Jim Yong Kim: Continuing to accomplish the impossible

by Anjali Sastry on April 13, 2012

By Anjali Sastry and Rebecca Weintraub

In 2007, we met Dr Jim Yong Kim as he gathered faculty across Harvard and MIT to envision a new field of study in Global Health Delivery. Dr Kim already had an astounding record to build on: a practicing physician and medical anthropologist, he’d put his smarts to practical use as an early partner of Paul Farmer, Ophelia Dahl, Todd McCormack, and Thomas White in building and then continuing to lead and shape the much-admired Partners In Health. Through the years, he has been an inspiring leader, visionary strategist, and highly effective manager who oversaw the growth and development of PIH. An early and enduring insight from PIH’s hard-won experience was that healthcare delivery could only generate value when accompanied by critical, targeted investments in human resource development, infrastructure, and the diffusion of knowledge.

Dr Kim studied and designed health care delivery, always in connection with economic development and increasing equity. With his colleagues at PIH, Dr Kim provided care for multi-drug resistant tuberculosis in the poorest neighborhoods in Peru, then took the evidence of its effectiveness to policy-makers, industry, and the global community. The ensuing international response drove down costs and greatly increased access to service delivery.

Dr. Kim then accomplished the impossible at the World Health Organization: this time it was via an ambitious global campaign to increase access to HIV/AIDS treatment. Capitalizing on a management insight–that stretch goals, such as rapidly getting 3 million people onto previously unavailable AIDS treatment–Dr. Kim led a WHO campaign that reached his goal by 2007. The stretch goal served its purpose excellently; as the Guardian‘s Sarah Boseley recently pointed out, now the number of people on treatment is closing in on 7 million.

After Dr Kim returned to Harvard,  MIT Sloan School of Management invited him to lecture in its Dean’s Innovative Leader Series. As his talk on bridging the health delivery gap made clear, Dr Kim had management and leadership lessons to offer. The conversation that day inspired MIT Sloan to create ghdLAB, an ongoing effort that pairs academic teaching and research with field work aimed at implementation. Working alongside the leaders and managers of organizations at the front lines of healthcare delivery, ghdLAB takes on the practical management challenges that most limit enterprises’ ability to deliver more and better healthcare. This work has been addressing the implementation gap that Dr. Kim described so compellingly and is demonstrating why management tools, leadership qualities, and systems thinking are the necessary complements to medical knowledge and financial investment. This sets the agenda for our own research into healthcare delivery.

The Global Heath Delivery Project was cofounded by Dr Kim and Harvard Business School’s Professor Michael Porter. At its core is a new vision for sharing learning and advancing practice by creating Harvard Business School style case studies to train the next generation of managers in global health delivery. Public goods are being created as implementers seek counsel from experts via GHDonline.org‘s online virtual professional communities. To take these ideas further, in his three years as president of Dartmouth Dr Kim has articulated his vision of a new science of healthcare delivery. Today a growing number of innovative efforts are taking on his call for a rigorous and interdisciplinary new field of study and practice.

Over the years, we’ve seen Dr Kim at work as leader and strategist, marshaling creativity, ideas, skills, and knowledge in business, economics, and development in order to deliver–more effectively than ever before–needed services, goods, and knowledge to communities that are too often ignored. Now that he’s nominated to the presidency of the World Bank, we agree with others: it’s an inspired choice. Dr Kim has delivered results, and he’s done so in innovative, effective, and collaborative new ways. If so much has been accomplished in healthcare delivery, there is much more that can be done when its lessons are applied to poverty reduction and development.

 

Anjali Sastry, PhD, is Senior Lecturer at the MIT Sloan School of Management where she directs ghdLAB; she is also Lecturer, Department of Global Health and Social Medicine, Harvard Medical School.

Rebecca Weintraub, MD, is the Executive Director of the Global Health Delivery Project at Harvard University and an Associate Physician at Brigham and Women’s Hospital Division of Global Health Equity.

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April 17, 2012 at 1:08 pm

{ 1 comment… read it below or add one }

Jeremiah Norris April 16, 2012 at 9:50 am

Dear Ms. Sastry & Weintraub:

You have placed far more weight on Dr. Kim’s leadership of WHO’s ’3 by 5′ programme than it deserves. While there can be no doubt that he is without peer when it comes to the administration of single therapies in resource litted settings, this micro-level experience didn’t transfer into a his macro-level leadership at WHO. For one thing, most observers didn’t understand why WHO had to initiate an AIDS program when other global programs were well underway and had been for years, e.g., the UN/Accelerated Access Initiative–in which WHO was a founding member; PEPFAR; the World Bank’s MAP Program; the Global Fund to Fight HIV/AIDS; and private sector programs in ten Southern States of Africa. At a time when global AIDS coordination was badly needed, ’3 by 5′ was an unnecessary and expensive intervention. Most importantly, it was inexplicable why a clinician of his reputation would recommend a fixed dose combination ARV from India, Triomune, as the “backbone” of treatment. The drug had been licensed by the Drugs Controller General (India) in June 2001. Of the twelve conditions for its use, one was: “no reference in the advertisements or medical literature is made that the Government has approved the drug”. Another: “to be prescribed only by a R. M. P.”. Beginning in May 2004 and running through September, WHO had to de-list 36 of the ARVs on its Prequalification Programme. The stated reason: lack of proof of bioequivalency. None of the 36 ARVs had been approved by any stringent regulatory authority. All of these products had been produced in India. The leadership of ’3 by 5′ never requested a post-marketing survey to determine if any patients had experience adverse reactions–a standard requirement of stringent regulatory authorities. In 2006, PEPFAR, the Global Fund, and the UN/AAI Programme announced that 1.51 million patients had been enrolled in ARV treatment programs. The number which could have been attributed to ’3 by 5′ was never publicly acknowledged by WHO in its final report. In addition, there was an antocratic bent to ’3 by 5′. Dr. Kim went public in 2005 and accused South Africa of refusing to adhere to its assigned coverage of 375,000 patients for AIDS treatment. He said that ’3 by 5′ would miss its goal because of South Africa’s refusal to follow numerical directives from Geneva. This forced an unusual public response from its minister of health. She stated: “WHO had not consulted South Africa on its plan and that the country was not chasing numbers but treating AIDS patients responsibly”.

Before his nomination, Brazil, Russia, India and China had been advocating for a BRIC Bank to undertake much needed infrastructure programs in the developing world. Dr. Kim will be elected. Yet, his limited and unremarkable experience at the macro-level in WHO will be seen as a convincing rationale for the formation of a BRIC Bank.

Sincerely,
Jeremiah Norris
Director
Center for Science in Public Policy
Hudson Institute
Washington, D. C.

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