Innovations for equity

Beyond Resource Mobilisation

In Global Symposium on Health Systems Research, Uncategorized on November 16, 2010 at 11:10 pm

BY DAVID BISHAI, JOHNS HOPKINS SCHOOL OF PUBLIC HEALTH

Transmitting the needs of the poor to the ears of the policymaker is not as easy as it seems.  The poor themselves do not fully know what causes their ill health.  They and their doctors frame the problem in medical terms.  Epidemiologists multiply case counts into “burden”.  Economists prioritize disease burdens according to the costs of the medical solution.  Advocates use photo journals, tales of woe, body counts and whatever cost-effectiveness estimates they can get their hands on to elbow their way into the hearts and minds of the global policymakers, government officials, and donors.

There is a little 5 year old at the checkout counter lurking in the soul of global health discussions.  The pleading entreaties and playing on heartstrings to divert Mama and Papa’s money to the latest fancy is a game for grownups too.  In global health the game is much more serious.  Donors’ goal to spend their resources on improving the lives of the poor is vulnerable to distortion.  Donors and the governments they serve don’t always frame health issues the same way.  People die needlessly when priorities are wrong.

Will the first global symposium on health systems research be a step towards improvement?  At this morning’s plenary we heard from WHO, a minister of health, and the president of the Rockefeller Foundation.  They see the promise of focusing on health systems as a way to reframe global health as not just collection of disease interventions waiting for someone to pay for them.  Thinking about health systems permits more of a chance to ask why the poor and vulnerable keep getting sick and injured, and opens a broader vision of what makes people healthy. 

But the world is what it is.  It’s a competitive world.  WHO anticipated the need to mobilize resources to support work in health systems. Let the world be on notice that now “health systems” is joining AIDS, TB, Guinea Worm, etc. as one more supplicant at the donor trough. The Minister of Health described obstacles caused by those in Laos who don’t see health systems as the priority.  He described his long struggle to bring in reforms.  The foundation president made the case for why universal health coverage should be top priority in health systems research.  Ultimately many of the things that make people healthy are publicly organized and they are not available in medical clinics.   Their financing outstrips donors’ resources and must be financed locally.  Fundamentally the goal has to be to help countries build institutions to be a foundation for future health systems with a vision that reaches far outside the clinic. The idea of trying to compete for donor resources to make a population healthy will someday be consigned to history.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: