First week of class!

by Anjali Sastry on November 1, 2008

We kicked off the new course with some great material. Things are moving quickly at the moment, and there’s a lot to cover. We’ll use this blog to add resources, ideas, and follow-up readings for everyone to share.

In our first class, we spent a little time on the question: why do we need a new science of global health delivery? We drew on ideas from our Global Health Delivery Project colleagues to explain what a better understanding of the delivery challenge entails:

  • Understanding health care delivery as a complex, multidimensional phenomenon
  • A focus on the whole and the parts
  • Data-driven design of outcomes focused health care systems
  • Pragmatic focus on dissemination of innovative health care delivery models
  • Frameworks that identify context-specific and context-independent factors affecting health care delivery

We’ll build up our understanding in each of these areas as we go. And in so doing, we’ll draw on existing theory, models, and frameworks that may help in the task. What readings, ideas, and resources might be helpful in this area? Please post a comment!

{ 2 comments… read them below or add one }

James Larson November 2, 2008 at 11:09 am

I was unfortunately out of town for our first class session, but I enjoyed reviewing the preparation materials for Monday’s class. I am particularly impressed with PIH and its efforts in Haiti and Rwanda. I had the opportunity to live among the poorest of the poor in South America. I saw first hand how people struggled with illnesses and afflictions that for us are not an issue. On a couple of occasions I volunteered to help clean at a hospital – the entire time abhorring the idea of being treated in a hospital in such poor condition. I had access to better hospitals in a larger city. But for the people in that area, they were stuck. If they could afford treatment at all, it was not very good.

In my mind, the best part about PIH is its focus to build an organization that over time will become less reliant on foreign aid as locals are trained to operate and pay for the facility. I was in South America during the 2000 Bush v Gore election. On one occasion, I visited with a man in his home and he brought up US politics. He flat out said that he did not care who won the election as long as the US keeps sending money to his country. I was shocked, surprised, and disappointed. He and others like him had accepted a lifestyle dependent on a US funded “welfare” program and did not want to change. I’m sure some of the same attitude exists in the countries we will be visiting in Africa.

PIH is on the right track in teaching and inspiring locals to take charge of their own health. Hopefully we can take this mindset to Africa with us and help our partner organizations achieve the same goal.

-James Larson

Fernando Garcia Migliaro November 3, 2008 at 1:36 am

In his article “Doctors Without Orders”, Josh Ruxin says that “to improve global health what we need is not just Bill Gates’ billions, but Microsoft’s managers”. This is a summary of the thoughts of many leaders in a new Global Health trend, in which they propose merging private sector thinking (profit oriented) with public health priorities. Doing so, they are trying to mix management way of thinking and tackling problems with the necessary experience brought by doctors and epidemiologists.

What needed to make this idea sustainable? I share Ruxin’s opinion that in order to do so there is a need of knowledgeable management, plus scientific and technical people working on site, even better if some of these people know the local environment and traditions of the native people. I would like to add to this list the need of local policies with that should coordinate the work of the different projects with a long-term common goal.

Where to get all these resources? For many of African countries is not that difficult to form people in the health area, what is really difficult is to retain them in rural areas or even in their biggest cities. Health people is turning into a scarce resource in the developed world and there are many opportunities for many native doctors/nurses to travel abroad and work in developed countries, depleting local resources.

The management people can come from different sources: Management experience in health is difficult to find, but not impossible. There can be people with a vast experience in management, but who will need to the way to adapt their experiences to public health (management consultants represent a good pool). Another option is to form people specifically for this need (MBA in public health?).

The people with management capabilities can be a good resource for working in the policies, but here is also necessary politicians that know the subject and that are allowed to worked independently in this matter. It is well known that many politicians get their positions not because of their knowledge, but because of their connections; and many times, once they get to their positions they need to respond to so many interests that is difficult for them to focus in long-term projects (specially if they are not going to be there to collect the results from them).

I would like to finish with a thought. It is possible to find this topic in many places, always focusing in developing countries. My question is: Isn’t this kind of action needed for developed countries such as USA also? The expenditure in public health in USA is the biggest per capita in the world, and we can’t say that its quality is the best, nor it is close to ideal. I believe that this model can be applied to any country in the world, not just to those that in a more urgent need. Why is so difficult to hear someone proposing such integration in developed countries?

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