INVESTING IN GLOBAL HEALTH SYSTEMS
SUSTAINING GAINS, TRANSFORMING LIVES
Committee on Investing in Health Systems in Low- and Middle-
Income Countries
Board on Global Health
Gillian J. Buckley, John E. Lange, and E. Anne Peterson, Editors
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
This study was supported by Contract/Grant No. APC-GM-0002 between the National Academy of Sciences and JSI Research and Training Institute/USAID. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.
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The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.
Photo credit: Front cover, Copyright 2005 Anthony Legg, Courtesy of Photoshare.
Suggested citation: IOM (Institute of Medicine). 2014. Investing in global health systems: Sustaining gains, transforming lives. Washington, DC The National Academies Press.
“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
—Goethe
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
Advising the Nation. Improving Health.
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
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The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council.
COMMITTEE ON INVESTING IN HEALTH SYSTEMS IN LOW-AND MIDDLE-INCOME COUNTRIES
JOHN E. LANGE (Co-Chair), Retired U.S. Ambassador; Senior Fellow for Global Health Diplomacy, United Nations Foundation
E. ANNE PETERSON (Co-Chair), Director, Public Health Program, Ponce School of Medicine and Health Sciences
RIFAT ATUN, Professor of Global Health Systems; Director, Global Health Systems Cluster, Harvard School of Public Health
GEORGES BENJAMIN, Executive Director, American Public Health Association
TINA BROCK, Associate Dean for Global Health and Educational Innovations; Professor of Clinical Pharmacy, University of California, San Francisco School of Pharmacy
MARGARET E. KRUK, Associate Professor of Health Policy and Management, Columbia University Mailman School of Public Health
CHARLES MACCORMACK, President Emeritus, Save the Children; Executive-in-Residence, Middlebury College
NACHIKET MOR, Chairman of the Board, CARE India; Board member, Reserve Bank of India and CRISIL
DAVID ROSS, Director, Public Health Informatics Institute
SUSAN SCRIMSHAW, President, The Sage Colleges
NANA A. Y. TWUM-DANSO, Senior Program Officer, Division of Maternal, Neonatal and Child Health, Bill & Melinda Gates Foundation
IOM Staff
GILLIAN J. BUCKLEY, Program Officer
MEGAN GINIVAN, Research Assistant (until August 2014)
RACHEL E. PITTLUCK, Research Assistant (from July 2014)
KATHERINE M. BLAKESLEE, Global Program Advisor
JULIE WILTSHIRE, Financial Officer
PATRICK W. KELLEY, Director, Boards on Global Health and African Science Academy Development
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Reviewers
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:
Floyd Bloom, The Scripps Research Institute
Leo Anthony Celi, The Institute for Medical Engineering & Science
Timothy Evans, The World Bank
Kent Hill, World Vision
William Hsiao, Harvard School of Public Health, Harvard Global Health Institute
Salim Abdool Karim, Columbia University, University of KwaZulu-Natal, Cornell University, Centre for the AIDS Programme of Research in South Africa (CAPRISA)
Sheila Leatherman, UNC Gillings School of Global Public Health
Anne Mills, London School of Hygiene and Tropical Medicine
Muhammed Ali Pate, Duke Global Health Initiative
David H. Peters, Johns Hopkins Bloomberg School of Public Health
Prashant Yadav, William Davidson Institute, University of Michigan
Winnie Yip, University of Oxford
Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by David Challoner, Vice President for Health Affairs, Emeritus, University of Florida; and Charles E. Phelps, Professor and Provost Emeritus, University of Rochester. Appointed by the National Research Council and the Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.
Acknowledgments
This report is a product of the cooperation and contributions of many people. The committee and staff are especially grateful to Rebekah Hutton for her design of the report cover and graphics and to Chelsea Frakes, Greta Gorman, and Nicole Joy of the Institute of Medicine (IOM). We also appreciate the contributions that Rebecca Morgan and Ellen Kimmel of the National Academies made to this report.
The committee thanks all the speakers and moderators who participated in committee meetings, as well as others who provided information, input, and assistance. They include Karen Cavanaugh, Eric Goosby, Kent Hill, Laura Holgate, Michael Johnson, Mirta Roses Periago, and David Peters.
The committee and staff thank the U.S. Agency for International Development (USAID) for generously funding this study.
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AIDS | acquired immune deficiency syndrome |
ART | antiretroviral therapy |
CDC | Centers for Disease Control and Prevention |
DOTS | Directly Observed Treatment, Short-course |
G8 | The Group of 8: Canada, France, Germany, Italy, Japan, Russia, the United Kingdom, and the United States |
GDP | gross domestic product |
Global Fund | The Global Fund to Fight AIDS, Tuberculosis and Malaria |
HIV | human immunodeficiency virus |
icddr,b | International Centre for Diarrhoeal Disease Research, Bangladesh |
MDG | Millennium Development Goal |
MDR-TB | multidrug-resistant tuberculosis |
MEPI | The Medical Education Partnership Initiative |
NGO | nongovernmental organization |
PEPFAR | The President’s Emergency Plan for AIDS Relief |
PMI | The President’s Malaria Initiative |
SARS | severe acute respiratory syndrome |
TB | tuberculosis |
UN | United Nations |
USAID | U.S. Agency for International Development |
WHO | World Health Organization |