|
Independent research & practical ideas for global prosperity
|
|
|
|
Independent research & practical ideas for global prosperity
|
|
May 4, 2009Preparation for a Flu Epidemic Requires Collective Action on Surveillance; Or, Three More Things I Wish I’d Said on the CBS Nightly News Last FridayPosted by Mead Over in Health Systems Tags: Health Systems, Swine fluOn Friday Cynthia Bowers of CBS News asked me some questions about the economic impact of the current flu epidemic, particularly on the United States. Since my own focus, as reflected in my recent post, has been on the impact on the developing world, I wish I had said just three more simple things: “To prepare for the next time, the US together with the international community should: 1. Sustain international cooperation on surveillance Here’s what’s behind my recommendations: Read More… Comment »March 26, 2009Health Systems Strengthening: Whither the World Bank?Posted by April Harding in Health Systems Tags: GAVI, Global Fund, Health SystemsWith Ruth Levine. The High Level Taskforce on Innovative International Financing for Health Systems met week before last in London. To their great credit, they’ve posted draft reports from their two Working Groups so interested observers can see the where they’re going. Working Group 1 seeks to identify the health systems-related constraints to achieving global health goals, and presents estimates of costs of achieving priority goals (e.g. targeted reductions in maternal and child health). Working Group 2 (WG2) aims to identify new sources of funding and lay out the best options for channeling the funding to countries to improve health system performance. Further work and consultation is pending over the next three months, and then the Taskforce will provide their suggestions to the G8 for consideration at the July Summit in Italy. Read More… 2 Comments »August 21, 2008Donors Officials Discuss HIV/AIDS Monitor Report on Health Systems at the 2008 International AIDS ConferencePosted by David Wendt in HIV/AIDS & Infectious Diseases, HIV/AIDS and other Infectious Diseases, Health Systems, NewsFrom Aug 2-9, the Center for Global Development’s HIV/AIDS Monitor team and its research partners from Mozambique and Uganda attended the international AIDS Conference in Mexico City. In addition to taking advantage of the fantastic opportunity for learning and exchange with the over 23,000 participants committed to addressing HIV/AIDS globally, our team also launched its new paper “Seizing the Opportunity on AIDS and Health Systems.” This turned out to be a very timely piece of research, as discussions on health systems strengthening dominated much of the conference. Comment »August 4, 2008AIDS 2008 in Mexico City: New Focus on High Risk Behavior in all CountriesPosted by Mead Over in HIV/AIDS & Infectious Diseases, Health Systems, NewsMexico City, August 4, 2008: The biannual international AIDS conference opened last night with great fanfare here in the capital of one of the countries that has the greatest success in combating AIDS. To me, the biggest surprise is the noticeable increase in attention to the need to assure prevention coverage among those at highest risk, including sex workers, men who have sex with men, and other groups at high risk. Since the Stockholm conference in 1988, which was the fourth ever held, I have attended almost all of these international conferences and a substantial number of the regional conferences in between. During the early conferences, most attention was on HIV prevention with only the most specialized medical researchers and activists from the rich countries talking about treatment. Then as triple-drug therapy was developed and improved, attention turned towards extending access to poor countries. In 1997, when Martha Ainsworth and I launched our book on the economics of AIDS at the African AIDS conference in Abidjan, effective treatment still cost $20,000 or more per patient-year with only about a 50% price reduction in Thailand and Brazil. So our book’s major message was that efficiency, equity and public health arguments all compellingly converged to support government action to prevent HIV infection, especially among those most likely to contract and transmit the epidemic. Our message on treatment was one of horizontal equity. Countries should subsidize AIDS treatment to the same degree they subsidized the treatment of equally expensive chronic adult illness. These two messages were and have been very unpopular. Indeed, ACTUP and other activist groups sometimes marched through the auditorium chanting hostile slogans when I was on the list of speakers. Even the World Bank turned its back on the first of our messages. Now, 20 years after I attended my first AIDS conference and 11 years after the launch of Confronting AIDS, I think I detect a movement towards both of our 1997 messages. On treatment, after worldwide efforts have substantially lowered treatment costs and expanded access, there are now calls (including here at the Mexico conference) for horizontal equity between AIDS and other diseases within developing country health sectors, but the more dramatic change is on prevention. Comment »June 2, 2008We Need a Metaphor for Health Systems. What About the Human