The first part of this article appeared in Issue 264 of The African Executive.
The future of global health appears bright. Political support for global health remains strong around the world. Pragmatism in policy making and a program focus on solving problems is steadily gaining traction in global health. Concerns of poor nations are receiving appropriate attention in various global health entities and forums. Africa and other geographical regions with large numbers of poor nations are developing continental platforms for action on health issues. Poor nations are increasingly linking national priorities to external donor supported initiatives.
As global health evolves, certain trends are emerging. An emerging trend is how best to share technical expertise across national boundaries, continental limits and institutions. Clinicians, public health experts, development experts and infrastructure experts increasingly work together to address basic needs in health, water/sanitation and agriculture. Road construction projects and rural electrification programs have major implications for the timely and efficient delivery of health services. Health experts in rich nations are paying close attention to lessons learned from global health programs in developing countries.
In addition, healthcare financing issues are critical issues in global health. Economists and financial experts now seat at table with health experts. Finance ministers in Africa are as important as health ministers on healthcare financing and health policy issues. National parliaments, with their appropriation functions are important in healthcare financing issues.
Efforts to address the quantity and quality of global health workforce represent another emerging trend. In some regions of the world, the situation is troubling. The WHO estimates that although Africa accounts for 24 percent of the global burden of disease, the continent represents only 3 percent of the global health workforce and less than one percent of global healthcare spending. Africa faces the daunting challenge of training, retraining and retaining its health workforce.
Another emerging trend is the integration of health and international development programs. Integration efforts remain focused on how best to mainstream health interventions into existing poverty reduction programs. Development programs in Africa usually have a health component.
The need for valid clinical, public health and laboratory research in global health is now center stage. An exciting growing trend is the sharing of financing, coordinating and management responsibilities of joint global health research projects across disciplines, countries and continents. These shared global health projects link universities and research institutions with their counterparts around the world.
Another emerging trend is the rise and influence of out-of-the-box bilateral/multilateral action against emerging health threats. The US President’s Emergency Plan for AIDS Relief (PEPFAR) initiative is a recent example. The UN Global Fund against AIDS, TB and Malaria is another example. The African Union resolution on drug manufacturing in the continent is a bold attempt to address a major health issue. The robust HIV/AIDS community-based response in Brazil is another example
Global health diplomacy is another burgeoning field in global health. Global health diplomacy has the dual focus of improving health services around the world as well as enhancing international relations worldwide. Global health diplomacy is now more visible in conflict situations, natural disasters and in resource challenged countries. Global health diplomacy is focused on addressing the intersection of foreign health assistance, economic inequities in recipient countries and the enlightened self-interest of both donor and recipient countries.
Enduring Problems in Global Health
Despite the bright future of global health, enduring problems remain. First, global health has its fair share of idealists with high expectations. Global health idealists believe that money and technical assistance must be available in sufficient quantities to meet demand. This pits global health idealists against policy makers in both rich and poor nations that must make tough decisions within the realm of finite resources and competing priorities. Pitched battles between global health idealists and policy makers in rich nations are well known. Luckily, some of these battles have led to remarkable results. Without the dogged determination of global health idealists, it is debatable whether rich nations would have moved decisively against HIV/AIDS in poor countries.
Two, lack of coordination of policies and programs remains an enduring problem. In a typical low income country, multiple global health programs may be operating at the same time in same target communities. It is not always evident that these multiple global health programs are operating in response to local health problems and priorities. The effort to coordinate and better operate global health programs has led to the emergence of non-traditional global health powerhouses. The emergence of the World Bank as a powerful “global health agency” and the growing, influential role of the Gates Foundation are recent examples.
Three, global health continues to operate on a financing mechanism that strengthens the hand of donor organizations at the expense of host nations and their priorities. Today, donor nations and agencies are very influential in the choice of programs implemented in host nations. A more equitable scenario will be a meeting of minds between the financial/technical assistance of donors and the articulated priorities of host nations. In the longer term, global health programs should aim at self sufficiency in host countries.
Fourth, measuring the impact of global health programs remains a challenge. It is difficult to provide direct evidence of linkages between a specific global health program and specific health outcomes in target populations largely due to the concurrent roles of multiple agencies working on similar issues within the same target population. Fortunately, universities and research centers have taken up the challenge. A major focus of this effort is the identification of what works and does not work in global health.
Finally, the direct voice of the poor and target populations remains elusive in global health decision making. Global health continues to grapple with the fundamental question of who represents or speaks for the poor, target communities and vulnerable populations. There are few verifiable examples in global health where target populations have participated directly, without filters, in the conceptualization and design of projects. There are even fewer instances where the knowledge, attitudes and perceptions of target populations directly informed the design of global health programs. Civil society organizations have done an admirable job of bringing attention to the health needs of vulnerable populations worldwide. However, the direct voices of the poor and vulnerable populations remain deafeningly silent in global health, whether it is in Africa or in other continents with large number of poor nations.
Global health is transforming how nations work with each other, how geographic regions collaborate on specific health issues and how the international community responds to specific health threats. In Africa and other parts of the developing world, global health is evolving from traditional concerns about the spread of infectious diseases to concerns about human security and dignity. The future of global health is bright as long as it focuses on the felt needs and priorities of target populations as well as on providing evidence that funded programs are efficiently and effectively implemented. Africa and continents with large numbers of poor nations have important roles to play in the unfolding scenario and emerging trends in global health.
By Dr. Chinua Akukwe
Former Chairman of the Technical Board of the Africa Center for Health and Human Security, George Washington University Medical Center, Washington, DC. He is also the Executive Chairman of the Africa Union Africa Diaspora Health Initiative.