Five things that won’t do much for global health

Published January 13, 2009 @ 02:45PM PT

Picture of the USS Mercy

We don't like talking about the programs that don't work. No one wants to think of money wasted, or the lives that could have been saved if a program just worked better. Most of the time, bad health programs don't hurt people; they just absorb resources that could have gone to programs that actually did something.

In my opinion, though, saving fewer lives than you could have is almost as immoral as not helping at all. In that context, it's important to look at the things that don't work. Here are five solutions that won't do much at all for global health.

1. Sending excess pharmaceuticals overseas.

This doesn't work because there is very little match between supply and demand. The developing world has different pharmaceutical needs that the wealthy world. Developing countries need antibiotics, painkillers, HIV drugs, and vaccines. The developed world tends to have excesses of drugs like Viagra, blood pressure drugs, and allergy medicine. Sending that to the developing world is worse than doing nothing because it forces recipients to find a safe way to destroy it once it has expired.

2. Sending used medical equipment overseas

Almost all medical equipment used in the developed world is expensive and requires sophisticated maintenance. Donated equipment may not be reparable, and it often breaks down quickly when housed in un-climate controlled buildings with extreme temperatures. Furthermore, providers may not know how to use the equipment, or when it is useful.

3. Hospital ships

Hospital ships serve only coastal populations. They provide one-time treatment that people have to travel a long way to access. They can't give follow-up care. They are staffed by volunteers who have varying degrees of familiarity with the illness of the developing world. They are a band-aid, and not one of those good-quality flexible fabric bandaids. They are a cheap plastic band-aid that won't even stay stuck.

4. Tertiary care hospitals

It's true that the developing world lacks of specialist hospitals. There are few cancer hospitals and few cardiac hospitals. Not many providers can provide ultra high-level care like neurosurgery, cancer treatment, or care for very premature infants. While it's heartbreaking for people to go untreated, a dollar spent on increasing vaccination coverage or improving training for healthcare providers will go a lot farther than a dollar spent on providing specialist care.

Here's a blog post on cervical cancer that offers a different approach, and makes its point well.

5. Sending people to the US for medical care

Sending people to the US for medical care is expensive, logistically complex, and taxes vulnerable people far from their homes and leaves them without emotional support. It also does nothing to build capacity on the health care system of their home country. We can find better ways to help people who can't get care in their home countries.

Isaac Holeman thinks I am wrong about this, and he's got a good point.

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Comments (10)

Hi Alanna,

I began to leave a comment and, as has happened so many times, it stretched on to become the length of an entire post. Here is the introductory paragraph.

I think a key issue at the heart of some such of programs is the balance between long term effectiveness and the fierce urgency of now. I agree that the programs you describe would play a very small role in an ideal global health care service, but ultimately what we need more than any specific program is for people to give a damn. Some people have excess resources; we need them to care enough that they are willing to share some of those resources with the rest of the human family. If irrational programs will occasionally inspire people, perhaps they are worth the cost.

I'd love to hear your thoughts and have comments on the rest of my post.

http://www.isaacholeman.org/2009/01/13/defense-of-irrational-medicine/

Posted by Isaac Holeman on 01/13/2009 @ 04:41PM PT
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Isaac,

Just went and read the post. You've got a great point, and it's one I tend to forget about. You can't ignore the human heart.

Posted by Alanna Shaikh on 01/13/2009 @ 04:58PM PT
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isaac-

ditto to isaac. i was planning on making a similar point, using the same example :)

what's need is a patient-centered approach, one that positions health as a human right. this calls into question both (4) and (5).

the money's out there - even for treating cancer in a place like rural rwanda. one potential source.....:

http://www.globalissues.org/i/military/increase-1996-2005.png

Posted by Peter Luckow on 01/13/2009 @ 09:11PM PT
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In an ideal world, I agree. The money is out there.

When you're facing a limited budget, though, it's a different story. I think you have to use your limited budget in the most effective way possible, and push for the budget that lets you do everything.

Posted by Alanna Shaikh on 01/13/2009 @ 09:19PM PT
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I wholeheartedly agree with your points, especially #2, which I witnessed firsthand living in a developing country that had sporadic electricity and therefore not much use for equipment that needed 24-hour "juice".