Body?Posted by Ruth Levine in Donor Community, HIV/AIDS & Infectious Diseases, Health Systems, NewsCreating a shared metaphor is a powerful way to make an abstract concept tractable. Just think about how the metaphor of “war” dominates and shapes so much of what we do in public health: the war on cancer, the fight against AIDS, the battle against TB. Metaphors also shape and define the boundaries of how we think about problems and how to solve them. We fight diseases with campaigns, with armies of health workers, with magic bullets. In fact, metaphors are often the boxes (metaphor alert!) that we are asked to think outside of. The contemporary concept of “health systems” desperately needs a better metaphor. Right now, we have a couple of contenders out there. I’ve seen a puzzle (View image), with five interlocking pieces (financing, human resources, infrastructure, technologies and drugs, and knowledge and information). OK, it gets across the notion of some sort of relationship among the parts, but is static and conveys the (wrong) idea that there’s one way to put together the system elements. Health economists occasionally invoke the dominant metaphor in neoclassical economics: The “sides” of demand and supply, and the “invisible hand” of competition. This has a lot of meaning for practitioners of the gloomy science, and leaves just about everyone else glassy-eyed. I have to admit that neither of these metaphors quite do it for me, nor do the growing numbers of boxes-and-arrows diagrams that are cropping up in journal articles and powerpoint presentations. They just make me think, “Wow. That’s complicated….I wonder what software they used to make that diagram?” And I suspect I’m not alone in yearning for a useful metaphor, given the inarticulateness that often overcomes very smart people when faced with the question, “What to do you mean when you say ‘health system’?” Comment »May 30, 2008Shining a Light on What Works: Aravind Eye Care System Wins Gates AwardPosted by Danielle Kuczynski in Donor Community, HIV/AIDS & Infectious Diseases, HIV/AIDS and other Infectious Diseases, Health SystemsCongratulations to the Aravind Eye Care System for winning the Gates 2008 Global Health Award, a $1 million prize that is the largest of its kind given for international health. Presented at the Global Health Council’s 35th Annual International Conference last night, the award honors exceptional efforts to improve health in developing countries. Established in 1976, Aravind is a global health example of ‘what works’ – one of the biggest eye care clinics in the world, they aim to prevent unnecessary blindness in rural India. Between April 2006 and March 2007, over 2.3 million outpatients were treated and over 270,444 surgeries were preformed through Aravind and Managed Eye Hospitals. See the CGD publication Case Studies in Global Health: Millions Saved which highlights their work in treating cataracts. Comment »May 22, 2008“AIDS Spending Harms Health Systems” — Passionately Disputed but Hardly RefutedPosted by Mead Over in HIV/AIDS & Infectious Diseases, Health SystemsRoger England’s article on “AIDS exceptionality” in the British Medical Journal argues that AIDS has received a larger share of total health spending than its contribution to the burden of disease would justify and that this large increase is having negative effects on the rest of the health care system in recipient countries. His article has so far generated 17 often passionate and lengthy responses. Some of the effort of responders is devoted to demonstrating that the effects of AIDS are worse than its burden of disease would indicate. This effort to justify donor spending on AIDS seems futile, since the same is true of many other diseases, including tuberculosis, motor vehicle deaths, smoking caused disease, etc. (In any case, the cost-effectiveness of public spending should play a larger role than the total burden of disease in guiding the allocation of public health spending). Much of the rest of this prodigious rhetorical effort asserts that AIDS spending is really helping, not harming, the rest of the health sector. If Roger England’s assertion that AIDS spending harms the health sector could have been refuted by data, one of those posting would have cited such data and the others would not have felt the need to post. The problem is that we really don’t know, in any general way, what the extraordinary scale-up of AIDS spending has done to other parts of the health sector. [For previous discussion of this issue on our blog, look here, here, and here] An interview I had last November with the nurse who was responsible for managing a health center in Western Kenya is perhaps revealing. His district health center had tripled in size due to the addition of a clinic, lab, waiting and storage space for treating AIDS patients and for warehousing the fresh produce, cooking oil, flour and other groceries given to supplement the diets of many AIDS patients. The staff nominally reporting to him had increased by several young physicians, who had received special training in AIDS case management. Comment » |
|
|
CENTER FOR GLOBAL DEVELOPMENT
1800 Massachusetts Avenue NW, Third Floor
Washington DC 20036
Tel 202.416.4000 | Fax 202.416.4050
|
|
|
Print
Share
