what is global health delivery?

Global Health Delivery is an emerging field of study into how health care can reach all — in advanced economies and resource-constrained settings. Here’s how the Gates Foundation frames the need; Harvard’s François-Xavier Bagnoud Center for Health and Human Rights overview.

start learning: an introduction

Mountains Beyond Mountains, by Tracy Kidder (Random House 2003) is a readable introduction to the needs for and challenges in delivering healthcare in resource-poor settings.

Kidder’s writing is compelling, but for another motivating introduction, look at XDRTB.org, where James Nachtwey’s powerful photographs tell the story of extremely drug-resistant tuberculosis (XDR-TB) and TB; see commentary here.

For a quick video introduction: watch Dr. Farmer’s Remedy For World Health in which Byron Pitts Meets A Man Who Dedicates His Life To Bringing Healthcare To The Poor. From CBS 60 Minutes, May 4 2008. Pair this video with Bill Clinton’s TED Prize talk from 2007 in which he asks for help in bringing health care to Rwanda — and the rest of the world. Add the clips from the PBS series below for a picture of the work that’s been done in one area.

More depth via these four excerpts from a PBS television series documents how Jim Yong Kim and his colleagues have changed the way the world combats multi-drug resistant tuberculosis.
Part I: Poverty and the Rise of MDR TB in Peru (3:49)
Part II: Everyone Around Her is at Risk (8:20)
Part III: Facing TB Head-On (4:56)
Part IV: Reason to Endure (3:40)
For more, check out the site for the entire series, Rx for Child Survival.

some specific needs and opportunities

Inequalities are particularly stark in some African countries. Life expectancy between the world’s richest and poorest countries can vary by more than 40 years, a report shows. The World Health Organization examined primary health care systems around the world, and uncovered huge inequalities and inefficiencies. See warning over health inequalities from the BBC, Tuesday, 14 October 2008. From CNN the same day, the story WHO slams global health care reported that the WHO director calls for universal coverage: health care disparities, she said, makes the world “neither stable nor secure.”

On June 11, 2008, the New York Times’ Nick Kristof asked Are Doctors Screwing Up Public Health? in a piece that considered Josh Ruxin’s argument in Democracy Journal that we need to reward efficient corporate practices among public health practitioners.  Ruxin’s full article is Doctors Without Orders. To improve global health, he argued in Summer 2008, what we need isn’t just Bill Gates’ billions, but Microsoft’s managers.

PIH Medical Director Joia Mukherjee reflects on the past two decades of fighting the spread of HIV/AIDS in One world, one hope, a multitude of voices, January 2008. She notes:

During 2001, our group worked with faculty members from Harvard to publish the “Consensus Statement on Antiretroviral Treatment for AIDS in Poor Countries.” Partners In Health and Zanmi Lasante published the first report of The HIV Equity Initiative in the Lancet and the Bulletin of the World Health Organization.  In these articles, we described 60 and then 150 patients in Haiti on antiretroviral therapy.  We reported on the general outcomes: the patients were doing well and had gained weight; the price of ART had dropped considerably with the entry of generic drugs on the market (thanks to activism by Doctors Without Borders (MSF) and others); and community health workers accompanying patients on ART were the backbone of the program addressing adherence and social support.

These themes are, of course, interrelated. As you’ve seen, the next task–of scaling up–may require management skills and approaches to address needs for basic healthcare globally. Consider the challenge of scaling up healthcare in Rwanda, presented in a newsletter article on Rwanda’s new healthcare model and in talks at MIT’s School of Humanities, Arts and Social Sciences and at MIT Sloan School of Management.

introduction to policy issues

Here’s a readymade debate to start you thinking about some of the policy questions.

The Challenge of Global Health Laurie Garrett, Foreign Affairs, January/February 2007
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.

How to Promote Global Health A Foreign Affairs Roundtable. In this special Web feature, Paul Farmer, Jeffrey Sachs, Alex de Waal, Roger Bate & Kathryn Boateng, and Laurie Garrett discuss Garrett’s essay “The Challenge of Global Health” and debate how best to help the world’s poor and sick.