Advocacy Project

C hapter 7

G lobal H

ealth Im

plem entation

G lobal H

ealth Interventions 7.1

G lobal H

ealth Players •

T he entities that set global health priorities and fund

global health activities are usually distinct from the

entities that im plem

ent health projects in com m

unities. •

T he typical funding pathw

ay for a global health initiative is for a donor(usually a high-incom

e country’s governm

ent or a large foundation) to give m oney to a

first-level recipient(such as an international cooperation agency; a m

ultilateral organization, such as U nited

N ations agency or a global partnership; or a

nongovernm ental organization), w

hich then passes funding along to num

erous second-level recipients that

im plem

ent the project (such as a governm ent agency,

nongovernm ental organization, or private-sector

contractor).

Figure 7-1

Typical pathw ay from

global health funders to im

plem enters.

G lobal H

ealth Interventions •

Funders often use term

s like strategy and policy to describe the outputs they generate. •

Strategy = a big picture plan for how to achieve a m

ajor goal. •

P olicy = a set of principles and procedures that guide decision-

m aking and resource allocation.

• A

ction plan

= the steps that w ill be taken to achieve strategic goals

and im plem

ent approved policies. •

Schem e = an operationalized plan that spells out the desired

outcom es and com

pletion tim elines for an action plan.

• Im

plem enters

m ore often use term

s like program and project to

describe their w ork.

• P

rogram = a portfolio of related projects that together achieve part

of an action plan. •

P roject = a series of coordinated tasks that are com

pleted w ithin a

lim ited tim

e period in order to achieve a specific target.

Project M anagem

ent

•D eliverable

= a product, service, or other result of a project. •P

roject m anagem

ent = the process of initiating, planning, executing, m

onitoring and controlling, and closing out projects. •A

project m anager is responsible for

ensuring that deliverables are com

pleted on tim e and w

ithin budget.

H orizontal and V

ertical C linical

Program s

• M

any im plem

entation groups provide clinical health services at hospitals and clinics or through com

m unity-

based care providers. •

A horizontal program

strengthens an existing health system

so that it can deliver additional health services. •

H orizontal program

s are often described as integrating new

ly funded packages of health services into existing prim

ary care delivery system s.

• A

vertical program delivers disease-specific services that

are not fully integrated into the health system .

• V

ertical program s are often used to address global health

priorities like disease eradication efforts that dem and an

intensive but tim e-lim

ited series of coordinated efforts.

R elief and D

evelopm ent

• R

elief is aid that m eets the im

m ediate needs of people w

ho m ight

otherw ise not have access to w

ater, food, shelter, em ergency

m edical care, and other urgent necessities after m

ajor natural disasters and during w

ars and other types of hum anitarian crises.

• D

evelopm ent is a long-term

process of im proving the

socioeconom ic and environm

ental conditions that are associated w

ith poor populations’ health status. •

Som e developm

ent program s are designed centrally by professionals

and dissem inated to participating localities.

• Som

e use a slow er com

m unity developm

entprocess through w hich

com m

unity m em

bers identify their ow n priorities and take action to

achieve them w

ith the support of partner organizations. •

R elief groups quickly deliver the m

aterial goods needed for survival, w

hile com m

unity developm ent groups m

ake long-term

investm ents in capacity building and sustainable change.

A dvocacy and L

ogistics •

A dvocacy

= the process of increasing aw areness of a

specific cause in order to influence policy and resource allocation decisions related to that issue. •

Social m edia

(electronic com m

unication tools that allow

users to generate and share content) have becom e an

im portant part of m

odern advocacy because they enable new

s about em erging public health problem

s to be dissem

inated to large audiences in live tim e.

• L

ogistics = the process of coordinating com

plex operations, especially the m

ovem ent of supplies and

equipm ent.

• L

ogistics specialists are able to efficiently procure or produce, package, transport, store, and deliver food, m

edications, m edical devices, and other goods to people

and com m

unities in need.

A dvocacy and L

ogistics (cont’d)

•A dvocacy calls for an action to be taken,

and logistics m akes that action happen

after funding for the activity has been secured. •M

any of the largest global health im

plem enters w

ork across a diversity of functional areas and in m

ultiple w orld

regions; sm aller im

plem enting entities

m ay focus on one area of expertise and

w ork w

ithin a lim ited geographic area.

