NEWSBYMARIAM MOSTAMANDY

Our comment of the week is from Catee Lalonde, who disagrees with Michael Keizer's take on global health equity. In the Why We Can't Have It All post, Michael says inequalities in global health will never completely disappear. Catee disagrees, arguing that efficient use of our resources could bring cost down and quality up at the same time:

I think sometimes we only look at quantity of resources rather than the quality of the resource allocation.  Spending what limited resources you have wisely might be more effective than spending a large amount of resources unwisely.  When it comes to extending life expectancy at birth (the example used last week) prevention programs can provide more bang for your buck than by focusing on treatments.  Don't get me wrong:  treatment is crucial - but more of a focus on prevention could reduce the often exorbitant costs of health care.

Catee, please contact me to choose where you would like your charity gift sent.

Sometimes we can see the future from this blog. Our comment of the week is from Scot Frank on the What Can Crowdsourcing Do for Global Health? post. Scot tells us about Citizen Water who are already using crowdsourcing to magnify their impact.

Citizen Water provides communities with the tools they need to conduct their own water testing. Their goal is to bridge the gap between "communities seeking safe water and the people with the knowledge and resources to help them achieve it." That is practically a definition of crowdsourcing best practice, and they are doing some exciting things. Read about it:

At Citizen Water we are using crowdsourcing in rural and urban communities around the world to collect water quality data which is then displayed on an interactive map. Participants are provided with appropriate and locally-producible treatment solutions based on their specific test results, along with education about water and sanitation. These citizen science efforts are currently underway in Ghana, The Philippines, Dominican Republic, and China.

Through crowdsourcing we've also successfully translated the water testing instructions into Spanish and Chinese, and we hope more will come soon so other communities can participate to obtain safe drinking water for themselves.

As one example: a barefoot doctor we trained last month is now testing for water-borne diseases in rural Himalayan villages he visits, while students of the nearby school instruct fellow classmates on how to test water in their remote home areas.

As one effort within 'crowdsourcing for global health', we agree with you that there is much potential in this space, as well as for people to innovate their own solutions for health.

http://www.CitizenWater.org

Scot, please contact me to choose where you would like your charity gift sent.

Our comment of the week is from Theo Smart on the Against A Global Fund for Maternal Health post. Theo offers a new perspective on global funding for maternal health. He points out that any health care intervention will have its complexities. But before a country with an already poor health care system can invest its own resources, new policy is needed. If this can happen, a global fund may work.

Although there clearly have been cases where programs with a single-issue focus have weakened health systems, I don't think that necessarily HAS to be the case. The Global Fund/PEPFAR were established to catalyze an emergency response and at the start, perhaps too little thought was put into how to set up HIV programmes without throwing already fragile health systems off-balance. But we know better now; and these institutions are evolving to adopt a health systems strengthening lens when planning and implementing programmes and interventions. To fulfil their mandate, this has to happen anyway, because HIV care and treatment programmes will only be sustainable, equitable and universal when they are decentralised to the primarycare level. It simply can't be done without strengthening the health
system.

RE a Global Fund for maternal-child health: True, MCH also requireshealth systems strengthening & there is a very long laundry list of essential MCH activities. But many of the complexities you mention are
just part of delivering any healthcare intervention in resource-limited settings (specialised human resources, often equipment (at least re diagnostics/lab), accessibility, financial/social barriers to care, transportation -- though rarely emergency). Addressing gender inequity, reproductive rights and sexual autonomy are also critical for the HIV prevention programmes being implemented by PEPFAR/Global Fund. These programs aren't just distributing pills.

However, I think setting up a Global Fund for maternal-child health could inadvertently transfer to the new multilateral much of the national government's responsibility for providing essential MCH services (just as some 'focus' countries leave HIV to PEPFAR). And if you can't convince countries to allocate adequate resources for the health and survival of mothers and children, there is little hope of getting them to invest in 'health systems.' Of course, because of the sorry state of health systems, these countries do need help — starting with debt forgiveness and other policies to get countries to invest sufficient resources in their own health systems. This should lead to programmes that are home-grown and not dependant upon the whims of international donors.

Theo, please contact me to choose where you would like your charity gift sent.

The comment of the week is from Robert Marten on the Against a Global Fund for Maternal Health post. Robert posed an interesting idea about a Global Fund for Health Systems.

Here is the comment:

"Don't you think it's a bit misleading to say that "Programs with a single-issue focus don't strengthen health systems"?  ...There is an article in this week's Lancet that talks about how, in fact, the Global Fund has roughly one third of its financing going to support health systems.  (Not that financing automatically implies strengthening, but still!)  Moreover, you go on to admit that if such a fund for maternal health were established and it were able to take a broad approach, it would, indeed, strengthen health systems.  There seems to be an inconsistency here.

And so, if able to ensure such a fund supported a broad approach, don't you think appeals at the G-8 (and in general) with pictures of mothers and babies would be a whole lot more effective raising funds, which would improve health systems, than a Global Fund for Health Systems or even the status quo.  (The current status quo seems to be critics assailing horizontal and disease-focused approaches and calling for a health systems approach, but as of yet, efforts for supporting health systems seem to be quite uncoordinated and piecemeal.)

And what about a Global Fund for Health Systems?"

Robert, please contact me to choose where you would like your charity gift sent.

