Posts Tagged 'horizontal vs verticle'

Top 3 Debates in Global Health

Victor Roy has a great post up on GlobeMed‘s Article 25 Blog about 3 major debates common in the globalĀ  health community: 1) horizontal vs. vertical design of health programs, 2) the prevention vs. the treatment of disease, and 3) paternalism vs. measuring the effectiveness of international aide $$.

I think that the debate of horizontal vs vertical health programs is nicely summed up by the back and forth correspondence between Dr. Paul Farmer and Laurie Garrett published in Foreign Affairs‘ discussion of how to best promote global health. Garrett is a strong critic of the “stovepiped” models of providing disease specific, large scale funding citing evidence that it can pull vital resources away from underfunded primary health care efforts. Farmer tends to agree with Garrett in that western dominated funding of programs that ignore the social underpinning of suffering and disease are not nearly as effective as those that engage grassroots leaders and address fundamental human rights. However, he cautions us not to be so quick to dismiss the good that can come from using disease specific aid and diverting it to programs that work towards achieving more broad health equity goals.

The influx of AIDS funding can indeed strangle primary care, distort public health budgets, and contribute to brain drain. But these untoward or “perverse” effects are not inevitable; they occur only when programs are poorly designed. When programs are properly designed to reflect patients’ needs rather than the wishes of donors, AIDS funding can strengthen primary care. PIH has shown this throughout central Haiti, in eastern Rwanda, and in the mountains of Lesotho, and is going to use the same model in southern Malawi. In each of these settings, we work under the aegis of the Ministry of Health (and, in three of them, with the Clinton Foundation) in order to promote the notion of health as a human right. In some cases, programs have to be built from scratch; in others, it is necessary to rebuild public infrastructures damaged by war, neglect, or the misguided advice of outside experts.

Farmer et al. has been tremendously effective in developing a model that is able to take foreign funding – which in many contexts has at best shown modest results and at worst (as Laurie Garrett discussed) negatively impacted people’s health – and transform it into a vehicle for equity. Hopefully PIH‘s model and evidence of success will act to catalyze a change in international aid from a force propagating structural violence to a force restoring human dignity and rights.

I’ll try to add some comments about debates #2 and #3 as well as the wild card – public vs. private models in global health – in the coming days. Stay tuned!

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