L ocal and N

ational G

overnm ents

7.2

G overnm

ents and H ealth

• In m

ost countries, the m ajority of clinical health services

are provided at governm ent-ow

ned and -operated health facilities or at private nonprofit or for-profit health facilities that are highly regulated by governm

ents. •

G overnm

ents set health policies. •

G overnm

ents are responsible for the public health system .

• G

overnm ent public health agencies protect residents from

unsafe foods, m

edicines, other products, and environm ental

hazards; provide recom m

endations and regulations about nutrition, vaccination, screening tests, w

orker safety, and other actions that prom

ote health and prevent disease; and respond to outbreaks and other threats to public health.

Figure 7-2

G overnm

ents are responsible for im

plem enting m

ost public health activities.

H ealth O

fficials •

T he lead governm

ental health agency in a country is often called the M

inistry of H ealth (M

O H

). •

T he M

O H

takes the lead on m aking form

al requests for assistance from

the governm ents of other countries,

intergovernm ental agencies (such as the W

orld H ealth

O rganization), and global partnerships.

• T

he M O

H also oversees the w

ork of outside groups that are providing clinical and public health services w

ithin their borders. •

E ven w

hen form al approval prior to the

im plem

entation of a new initiative is not m

andated, projects often benefit from

the advice and support of local and national governm

ental officials.

H ealth in the U

SA

•In the U nited States, the D

epartm ent of H

ealth and H

um an Services (H

H S) conducts the

functions of a health m inistry along w

ith other roles. •H

H S’s lead health protection agency is the

C enters for D

isease C ontrol and P

revention (C

D C

). •

O ne of the m

any roles of C D

C is responding to

outbreaks and other public health em ergencies,

including participating in international responses w

hen foreign governm ents invite C

D C

to collaborate.

H ealth in the U

SA (cont’d)

• T

he N ational Institutes of H

ealth (N IH

)is H H

S’s division that conducts health research. •

O ther operating divisions of H

H S include the

A gency for H

ealthcare R esearch and Q

uality (A

H R

Q ), the A

gency for Toxic Substances and D

isease R egistry (A

T SD

R ), the C

enters for M

edicare & M

edicaid Services (C M

S), the Food and D

rug A dm

inistration (FD A

), the H ealth

R esources and Services A

dm inistration (H

R SA

), the Indian H

ealth Service (IH S), and the Substance

A buse and M

ental H ealth Services A

dm inistration

(SA M

H SA

), am ong others.

International C

ooperation 7.3

Foreign Policy •

F oreign policy

describes the strategies and approaches a country uses to engage w

ith other nations and to protect its ow n interests

as they pertain to security, trade, and other critical functions. •

T he “3 D

s” of foreign policy are diplom acy, defense, and

developm ent.

• D

iplom acy

is the process of negotiating agreem ents betw

een countries, resolving disputes peacefully, and navigating other aspects of international relations.

• H

ealth diplom acy

uses health projects as part of m eeting foreign

policy goals. •

D efense is carried out by m

ilitaries. •

D evelopm

ent in the foreign policy context is often called international cooperation

or developm ent cooperation, and it

includes financial assistance, capacity building, and other actions that im

prove the econom ic situation in low

er-incom e countries,

prom ote stability, and foster future opportunities for expanded trade.

International C ooperation

• M

any donor countries have a specialized agency that leads bilateral cooperation efforts. •

W hile each country’s developm

ent agency w orks to

alleviate poverty and im prove health, the goals, m

ethods, and targeted recipient countries vary based on the political situations and historic connections of the donor nation. •

T he U

nited K ingdom

’s D epartm

ent for International D

evelopm ent (D

FID ) tends to w

ork especially closely w ith

m em

bers of the C om

m onw

ealth of N ations (form

erly the B

ritish C om

m onw

ealth), w hich are alm

ost exclusively form

er B ritish colonies or protectorates.

• T

he Japan International C ooperation A

gency (JIC A

) w orks

w orldw

ide but is especially active in the A sian countries

w ith w

hich it has strong econom ic ties.

Figure 7-3

Exam ples of international developm

ent and cooperation agencies.

