Investing in Global Health Systems Sustaining Gains, Transforming Lives (2014) / Chapter Skim
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3 An Effective Donor Strategy for Health
3 An Effective Donor Strategy for Health
Pages 57-82
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From page 57... ...
As the previous chapter explained, the future disease burden in low- and middle-income countries will be a complicated amalgam of chronic and infectious conditions, likely aggravated by climate change. A successful donor strategy in global health needs to respond to the epidemiological, political, economic, and demographic changes described earlier.
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Similarly, eradicating malaria depends in part on building local capacity for the regulation and efficient distribution of medicines. Ending preventable maternal and child deaths means guaranteeing access to basic health services, especially among the poorest people on society's periphery.
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. Exposure to the logistics and management required to implement these large health programs can help build local capacity.
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An emphasis on country leadership is a departure from the recent practice of setting ambitious global targets for health. Targets like the Millennium Development Goals help build political will to tackle global health problems but are sometimes seen as owned by donors, not developing countries (Fehling et al., 2013; Haines and Cassels, 2004)
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. Contracting and working with nongovernmental organizations can help build local capacity in fragile states (Newbrander et al., 2014)
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The Millennium Challenge Corporation, a U.S. government corporation that works in foreign aid, has made country ownership a central tenet of its strategy.
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The challenge of translating the intellectual commitment into longer working project timelines remains. Outcomes Not Inputs Typically, donors measure the success of health programs by counting what their support buys: the number of patients on antiretroviral therapy or the number of children sleeping under bed nets, for instance.
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Over the shorter term, the proportion of the population receiving effective health interventions can be a useful measure of the reach of donor assistance. Integrating proven, effective interventions for child survival with primary care (sometimes called the diagonal approach to child survival)
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Measuring these and other outcomes of health care is at least as important to understanding the consequences of a donor funding as counting the volume what the funding buys. Attention to the outcomes of global health programs can only drive better stewardship of taxpayer money.
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Building capacity in aid recipient countries can help relieve this constraint, and would show the United States' commitment to a future when countries run health programs independently. • A transformative investment in global health is one that supports recipient countries' priorities, understanding the gaps they identify in their health systems and tailoring development work to help close them.
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Directing their skills to questions that benefit the poor makes efficient use of the United States' comparative advantage in science and technology. Funding Research The private sector has little reason to develop products intended for markets that have no ability to pay (UN System Task Team, 2013)
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The emerging field of implementation science1 has great promise to improve health in developing countries by identifying the social, economic, and political factors that affect health programs (Peters et al., 2013a)
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Rolling out antiretroviral therapy in sub-Saharan Africa, for example, required the training of community health workers in voluntary counselling and testing, monitoring treatment adherence, medicines storage and dispensing, and clinical administrative tasks (WHO, 2007b)
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. The use of task shifting, especially the efforts of the community health workers, greatly improved prognosis for these patients, and reduced their health costs by half (Gawande, 2011; RWJF, 2012)
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. There are far too few doctors, nur on e w rses, midwivees, pharmmacists, and coommunity health workers in developin countries.
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. The United States could help alleviate this training crush by investing in the education of health professionals in low- and middleincome countries.
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Despite resounding international consensus on the value of health professional training, it "remains chronically underfunded in national budgets and cooperative development efforts" (Frenk et al., 2010; Taylor et al., 2011, p.
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Training more primary care clinicians will help alleviate some of the strain on health systems, but the shortage of health workers is only one dimension of the workforce problem. In many countries there are serious problems with the quality of the education available; in rural India, there fifteen times as many unqualified providers as qualified ones (Das et al., 2012)
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. Donor countries have good technical depth in public administration, and should make developing strong administrative systems in their partner countries a goal of development.
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. When high-level commitment is missing, donors often work around their partner countries' deficiencies, setting up parallel monitoring programs for their vertical health programs.
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. Neglect of appropriate monitoring in previous projects has created gaps in our understanding of how to improve health infrastructure.
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Nevertheless, the agency allows implementing organizations considerable leeway, requiring impact evaluations only "if feasible" (USAID Bureau for Policy Planning and Learning, 2011, p.
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. Analyses of Chiranjeevi Yojana and similar programs give cautionary examples of the cost of neglecting formal impact evaluation.
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government development agencies be required to publish the results of impact evaluations.
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• Higher education and professional training for students from developing countries is a useful contribution to global development; short workshops and seminars are much less so. • The United States can help alleviate the shortage of health professionals in developing countries by investing in their training.
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