These are Exciting Times

Week 14 is over and we've come to the end of the semester and while I'm elated to be graduating, it seems a bit bittersweet, as I no longer have the safety net of school and must go out into the real world.
It's a also a very exciting time, as my colleagues are working on creating a project we hope will go on beyond our careers at USC.
We're starting a new venture called the Global Health Review
with a newsletter publication, website and multimedia components, similar to the law reviews put out by law students. Global Health Review's mission is to increase awareness of global health issues, needs, and opportunities, to promote education & initiative, and to facilitate change in global health.

The newsletter is most likely going to be on a monthly basis with email blasts to PH students at USC as well as other stakeholders and PH professionals around the globe (connections will be facilitated by our prof. Dr. G. Shahi), and the website will provide a channel for for people to sign up for publications, to find resources, to post media (i.e. documentaries, interviews, etc.), to mediate a forum, to create a blog and for networking. Eventually we will put out a journal once we've established the endeavor.
Stay Tuned for more on Global Health Review.
Yet another reason for the excitement is the publication of our book Emerging Trends in Global Health, which is a compilation put together by Dr. Shahi of our topical review papers from PM 565 and it's available for purchase and all proceeds go to the Global Health Review. So please purchase away!


P.S. When this class is over and I start my practicum in India at the end of May this blog will be transformed as a journal for my Indian adventures. I'm very excited about that as well.

Ethics in Global Health

During Week 13 we discussed Ethics and Global Health and the need for a universal code of conduct for Global Public Health professionals. In addition to increased empathy, I believe we must be educated in and have strict adherence to a set of values which are consistent with our desire to do good and conduct ourselves in an ethical and professional manner.

While there are international standards for conducting medical research on human subjects as established by the 1964 Declaration of Helsinki, there is currently no universal code of ethics for public health practice and no mechanisms in place for enforcement.

As a result, our own Dr. Shahi has proposed a code of conduct for life science professionals in Future of Biotechnology: Safeguarding the Opportunity, Dealing With the Risk”
at a 2004 Conference in Singapore. It serves as a guide for ethical behavior in global health.

Public-Private Partnerships in Global Health

During Week 12 we discussed Public-private partnerships (PPPs) , which have become prolific in Global Health in the past several years. While government has the ultimate responsibility of providing and improving the health of its population, there are limits to what the public sector can achieve on its own, as has been demonstrated again and again. Also, the private sector is now realizing that good health is a prerequisite to an effective workforce and fundamental fro economic growth and development and has increasingly become involved in global health solutions.
PPPs pool resources (financial and human capital) from the public and private sectors and have evolved as a response for the need to improve the quality of public service delivery. According to Thomas and Curtis, PPPs have emerged as a result of "an ideological shift which has created a facilitating environment for business, disillusionment with UN efficiency, a recognition that the global health agenda is too large for a single sector or organization to address on its own, a realization that the market alone cannot provide solutions, and a growing interest within the private sector to enhance its involvement in social issues."

Currently, PPPs in health provide preventative healthcare for Sexually Transmitted Disease and malaria, as well as developing and facilitating access to vaccines and drugs ( GAVI Alliance )and improving health service delivery.

The emergence of such cooperation between the public and private sectors is very exciting in global health because they 1. signal a fundamental shift in how things are done in Public Health 2. the adversarial relationship and distrust that has long existed between the sectors is now morphing into mutually beneficial partnerships and the global community will benefit as a result 3. The private sector will bring in efficiency and understanding of market mechanisms and the public sector will contribute with accountability and creation of markets 4. cooperative partnership will yield more favorable health outcomes, especially in developing countries where public health infrastructures are anemic.

However, in order for these partnerships to succeed they must be transparent, have accountability, a well-defined leadership and good governance.
It is an exciting time to be involved in Global Public Health, as technology and now public-private partnerships offer a viable solutions to global problems.

Heathcare Financing and Health Outcomes in the Global Context

During Week XI we discussed healthcare financing and health outcomes in the global context. I presented on performance based financing in health care based on the article Making Health Care Accountable: Why performance based funding of health services in developing countries is getting more attention by Hecht, Batson & Brenzel, published in 2004 in Finance & Development. The article discusses the increasing importance of performance based financing, which refers to efforts to link international aid money for health to concrete, measurable results on the ground. PB financing was pioneered by Global Alliance for Vaccine & Development GAVI, The Asian Development Bank, and USAID.

Governments in developing countries and their international partners are increasingly becoming more interested in performance-based health financing for three reasons: including Achieving the MDGs, increasing the effectiveness of aid resources, and increasing accountability.
Achieving the health MDG's: governments and donors are interested in funding programs that have measurable results toward health MDG’s & results are closely tracked for MDG achievement, for instance if immunization & fast treatment of pneumonia decreases # of child deaths (a health MDG) programs that combat respiratory disease are more likely to get funded.
Increasing Effectiveness of Aid Resources: Donor agencies want to increase effectiveness of aid money by allocating them to countries/programs that can demonstrate progress as measured by performance indicators
Accountability: If financing is dependent on performance results, providers are more likely to produce results.

Types of Performance-based financing in health include:
Performance-based contracts with NGO’s where governments in Low Income Countries fund NGO’s to deliver basic-health services on a performance basis. NGO's performance is measured against various indicators, i.e. immunization coverage, % of families using ORT and bonus structures are in place to reward NGO's for performance beyond the negotiated budget. Guatemala presents a success story in large scale contracting with 80 NGO's to provide basic health services to 3.7 million indigenous people, which resulted in a rise in immunization rates from 69% in 1997 to 87% in 2001.

Another type of PB Financing is accomplished when the central government makes per capita transfers of funds to local municipalities based on the municipality's performance in strengthening the health system.

The third type of PB financing is done through the mechanism of direct donor disbursements to national governments based on performance results. GAVI provides an excellent illustration of this type of PB financing. GAVI provides commodity assistance to countries in the form of new & underused vaccines and safe injection supplies. GAVI further allocates grant funds to countries that increase coverage rates for vaccinations. For instance, in 2004 GAVI gave $15 million each to 10 different countries for achievements in increasing immunizations particularly for DPT3 vaccine. The way this mechanism works is low income countries apply to GAVI, specifying current immunization coverage levels & at the end of the year countries receive $20 for each additional child immunized above the baseline level. GAVI verifies the country's performance based on externally audited data.

Performance based financing can help stimulate countries/providers to expand their coverage to reach poor people who lack access to health care and help enhance the quality of service delivery. PB financing is also helpful in focusing all parties on services produced, rather than inputs such as drugs, number of hospital beds etc.

There are a number of challenges that developing countries face in implementing PB financing, including difficulty of measuring performance quickly & accurately, quality & comprehensiveness of national monitoring systems to track health performance, and lack of Ministry of Health capacity to design, negotiate, and enforce performance contracts with NGO's.

Performance based financing, if designed and executed properly can result in accountability for international aid money and change in health status of people in developing countries and will become the standard in health care financing.