U SA

ID •

U SA

ID , the U

nited States A gency for International

D evelopm

ent, is a m ajor donor to global health activities

and also operates global health program s, partners w

ith other groups to im

plem ent global health activities,

engages in global health diplom acy, supports research and

developm ent, and provides technical assistance related to

global health. •

U SA

ID has been active for several decades in supporting

m aternal and child health program

s, infection control efforts, and health system

s strengthening, as w ell as other

aspects of global health. •

T he State D

epartm ent and the M

illennium C

hallenge C

orporation (M C

C ) also engage in health diplom

acy on behalf of the U

nited States.

T he W

orld H ealth

O rganization and the

U nited N

ations 7.4

T he U

nited N ations

•T he U

nited N ations (U

N ) is the w

orld’s largest intergovernm

ental organization. •

T he U

N w

as founded by 51 m em

ber states in 1945, at the end of W

orld W ar II, and since then

the m em

bership list has expanded to include m

ore than 190 m em

ber nations. •T

he goals of the U N

are “to m aintain

international peace and security,” “to develop friendly relations am

ong nations,” and “to achieve international co-operation in solving international problem

s of an econom ic, social,

cultural, or hum anitarian character.”

T he U

nited N ations (cont’d)

• T

he U N

is governed by its m ain bodies.

• T

he U N

G eneral A

ssem bly, w

hich is the chief policy-setting group for the U

N and is com

posed of one voting representative from each

m em

ber state •

T he 15-m

em ber U

N Security C

ouncil •

T he E

conom ic and Social C

ouncil (E C

O SO

C )

• T

he International C ourt of Justice, w

hich provides legal judgm ents

and advisory opinions •

T he U

N Secretariat, w

hich m anages num

erous departm ents and

offices, including the D epartm

ent of E conom

ic and Social A ffairs

(D E

SA ); the O

ffice of the U N

H igh C

om m

issioner for H um

an R

ights (O H

C H

R ); and the U

N O

ffice on D rugs and C

rim e

(U N

O D

C )

• T

he U N

also hosts program s and funds, specialized agencies, and

several U N

-related organizations, including the International A

tom ic E

nergy A gency (IA

E A

), the International O rganization for

M igration (IO

M ), and the W

orld Trade O rganization (W

T O

).

U N

Program s and Funds

• U

N program

s and funds are overseen by the G eneral

A ssem

bly and financed through voluntary contributions from

m em

ber nations. •

U N

D evelopm

ent P rogram

m e (U

N D

P ) focuses on

poverty reduction. •

U N

E nvironm

ent P rogram

m e (U

N E

P ) prom

otes healthy ecosystem

s and sustainable use of natural resources. •

U N

P opulation F

und (U N

F PA

), form erly the U

N Fund

for Population A ctivities, supports reproductive health

program s.

• U

N C

hildren’s F und (U

N IC

E F

), form erly the U

N

International C hildren’s E

m ergency Fund, advocates for

children’s rights and provides hum anitarian assistance for

children.

U N

Program s and Funds (cont’d)

• U

N -H

abitat, the U nited N

ations H um

an Settlem ents

Program m

e, advises on sustainable urban developm

ent. •

O ffice of the U

N H

igh C om

m issioner for R

efugees (U

N H

C R

) is the U N

R efugee A

gency. •

U N

W om

en, the U N

E ntity for G

ender E quality and

the E m

pow erm

ent of W om

en, prom otes gender

equality and w om

en’s em pow

erm ent.

• W

orld Food Program m

e (W FP) aim

s to eradicate hunger and m

alnutrition.

Figure 7-4

U nited N

ations program s and funds.

U N

Specialized A gencies

•U N

specialized agencies are autonom

ous international organizations that w

ork w ith the U

N

and are funded through both assessed contributions and voluntary donations.

Figure 7-5

U nited N

ations agencies.

O ther U

N E

ntities

•Joint U nited N

ations P rogram

m e on

H IV

/A ID

S (U N

A ID

S) is an entity co-

sponsored by 10 U N

system agencies

(U N

H C

R , U

N IC

E F, W

FP, U N

D P, U

N FPA

, U

N O

D C

, the IL O

, U N

E SC

O , W

H O

, and the W

orld B ank) to advance H

IV /A

ID S prevention

and control. •O

ther U N

entities that are not specialized agencies but w

ork w ith them

include the U N

O

ffice for D isaster R

eduction (U N

ISD R

) and the U

N O

ffice for Project Services (U N

O PS).

