Why the Global Health System Is Broken and How It'll Get Fixed

In an opportunity of a lifetime I was invited to the 77th World Health Assembly by the World Health Organization in Geneva.?

Not only did I get a chance to attend, I was asked by Devex to speak to a global audience.?

I also got a rare opportunity to sit down and break bread with some of the biggest leaders in Global Health from both the Private, Public, Donor and Governmental sectors.?

What I had learned is that many of the problems that face Global Health stem from the same root cause.

Fragmentation?

By fragmentation I mean, that different institutions, often with similar goals, go about implementing projects and programs in their own way.?

In isolation this isn’t a big deal, but when viewed at a macro level, and considering the incentives at play, it leaves patchwork Health Systems as the result. Something where long-term sustainability is difficult to achieve.?

Some of the most impactful things I had heard were the stories of how siloed global institutions had historically been.?

Some organizations focus on strengthening the capabilities of the local government, other Private sector actors want to empower consumer purchasing power and choice, and Donors want to achieve maximal impact by minimizing the loss of life.

To many outsiders these goals are not incompatible, in fact they seem very complimentary.

I’d agree with them.?

However like with many things, it all comes down to incentives and execution.?

Let me try to provide a fictional, but representative example.?

1. A Global Institution called the “World Wellness Organization” wants to help a developing country of “Davidland” to rapidly respond to a new crisis by investing huge resources into their health system.
2. Meanwhile a Global Pharmaceutical “Healthy Inc.” is investing into the same country by trying to address the significant supply-demand gaps for a particular health product as a result of the crisis.
3. A Donor “Good Human Foundation” wants to save lives by providing products to the people that need, but can’t get access to them.

This is what typically happens:

1. The local government, via the “World Wellness Organization”, invests in training and up-skilling their staff.
2. “Healthy Inc.” invests millions in hiring staff, and building a sales team to close the supply-demand gap.
3. "Good Human Foundation" raises billions of dollars to procure the medicines in order to freely distribute them to the people that need it.

When this happens all at once:

1. The newly trained staff in the "Davidland Ministry of Health" leave to join the private sector for better salaries, career prospects, and opportunities for their families
2. Healthy Inc. now has huge upfront costs, and a reduced market size due to the dilution of demand as a result of the free products. Their profitability is hit and that harms any business case for further investment into that country.
3. The Good Human Foundation has saved thousands of lives, however once the funding stops, the need for the medicines, and therefore the need for more funding will emerge again.

This is the opposite of sustainable.?

However in spite of this bleak picture, it is really encouraging to see that this problem has been recognized by all parties, and new joint efforts are emerging as a result.?

Private Sector Engagement

I was fortunate to witness first hand the proactive way that the Global Health Institutions are beginning to engage with the Private Sector.

You also have major Private sector players seeking to engage more actively with Public Health Institutions, Local Health Ministries, Donors and Startups like Kapsule to create long-term, and sustainable, solutions.

By sustainable, I mean solutions that once started, are able to continue, independently of government or donor funding.

This new, coordinated, approach to healthcare delivery is what I believe will not only fix the issues that happen in developing countries, like those in Africa, but health systems in developed markets too.

My take home message is that the future is bright because you have leaders who acknowledge the errors of the past, have clear and principled goals, and are willing to think and act creatively.