services…(Link)

Read the rest of this entry »

Written by Aman

February 8, 2007 at 1:44 pm

Posted in Global Health

ICT & Health Education: iTunes for Bioethics, MySpace for Darfur, Vietnam Radio for HIV

There are three examples this week of using various information and communication technologies (ICT) for global health issues that are worth highlighting. These examples use the:

  • power of online social networks,
  • organizing tools of iTunes, and the
  • reach of radio programming

And if you want to check out an NGO that is helping develop and disseminate locally created and driven educational radio content, visit Equal Access.

1) Highschool students raise dollars for Darfur via MySpace (Link)
Two highschool students are attempting to raise $200k for Darfur by organizing fundraising events via MySpace and Facebook. More on the story at the epidemiology blog – Aetiology. Various non profit organizations and cause driven profiles have jumped onto MySpace and there is even the MySpace Impact Awards for people who have had a positive impact on culture. Each award comes with $10,000 and promotional ad space. This is a great way to reach people, however, I am wondering if (really when) there will be a saturation point at which social online networks such as MySpace (or blogs even) are so numerous that people become weighed down and desensitized to educational/cause advertising and fundraising efforts. This seems like a really nifty idea, the student website states – “There are over 27,000 high schools in the United States. If each school raised just $50, we could raise over one million dollars!” It is great to be around young folks because of their energy, creativity and optimism.

Read the rest of this entry »

Written by Aman

February 7, 2007 at 2:45 pm

The Challenge of Global Health – A Development Aid Catch-22

The THD Blog would like to welcome our first guest contributor, Dweep Chanana. Dweep will be posting with us from time to time and we are fortunate to have his commentary. Dweep is currently working in philanthropy consulting, and focuses on sustainable enterprise and non-profit management. He has an MBA in International Organizations from the University of Geneva, Switzerland, and previously worked in telecom engineering. I highly recommend Dweep’s excellent blog, The Discomfort Zone.

Dweep’s post below is a brief summary of Laurie Garrett’s recent critique of global health funding priorities and her call for a dramatic shift to health systems investment. I would also like to note several related items:

  • Foreign Affairs, has published a roundtable debate of this article with Paul Farmer, Jeffrey Sachs, and others (link).
  • The ODI think thank blog has their own take on this issue.
  • Two rare pieces of news aligned with this call for infrastructure investment is worth noting. “The health minister of Karnataka, India has finalised an $800 million project to revamp its healthcare infrastructure and train health professionals at the grassroots – a scheme that is expected to benefit over 45 million people.” (Link). Also the GAVI Alliance has announced they will commit $500 million over 3 years to train health workers (LA Times).

by Dweep Chanana – Guest Contributor
The Challenge of Global Health – A Development Aid Catch-22

The venerable Foreign Policy has an excellent critique of the challenges of international development assistance directed at public health (The Challenge of Global Health), that documents the massive amounts being spent on public health by rich governments, philanthropists, and international NGOs, and the challenges that brings.

In this sector, money is clearly not a problem. International health-related aid doubled between 2002-2004, and will double again by 2007. By these estimates, it will soon account for over 10% of many African country GDP’s. Yet, this massive aid has not improved things, and brought many challenges. Two stand out.

The first, and perhaps, biggest challenge is a serious lack of qualified health workers in poor countries, that makes already poor health systems completely dysfunctional. The problem exists largely because qualified health workers in poor countries are often hired by western nations, themselves short of nurses and doctors. For instance, Botswana, an early test of international HIV/AIDS treatment programs, was “by 2005, losing 60 percent of its newly trained health-care workers annually to emigration,” and had to depend on Peace Corps workers to distribute ARV medication.

The second major problem is a manifestation of the aid curse, common to all development assistance. The proliferation of HIV/AIDS programs has been matched by a complete disregard for overall healthcare and an attendant failure to provide for maternal health, malaria, TB, dysentery, or vaccination programs. Of the billions being spent on HIV/AIDS programs, none goes towards training local health workers, or towards supporting a private healthcare industry. Worse, international NGOs and organizations, flush with funds poach the best local talent away from public health systems. As a result, even as HIV/AIDS infection and mortality rates have gone down, overall life expectancy and other health indicators have continued to deteriorate over much of Africa.