And I'd add on to your point #4 that basically any programmes that are specialised and neglect a holistic approach to health are bound to fail in the end. I work on behalf of survivors of rights abuses and political violence, and we know that medical treatment goes hand in hand with mental health and social programmes.

Posted by Brandy Bauer on 01/14/2009 @ 02:42AM PT
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Isaac raises a compelling point about personal compassion and the importance of stories.

However, much of what Alanna points to focuses on misguided good intentions, which can have all kinds of dangerous, if unintended, consequences.

A digression: Several months ago I saw a story about a group that was donating compact fluorescent light bulbs to somewhere poor in Africa (apologies for not being able to recall specific details). It was touted as being green, with lots of energy savings. Well... those darn CFL's have mercury. Is there take-back system in African villages? What do you do with broken bulbs? (Have you read the EPA's clean up guidelines? http://www.epa.gov/mercury/spills/index.htm Frankly, if I lived in a earthquake-prone I'd think twice about wanting them in my home or office...).

That an extraordinary effort to profoundly improve an individual's life - and by extension the lives of family and friends - has an intrinsic inspirational value there can be no doubt. But for much of what's on the list above, it's not just a good heart, but an *informed* good heart that makes the difference.

Posted by J A Ginsburg on 01/14/2009 @ 06:54AM PT
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It is unfortunate that good intentions can sometimes cause harm, and it is a rarely discussed issue. Unite For Sight trains its volunteers in best practices in global health, and a module in its Global Health Online Course (http://www.uniteforsight.org/global-health-course) discusses the "worst practice" principles that are often employed by some organizations that can do significant harm. Short term "plastic band aid programs", as Alanna eloquently describes, can do harm. We should work to ensure that those involved with short-term interventions become familiar with best practices in public health so that all of the efforts allocated for "plastic band aid programs" are redirected to creating sustainable, high quality medical programs that support local medical providers on a year-round, long-term basis.

Posted by Jennifer Staple on 01/14/2009 @ 08:31AM PT
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The best thing we can use in the developing/third world is concern and the willingness to help...and this comes in the form of genuine love for eachother regardless of location or social class...but perhaps more important is the establishment of rational and scientifically-based reasons for proper healthcare in disadvantaged regions.

If the people of any community are unhealthy today - then their children, and grand-children, won't be healthy tomorrow. That said...lack of proper healthcare creates a failure to thrive in all other socio-economic indicators....how can a teenage girl concentrate on getting her education when her mother is suffering from TB? How can the head of an impoverished household ever get his/her family out of poverty if his earnings can only go towards his children's medical issues? -- Most of these medical problems only exist because of the lack of preventative care - and even basic education (i.e. safe sex, handwashing, etc.) that is considered common sense in the US.

Great conversation Alanna.

Posted by Lateef X on 01/15/2009 @ 11:30AM PT
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I would like to heartily agree with the comments "sending excess pharmaceuticals overseas" and "sending used medical euqipment." Having worked in mission hospitals in Africa for the past twenty years, I have been on the receiving end of thousands of pounds of useless medicine and equipment. We spend hours sorting through donated medicines hoping to find something useful, and we seldom do. The used equipment usually runs on 110 volts, and our hospital runs on 220 volts, so most of it we cannot use.
As far as medicines are concerned, the best thing is to send money so the hospital or health organization can buy exactly what they need. A great organization supplying medicines to developing countries is the International Dispensary Association (IDA) in Amsterdam, Holland. Our hospital orders from this association on a regular basis. We cannot use Malawian kwachas to pay for the medicines, and need some source or hard currency to pay.
Dr. Sue MakinMulanje Mission Hospital

Posted by MarySue Makin on 01/16/2009 @ 07:02AM PT
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Wow! it's wonderful.I think a key issue at the heart of some such of programs is the balance between long term effectiveness and the fierce urgency of now. I agree that the programs you describe would play a very small role in an ideal global health care service.Thanks...

Posted by Buy Avodart James Paul on 03/20/2009 @ 12:25AM PT
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Alanna Shaikh has spent the last ten years immersed in global health; she has worked for NGOs, companies, universities, and the US government on projects that ranged from preventing antibacterial resistance to improving maternal and child health.