Member of the Month is a new feature for the Global Health blog, where we learn more about a member who has contributed and encouraged others to contribute to insightful and engaging discussion. If you notice that a community member deserves to be noticed, be sure to nominate them by contacting me. We'll interview the member of the month, to learn about their approach to global health engagement. The member is chosen at the beginning of the month, and we run their interview in the middle.

Patrick Mayne (also our first Comment of the Week) is our first Member of the Month. In his interview, Patrick touches on many of the ups and downs of global health, but ultimately he feels that it is rewarding and extremely necessary work. He says that global health is everyone's health, which makes it a basic and fundamental common interest.

What do you do for a living?

This is a tough question...I'm currently working as a temp in DC to pay the bills. And generally anger my parents about not being home for holidays and birthdays.

How/Why did you get to be doing this?

Going into college, I actually thought I wanted to be a doctor, but was drawn pretty much entirely to social science, international development and language classes--kinda made me realize I wasn't really cut out for the clinical scene.

Once I started studying abroad, I basically never stopped, and that coupled with an interest in health, it all sort of came together.  I interned with CARE in Bolivia right after graduating (and I have to be honest, I got a lot more out of it than they did, since of course I had no idea what I was doing), and have pretty much been continuing in that ever since.

Of course, if you're asking about the temping, I have to come back to the states occasionally for new visas, and working in DC is about as convenient as you can get.

How did you become interested in global health?

I've been surrounded by great, inspiring friends and people who have always pointed me in good directions for reading, work, discussion and school.

Is there a certain area of global health that you have a special interest in?

Right now, the program I'm starting up is based firmly in the vein of community-led health programs.  I think it's really important that communities in which "global health" is practiced are recognized as the experts on their own conditions, and involved in these projects as such.  I think small community-led projects are the future of global health, and I'm excited to be involved in one now.

How important is it for others to become involved in global health, and how can they do so?

Again, hard question.  Getting "others" involved (and here I'm assuming you're talking about others from the US and western Europe) is surely pretty necessary--the biggest problems of global health are generally problems of the post-colonial world, and it's pretty unfair to tell them to deal with it themselves after us northerners raped and pillaged the global south (and, uh, sometimes continue to do so, in the form of debt, exploitative contracts, etc.).  But on the other hand, increasing the number of northerners involved tends to increase the tendency to work like it's a white man's burden kind of thing, which is definitely not the kind of thing we need right now.

But, if someone were still determined to get involved in changing health outcomes in other people's countries, I'd recommend a lot of reflection, reading and talking with professors.  Be critical of your own intentions, and the intentions of your employers, and make sure you're never treating anyone as research subjects, or patients, or people in need, but as individuals with complex, usually contradictory histories and identities.

What roadblocks do you see in global health?

I'm not sure if we've all ever fully gotten over the white man's burden, or colonialism and racism in general.  I think the biggest problem I've come across is people (who are awesome, capable, well-trained and talented people) generally going into it believing that they're doing good, and that that belief then excuses them from critically interrogating their activities and intentions.

Why does global health matter?

By definition, global health is the health of everyone, no matter where you are.  And since in a lot of cases, health can be roughly equated to life, or at least quality of life, it's a pretty basic prerequisite for having any sort of society that we would want to live in.

Comment of the week is from Nneoma N on the Five Things to Know About Trypanosomiasis post. The maintenance of health systems is crucial and readers can see why through Nneoma's personal experience and her knowledge of public health.

Here is her comment:

I find that sleeping sickness is an excellent example of how the sociopolitical climate of a region can directly affect the prevalence of a disease - particularly as it relates to the latest outbreak of  Trypanosomiasis.  As you said it also highlights the importance of disease surveillance, but more importantly, the maintenance of health systems (over the single disease approach - I know, global health buzz word).  The most recent resurgence of the disease nicely corresponding to the independence of the affected nations because when colonialists left, so did health infrastructure.

Thanks for the piece on this often neglected disease.  I had an uncle who died from what was suspected to be sleeping sickness and as a  result decided to work in a lab that studied the biology of the parasite. However, once it became clear that sleeping sickness was a disease largely constructed by destabilised health infrastructure I packed my bags and decided to study public health. (Also was angered  that the previous drug used, eflornithine, was once discontinued because of lack of profit and then resurfaced back into the market when it was found to remove unwanted facial hair...see the BBC article here.

Nneoma, please contact me to choose where you would like your charity gift sent.

The comment of the week is from Sara Larson on the When Not To Volunteer post. Her experience in Honduras is a great example of how volunteers can take away jobs from the very people they are trying to help.

Here is the comment:

"I couldn't agree more, and you articulated many of the frustrations I had as a recent college student watching so many well-intentioned organizations ship well-intentioned, yet unskilled and inexperienced, volunteers across the country and around the world to do jobs that locals could have benefitted from doing.  A recent experience I had volunteering in Honduras epitomizes this point.  I went there, not really knowing what I was getting myself into, as part of a team to help rural villages improve their access to clean water.  To make a long and sad story short, the sponsoring organization's method of "empowering" villages to create "sustainable" water systems (their language), was to send in a bunch of rich, non-Spanish speaking white kids to do what the Honduran villagers could have done 10 times better and faster.  I told my project leader at the end of the week that I would have rather given the money I paid to get to Honduras directly to the villagers as wages for doing the work themselves."

Sara, please contact me to choose your charity donation.