Well, I didn’t win the CSIS Smart Global Health Essay Contest, possibly because I argued against innovation in a contest that was explicitly looking for new ideas. I liked my essay, though, so I am sharing it here. CSIS was asking how the US government should spend their money on global health, and specifically looking for new and exciting ideas.
An Argument Against Innovation
Now is not the time for programming innovation. Instead, we should focus the next fifteen years on expanding the programs that work. Innovation is aimed at system-changing efforts that will lead to huge success or major failure; that’s not what we need right now. US government resources are not limitless, and we have a deep body of research in what works in global health. We have highly effective programs that are begging for funding; that is where our money should go. The government is well suited for the role of supporting boring but effective health interventions.
Global health research is full of solid, evidence evidence-based interventions that have been proven to improve health. These include increasing access to contraception, increasing vaccination coverage, home visits by nurses or community health workers, and strengthening primary health care and training health care providers in Integrated Management of Childhood Illness (IMCI). These are many effective pilot projects – proven to work – that have not been broadly implemented. Three examples:
Incorporate IMCI into physician and nurse education in every developing country. IMCI prevents stunting, promotes breastfeeding, and gets mothers to support child development by talking to their children more. It provides inexpensive, effective care for children. We know how train health care works in the strategy, and we know how to include it in medical education. The only thing stopping global adoption is money.
Meet the unmet demand for contraception. Studies have shown that giving couples access to contraception reduces child mortality rates, maternal mortality rates, and deaths from unsafe abortion. Letting women control their fertility also helps to promote gender equality and improve a family’s income. And contraception can be provided by trained health workers; a physician is not needed.
Put more resources into tropical diseases. Onchocerciasis control is a demonstrated success story, but 18 million people are still infected with the nematode that causes it. The African Programme for Onchocerciasis Control seeks to control the illness through universal treatment by 2010, but it will require financial support to keep providing the necessary drugs.
If we want to innovate, we should innovate with our funding models. The United States should start a fund that is devoted to supporting pilot projects that want to expand their reach. That would be an effective counterpoint to the many funding programs that provide “venture capital” for innovative efforts. Governments, NGOs, or UN agencies could apply for funding to scale up pilot programs with a certain number of years of experience, and a certain level of proven effectiveness.
Individuals and foundations love to fund innovative ideas; exciting new programs are easily marketed to foundations and philanthropic individuals. The Gates Foundation, for example, has a clear focus on innovation. In contrast, there is an important role for the US government in supporting the interventions that have been proven to succeed.
The American government doesn’t need to sell its ideas to fickle donors or get intensive publicity for the work it does. Instead, it can commit to the slow and steady underpinnings of global health. It’s good for global health efforts to have reliable donors supporting programs that work, and it’s good for American taxpayers to know that their money is going to projects that will definitely have an impact in improving global health.
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I think you know how I feel about innovation. Consider this an electronic high-five from me to you.
I would have given you first place.
Interesting…I so enjoy your posts.
When I visited Cambodia a couple of years ago, I went to hear a talk by Dr. Beat Richner, a Swiss physician who has founded (I believe) seven public hospitals in Cambodia. You may be familiar with him.
The hospitals are well-equipped considering their locations & regional infrastructure.
What surprised me about Dr. Richner is that he believes that even the poorest of the poor should have access to the most advanced diagnostic & treatment technology…he is against the idea of equipping medical facilities according to WHO-defined “regional capacity.” I found his ideas interesting but impractical (though his funding model is probably worth exploring).
What good is a CT scanner (which Richner says is the only way to detect tuberculomas) if your socioeconomic status, housing conditions and poor nutrition leave you vulnerable to TB?
Not that I am anti-innovation…but the less-glamorous social determinants of health need to be considered in the selection of public health interventions.
More info on Dr. Richner: http://www.beat-richner.ch/
On a somewhat related note, I blog about ethical gift-giving vs. sophisticated intervention here: http://cmckeen.blogspot.com/2009/09/gift-of-goat.html
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This post was mentioned on Twitter by alanna_shaikh: New blood and milk post – against innovation in global health http://bloodandmilk.org/?p=1444…
I pretty much said the same thing to a group of mHealth funders (US Gov & Foundations) and was dismissed. They all wanted to fund innovation pilots for personal bragging rights, but yet complained that nothing scales.
what do you mean by “now”? why is intervention needed less “now” than at some vaguely undefined other time?
Wayan – that’s depressing, if even the government won’t fund the boring stuff.
Patrick – Good question. I was thinking that in times of prosperity, we have more money to spare on experimental efforts, and when money is tight we should only spend on what we know to work.
Just the other day I was thinking about how useful it would be to a charity called “The Boring Fund” that just rose money for programs that really wouldn’t turn anyone’s crank but are slow and boring and really ultimately helpful.
[…] Yes, I’m on about innovation again. First, if you haven’t done so, read this post at Blood & Milk. Programmatic innovation: skip it and focus on doing properly what we already know works. I […]