Global Health Futures: Smaller, More Local Aid Efforts
Efforts to improve global health will come more and more to depend on local skills and capacities. That's a good thing. Instead of being based on outsider contributions, they will build on local strengths. That will mean smaller, better targeted programs that cost less and do more. We're coming into what I see as a third stage in global health efforts.
First Stage - Way back when, knowledge about global health was concentrated primarily in the wealthy world. We had institutions like the London School of Health and Tropical Medicine and mission hospitals. International health efforts were based the wealthy world giving assistance to "the poor." It was a transfer of resources, not knowledge or skills. It was a very White Man's Burden view of things - sharing enlightenment with the heathens.
Second Stage - In the 60s, donors started to realize that just sending doctors and medicine was not a sustainable approach to global health. It was going to lead to an endless effort to address global health problems, leaving countries dependent on outside aid forever and unable to prevent health problems in the first place. (I credit David Werner and his passionate and readable rants for a lot of this shift) Aid efforts began to shift to a capacity building approach. Global health programs focused on training health workers, building government capacity, and strengthening health systems. We're in this stage now. But we're on the verge of an amazing new:
Third Stage - I think this is going to be great. Global health isn't about wealthy countries any more. Two things have changed - developing countries now have the tools to develop and share the kind of knowledge that is used by the scientific establishment, and there is greater respect for the value of existing knowledge in poor countries. Universities throughout the developing world have academic programs in health and global health, and graduates of those programs are applying the scientific methods to global health. In addition, approaches such as quality improvement and positive deviance are capturing the knowledge that already exists within communities and health systems to make things better.
What is third stage global health work going to look like? Partnerships between local institutions and international donors, social entrepreneurship, collaboration between developing countries, and low-cost technology developed by the same people who will use it.
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