Some supporters of foreign aid maintain that the problem with aid is not that it doesn’t work, but that there isn’t enough of it. This article explains what happens when significant aid is indeed made available. As it also illustrates, that is hardly the solution:

In the current framework, such as it is, improving global health means putting nations on the dole — a $20 billion annual charity program. But that must change. Donors and those working on the ground must figure out how to build not only effective local health infrastructures but also local industries, franchises, and other profit centers that can sustain and thrive from increased health-related spending. For the day will come in every country when the charity eases off and programs collapse, and unless workable local institutions have already been established, little will remain to show for all of the current frenzied activity.

The answers are not simple. If anything, the expanded aid has aggravated the underlying problems – weak public health systems that function within a distorted international system, and a market-oriented healthcare industry that does nothing for diseases that have no lucrative market.

A significant amount of money is indeed addressing the second problem, with new initiatives seeking cures to neglected and tropical diseases. However, the bulk of the money – directed at HIV/AIDS programs and infrastructure – is not being very helpful. As Garrett points out:

The health world is fast approaching a fork in the road. The years ahead could witness spectacular improvements in the health of billions of people, driven by a grand public and private effort comparable to the Marshall Plan — or they could see poor societies pushed into even deeper trouble, in yet another tale of well-intended foreign meddling gone awry.

Written by Guest Contributor

February 6, 2007 at 3:43 pm

Posted in Global Health

Link Fest: Malaria Marketing Mishap, Business & the Global Poor, Global Fund Shenanigans

Time for some more house keeping with another link fest, all of which are related to the development enterprise, enjoy:

1. Malaria Cause Marketing in Africa, Lost In Translation, worth reading, Link

2. Business and the Global Poor from Harvard (via Philanthropy 2173), Link

3. B-Schools Put Africa on the Curriculum (Business Week), Link

4. Changemakers Improving Health for All Competition, 139 entries, Link

5. Free global health book downloads thanks to the Hesperian Foundation, Link

6. Global Fund director in hot water? Money for limos, boat cruises and more, Link

7. More bad news for HIV – microbicide trial halted – 3rd trial stopped (3 left in Phase 3), Economist coverage, other Link

8. Malaria and Global Warming, Link

9. A take on the water crises from a recent conference of leading water NGOs, Link

10. Roof runoff saves lives, Save the Rain foundation, Link

11. Want to know the true cost of bottled water? Link

12. Nanotechnology and Global Health Panel in DC on 2/27,  Link

13. New book – Clear Blogging: How People Blogging Are Changing the World and How You Can Join Them, Link

Written by Aman

February 5, 2007 at 10:03 pm

Posted in Global Health

Micro Insurance: Ugandan health co-ops built from US dairy experiences

ugndacvr.jpgA couple of weeks ago, National Public Radio featured western Ugandan health co-ops on a recent broadcast [audio link] that sounds a lot like this 2002 NPR story “Bringing Health care to rural Uganda“. The Minnesota-based HMO, HealthPartners, was asked by Land o’Lakes dairy extensionists, who worked in western Uganda’s dairy heartland, to help communities develop health co-operatives using dairy co-operatives as a model. The Ugandan dairy co-ops were themselves a transplanted idea from Minnesota’s response to Depression-era economic hardship.

George Halvorson, former CEO of HealthPartners (now at Kaiser Permanente) recently published Health Care Co-Ops in Uganda: Effectively Launching Micro Health Groups in African Villages. A free PDF of the book is available to those interested in starting micro health groups in developing countries. To get a copy, you will need to register at this Kaiser Permanente link.

UPDATE:
I (Aman) am adding to this post for Ben who is currently in Uganda working on the Output Based Aid incentive driven project. Just last month, the InfoShop at the World Bank launched two books, one of them is the one listed above. The second one is Private Voluntary Health Insurance in Development: Friend or Foe? You can click on the image below to get to the video presentation page. Additional for a whole series of presentations and background papers on this issue, the Wharton Conference on this issue is a good resource.
wb_infosession.jpg

Written by Ben

February 4, 2007 at 1:14 am