Moving Along Smartly

I’ve observed that we in the US are gifted with an extensive global health industry composed of advocacy groups, policy think tanks, academic institutes, and non-governmental organizations/contractors.  I’ve also noticed that several of these groups in the past year have weighed in on what the US government should being doing (a change of administration helped, I guess).  Examples are:

-The U.S. Commitment to Global Health:  Recommendations for the New Administration, Institute of Medicine, May 2009 (IOM Report);

-The U.S. Government’s Global Health Policy Architecture:  Structure, Programs, and Funding, Kaiser Foundation,  April 2009 (Kaiser Report);

-The Future of Global Health:  Ingredients for a Bold & Effective U.S. Initiative, the Global Health Initiative, October 2009 (GHI Press Release); and most recently

-The Report of the CSIS Commission on Smart Global Health Policy, Center for Strategic and International Studies (CSIS), March 2010 (Smart Report).

I was pleased to learn more about the CSIS report first hand when three members of the Smart Commission as well as several notables from the New England global health community presented the report’s key recommendations and took questions at Boston University this past Monday (the Commission will present at several other locations this year; see Smart Global Health).

The Commission’s recommendations may be boiled down to two points:  give global health policy and action higher priority (in part by appointing a senior State department czar) and spend more money (primarily through advocacy groups, policy think tanks, academic institutes, and NGO contractors).  Their recommendations were not much different from those of the other reports, leaving me wondering what new findings the 25 commissioners found while holding two all-day meetings, making “numerous conference calls and expert consultations,” and visiting Kenya.  There is no reference in the report to what they thought about duplicating the efforts of the other advocacy groups or how they were funded.  The Commission did add a new slant to their deliberative process in that they solicited public input:  “With the help of the staff of Blue State Digital, we created an interactive Web site, www. smartglobalhealth.org, which allowed us to exchange ideas with thousands of people who proposed questions for deliberation, anecdotes and photos from the field, and most importantly, fresh, critical insights.”  It’s a great idea, to involve us nonprofessionals, but I did not see a description of how the input was/will be considered and incorporated (I’ll submit and see what happens).  I also noted that one of the commissioners is a founding partner of Blue State Digital, so perhaps it is not surprising Commission decided to seek web-based input using this company’s help (was it free?).  I also noted that the Commission concluded, as most of the professional global health industry has, there is little role for companies or market-based solutions in the government’s global health program.  On page 11, the authors recommend the “U.S. government can more systematically tap the special competencies of the U.S. private sector to strengthen the performance of U.S. global health programs,” so use companies as contractors but don’t use or learn from their abilities to invent and deliver products and services at affordable prices.

I followed up on a few of the points made by the presenters at Monday’s forum:.

Gerry Keusch, a professor of international health at BU (who I have met with about BU’s global health initiative) (Keusch Bio), mentioned the extensive involvement of our local biotech and pharma companies in global health but other than two representatives (from Genzyme and Novartis), I didn’t see other companies represented at this meeting.  Maybe New England would benefit from a regional association to bring together our academic, political, and corporate global health interests.

Peter Lamptey, a Commissioner and president at Family Health International (Lamptey Bio), summarized the Commission’s recommendations using the word, investment, many times but it seems to me that investments are made with an expectation of results and with a means of holding those who are receiving the investment accountable for achieving those results.  The report states that someone needs to create a “new evaluation framework” needed to measure results and verify progress, and I’m hoping the Commission follows through and undertakes a comparative study of evaluation methods, at least.

Jim Geraghty, senior vice president at Genzyme, said that global health is “central” to Genzyme, and but did not mention specifics.  On  their corporate website I found only one document, the 2006 Philanthropy Overview (2006 Overview), that briefly mentions their global health efforts.

Michael Capuano, one of our state’s congresspersons (Capuano), is know as a direct speaker and stated the audience should not expect leadership in global health (or anything else) from their elected representatives and said that, off the island of Massachusetts, many people don’t see a reason to spend money on improving other people’s health when they don’t have insurance themselves.  But is it really an either-or situation?  I can think of lots of ways to redirect current Federal dollars to pay for the Commission’s recommendations.  As for leadership, if he needs a staffer who can provide him advice on what “following” he needs to do in global health, I’m available.

Joel Lamstein, a founder and president of John Snow International, a government- and foundation-supported consulting firm (JSI) said that the implementation of change is often ignored in policy and is under-funded in practice, but, surprisingly, did not comment on the Commission’s approach to implementation, which seems more of the same with its mixed results at best.  As an example of the implementation challenge, he mentioned that JSI has been working on improving maternal and child health in Nepal for 20 years.  According to USAID (e.g., USAID Nepal), the country’s maternal and child health has improved (but is still too low) and improvement has been slowed by an insurgency (also noted by Joel).  I wondered what JSI has learned about implementation after 20 years there and if they could share it (and what their overhead rates were).

Next week:  BIO 2010 and the Partnering for Global Health Forum.

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