Interesting news from the Lancet – that the world’s contribution to global health programs has quadrupled from 5billion in 1990 to over 20billion at present. Also very interesting is that the funds are increasingly moving away from name brands – the UN, WHO, World Bank – and increasingly going to NGOs or private-public partnerships. This likely speaks to the fact that larger organizations are often hindered by bureaucracy, politics and inefficient administrative structures and smaller, non-political organizations can quickly ‘get the job done’. On the other hand, the private organizations are driven by different forces including accountability to their investors and often don’t have the overall health outcomes in mind.
This reminds me of a conversation with an Internist practising in a hospital in Dar who said that because the Clinton Foundation is spending so much money on fighting HIV, the majority of new health professionals who graduate go on seek jobs working in HIV or go on to get an MPH to help administer these funds…this then leaves a lack of healthcare providers available to care for the patients with all other common conditions such as diabetes, heart disease, cancer etc…
The impact of these various NGO or private initiatives is often very focused and distracts away from the true health needs of the overall population. The health system is then not adequately addressed and long-term health outcomes are not appropriately impacted. In addition, performance measures are not used often enough to drive the allocation of funds for global health.
As a physician, I am expected to practise “evidence-based medicine”. It’s time the public health world made this a priority and expectation as well – donors should start to mandate that global health initiatives are accountable to evidence-based interventions.