Health: The Challenges of Global Health

img Foreign Affairs US magazine Foreign Affairs – one of the most influential publication on international affairs and foreign policy in America – has an excellent opinion piece on Global Health.

The 12 page essay was written by Pulitzer Price winner and bestseller writer Laurie Garrett who is also well known for her book Betrayal of Trust: The Collapse of Global Public Health.

We strongly recommend reading the document to anybody working in Global Health and to anybody who is interested in what is happening in fighting AIDS, Malaria and TB.

We put some quotes together below to get you interested further. Please note that we have selected those quotes throughout the essay and the quotes should not be seen as a summary or directly related to each other:

Summary (from Foreign Affairs): Thanks to a recent extraordinary rise in public and private giving, today more money is being directed toward the world’s poor and sick than ever before. But unless these efforts start tackling public health in general instead of narrow, disease-specific problems — and unless the brain drain from the developing world can be stopped — poor countries could be pushed even further into trouble, in yet another tale of well-intended foreign meddling gone awry.

“…because decades of neglect there (there=>developing world) have rendered local hospitals, clinics, laboratories, medical schools, and health talent dangerously deficient, much of the cash now flooding the field is leaking away without result…”

“…Few donors seem to understand that it will take at least a full generation (if not two or three) to substantially improve public health — and that efforts should focus less on particular diseases than on broad measures that affect populations’ general well-being…”

“…Few of the newly funded global health projects, meanwhile, have built-in methods of assessing their efficacy or sustainability. Fewer still have ever scaled up beyond initial pilot stages…”

“…As a result, 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…”

“…The activists demanded that the Clinton administration and its counterparts in the G-8, the group of advanced industrial nations, pony up money to buy ARVs and donate them to poor countries…”

“…The Harvard faculty group labeled Natsios… and insisted that …all the alleged obstacles to widespread HIV/AIDS treatment in poor countries “either don’t exist or can be overcome,” and that three million people in Africa could be put on ARVs by the end of 2005 …” note: see the WHO 3by5 program on this as well

“…For most humanitarian and health-related NGOs, in turn, the surge in global health spending has been a huge boon, driving expansion in both the number of organizations and the scope and depth of their operations. By one reliable estimate, there are now more than 60,000 AIDS-related NGOs alone, and there are even more for global health more generally…”

“…In an analysis prepared for the second annual meeting of the Clinton Global Initiative, in September 2006, Dalberg Global Development Advisors concluded that much current aid spending is trapped in bureaucracies and multilateral banks. Simply stripping layers of financing bureaucracy and improving health-delivery systems, the firm argued, could effectively release an additional 15-30 percent of the capital provided for HIV/AIDS, TB, and malaria programs…”

“…A 2006 World Bank report, meanwhile, estimated that about half of all funds donated for health efforts in sub-Saharan Africa never reach the clinics and hospitals at the end of the line…”

“…This points to yet another problem, which is that aid is almost always “stovepiped” down narrow channels relating to a particular program or disease…”

“…Stovepiping tends to reflect the interests and concerns of the donors, not the recipients. Diseases and health conditions that enjoy a temporary spotlight in rich countries garner the most attention and money…”

“…A study by the International Labor Organization estimates that 18-41 percent of the health-care labor force in Africa is infected with HIV. If they do not receive ARV therapy, these doctors, nurses, and technicians will die, ushering in a rapid collapse of the very health systems on which HIV/AIDS programs depend…”

“…In a recent macroeconomic analysis, the UN Development Program (UNDP) noted that international spending on HIV/AIDS programs in poor countries doubled between 2002 and 2004. Soon it will have doubled again. For poor countries, this escalation means that by the end of 2007, HIV/AIDS spending could command up to ten percent of their GDPs…”

“…it is curious that even the most ardent capitalist nations funnel few if any resources toward local industries and profit centers related to health…”

“…Donor states need to find ways not only to solve the human resource crisis inside poor countries but also to decrease their own dependency on foreign health-care workers…”

“…American nursing schools reject more than 150,000 applicants every year, due less to the applicants’ poor qualifications than to a lack of openings. If it fixed this problem, the United States could be entirely self-sufficient in nursing…”

Foreign Affairs is the publication of the Council on Foreign Relations – one of the most respected and influential think tanks in the world and a good source for non-partisan information and analysis.

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