By Sanskriti Sasikumar, Key Correspondent for the Irish Forum for Global Health
IFGH Conference 2014 Opinion Editorial
Global health has witnessed an increasing popularity in recent years. Although we seem to have a better understanding of its weaknesses, we have yet to implement structural solutions for its structural problems. However, in recent years there has been an increasing realisation of the benefits of healthcare partnerships, whereby local and international organisations work off each other’s strengths to bring about holistic and sustainable solutions. The movement might take a couple of more years to find its footing, but here is why it is worth the wait:
1) Global health interventions are neocolonialist
According to the World Bank, international aid is primarily provided in the form of monetary donations. So, money is often the solution to fixing health systems or tackling disease outbreaks in low- and middle-income countries (LMICs). This current system of aid perpetuates an unparalleled laziness. Dambiso Mayo, famed economist and author of Dead Aid, quotes that over $1 trillion in development-related aid has been transferred to Africa, and that has neither helped reduce poverty nor increase growth. Oyewale Tomori, the WHO’s regional virologist for the African Region in 1995, describes the region’s overt reliance on international aid in saying that “ten years on, people will have forgotten that an outbreak even occurred”.
Instead of strengthening the expertise of medical education and health systems in LMICs, high-income nations and private foundations focus on a very top-down approach. Millions are invested to obtain a quick, tangible solution to a problem instead of preventative measures that will likely eliminate the problem entirely. Let’s take the recent outbreak of Ebola as an example. Instead of improving education, early detection and tracking distribution, the pharmaceutical company, GlaxoSmithKline, teamed up with the WHO to develop a vaccine. Several years from now, if there’s an outbreak of another disease, more lives will be unnecessarily lost and we will continue to blame the ineffectiveness of health systems in LMICs.
Partnerships enable organisations to work intimately with the needs of a community, thereby strengthening existing systems to bring about progress.
2) A top-down approach perpetuates existing corruption in LMICs.
Weak healthcare systems force LMICs to rely heavily on international aid. The decreased accountability associated with those transactions worsens, if not invites, fraud. At a recent meeting on Emerging Diseases and Surveillance, Oyewale Tomori mulls on the impact of corruption in many African countries. He comments on the misuse of existing resources, and the lack of responsibility taken by the WHO regional offices in Africa, especially during the Ebola outbreak. He attributes these downfalls to the leaders’ lack of priority towards healthcare, so much so that a recent $2 million donation from the Global Alliance for Vaccines and Immunizations (GAVI) to the Nigerian government went suspiciously unaccounted for.
Partnerships can help to avoid this problem, by ensuring the accountability of all parties involved. They can therefore ensure a tactical and traceable means to a solution.
3) Healthcare interventions in LMICs deserve long-term sustainability
Equitable partnerships allow for the implementation of solutions based on the needs of the community. Therefore, communities are strengthened where they need strengthening. For example, Rwanda’s Human Resources for Health program is an eight-year partnership that employs the expertise of academics based in the United States to achieve similar standards among their medical professionals. Another instance of successful partnership building is between HIV experts, community groups and police in Kenya and Kyrgyzstan in order to tackle the rising rates of HIV among sex workers and drug addicts.
Partnerships have also been successful on a larger scale. The most successful example is probably that of GAVI, a public-private partnership that has effectively improved access to vaccinations in LMICs.
4) Global Health lacks strong leadership
The most glaring reason for a lack of leadership is the sheer variety and number of global health organisations. In an interview with the Guardian, Dr. Mohga Kamal-Yanni of Oxfam argues that age-old organisations, like the WHO, have a duty to maintain a standard in healthcare systems around the world. Although the organisation is unable to implement plans, strong leadership can result in convincing countries to meet essential infrastructure requirements. He also asserts that good leadership can put an end to earmarked donations that the organisation currently receives.
Well, partnerships will provide the WHO with an intimate understanding of the healthcare challenges in a country, leading to more realistic and attainable policies being made at the World Health Assembly. As a policy maker in global health, the organisation becomes an important means of coordinating health initiatives in partnerships.
We have the tools to patch up the cracks in the current state of global health. We know that partnerships have succeeded in the past. They work intimately with communities in need, and maximise existing resources to ensure long-term sustainability in their initiatives. Partnerships offer a solution to these significant downfalls in the current state of global health.
It’s up to us to manifest them into practice and implement positive change.
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