How to Promote Global Health

April 25, 2007 at 12:37 pm (Morgan's Posts)

The Challenge of Global Health

How to Promote Global Health

Hi Everyone! I’m Morgan Chessia, Brown University ’05. I’m new to the blog. I’m uploading the articles “The Challenge of Global Health,” by Laurie Garrett. It came out a couple months ago in Foreign Affairs, and I think that it is really worth reading. It addresses an essential question: how best to use foreign aid to improve health outcomes. Almost more interesting than the article, are the responses to it, “How to Promote Global Health,” from folks like Paul Farmer and Jeffrey Sachs, which I have also uploaded.

One of the major points in this article is the need to focus on improving general public health measures like maternal and child survival instead of targeting specific diseases like Malaria, TB, and HIV/AIDS. In general, I agree with Garrett that there needs to be more resources targeted towards improving public health in general. However, I think her assertion that disease-specific programs could worsen health on the ground is unsubstantiated. Garrett writes: “As in Haiti, even as money has poured into Ghana for HIV/AIDS and malaria programs, the country has moved backward on other health markers.” The overall health situation in Haiti has undoubtedly declined in the last decade, but I don’t think you can attribute it to an increase in funding to treat HIV/AIDS and Malaria. In most parts of the country people still don’t have even the most basic health care, let alone an HIV/AIDS program. If you were to desegregate the data and just look at the catchment areas of specific HIV/AIDS projects in Haiti like Hospital Albert Schweitzer, GHESKIO, and Zamni Lasante, you would probably find improvements in general measures of population health in the context of disease-specific programs.

Working in Haiti over the past few years I have frequently seen funding for disease-specific programs like HIV/AIDS strengthen the ability of institutions to provide general care. It pays staff like nurses and social workers who treat other patients at the health facility in addition to those with HIV/AIDS; renovates clinics, labs, and operating rooms; buys trucks and diagnostic equipment; and increases the profile of these institutions making it easier for them to access additional funds and private donations. One reason that this happens is that funding goes to established clinics and hospitals that are already providing care to patients. The directors of these institutions have a vested interest in keeping their program afloat so they figure out ways to cover general expenses through their AIDS budget.

Furthermore, patients with HIV/AIDS need comprehensive care—counseling, nutritional aid, treatment for OIs, surgical procedures, lab tests, etc.—in addition to disease-specific treatment, therefore the facilities must be established to offer these services. Any disease-specific program that denies this fact will not be successful at treating their patients.

To really improve population health we need more resources that are devoted to community-based primary health care—that means community organizing, training and local health workers, and increasing community access to essential medicines and supplies. As Garret states: “Virtually no provisions exist to allow the world’s poor to say what they want, decide which projects serve their needs, or adopt local innovations.” I would like to see this change also, but don’t think that disease-specific interventions are to blame. One of the faults lies in the way that programs are designed. A disease-specific program be it Malaria,TB, or HIV/AIDS with local management, community involvement, and training for community health workers can be a venue for empowerment. A disease-specific program so designed then offers a platform that more general public health interventions can build on. The same workers offering DOT to TB patients can quickly learn to weigh babies, administer vaccines, and check for danger signs in pregnant women.

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