W H

O

•T he W

orld H ealth O

rganization (W

H O

), launched in 1948, is a specialized agency of the U

N that serves as its prim

ary health agency. •T

he W H

O is governed by the W

orld H

ealth A ssem

bly, com posed of one

representative from each U

N m

em ber

state, w hich convenes every M

ay to approve a budget, m

ake policy decisions, and approve conventions, agreem

ents, and regulations.

W H

O (cont’d)

• T

he core functions of the W H

O are to provide

leadership for the health w ork being done across the

U N

, identify global health research priorities, develop standards of practice (such as child grow

th charts and recom

m endations for laboratory and

diagnostic procedures), form ulate evidence-based

policy recom m

endations, provide technical support to U

N m

em ber nations, and m

onitor disease epidem

ics and other types of health statistics. •

C urrent priority areas include health system

s strengthening, health prom

otion across the lifespan, and em

ergency preparedness and response.

International H ealth

R egulations

7.5

IH R

• T

he International H ealth R

egulations (IH R

)are a global health security agreem

ent betw een all of the

m em

bers of the U N

. •

U nder the IH

R , all countries agree to notify W

H O

im

m ediately about situations that m

ight becom e public

health em ergencies and to share critical inform

ation w ith

all m em

ber nations w hen outbreaks are occurring.

• T

he m em

ber nations also agree to develop and m aintain

public health system s that are able to m

onitor population health status, identify em

erging problem s, and respond to

health crises, and they pledge to engage in travel and transportation practices that protect global public health.

IH R

H istory

•T he IH

R are derived from

agreem ents

negotiated in the m id-1800s by several

E uropean countries that w

orked together to prevent the spread of cholera outbreaks w

ithout stifling international shipping and trade. •W

H O

w as established in 1948, and in

1951 the m em

ber nations adopted a set of International Sanitary R

egulations that w

ere based on the existing cholera control fram

ew orks.

IH R

H istory (cont’d)

• T

hese international law s governing global health security

w ere renam

ed the International H ealth R

egulations in 1969 and updated to focus on control of six infectious diseases: cholera, plague, relapsing fever, sm

allpox, typhus, and yellow

fever. •

M odifications m

ade in 1973 and 1981 reduced the num ber

of reportable diseases to just three: cholera, plague, and yellow

fever. •

A m

ajor overhaul of the IH R

adopted in 2005 increased requirem

ents for shared com m

unication about and responses to influenza, viral hem

orrhagic fevers, and other em

erging infectious diseases and events of potential international public health concern.

SA R

S •

T he 2005 updates w

ere a response to the em ergence of

severe acute respiratory syndrom e (SA

R S), a

coronavirus infection that caused its victim s to develop

severe pneum onia.

• T

he first cases of SA R

S w ere identified in G

uangdong, in southern C

hina, in N ovem

ber 2002. •

In M arch 2003, SA

R S spread to H

ong K ong and then, days

later, a secondary outbreak occurred in Toronto, C anada,

w ith additional cases occurring in m

ore than tw o dozen

countries across five continents. •

T he SA

R S pandem

ic w as contained by isolating patients

and carefully observing their contacts so that anyone w ho

developed sym ptom

s could be isolated im m

ediately and treated under strict infection control protocols, but the outbreak raised alarm

s about gaps in global com

m unication, surveillance, and response capacity.

SA R

S (cont’d)

•T he 2005 IH

R address all types of

risks, m andating m

ore com

m unication about health events

from m

em ber nations and obligating

countries to strengthen their surveillance and response activities.

Surveillance •

H ealth surveillance

is the process of continually m

onitoring health events in a population so that em

erging public health threats can be detected and appropriate control m

easures can be im plem

ented quickly. •

Surveillance is the first step in a public health approach to responding to threats to health.

• Surveillance system

s, w hich are usually run by

governm ents, track infectious disease reports to

look for patterns and possible outbreaks or clusters of disease, w

hich occur w hen there is an unusually

high incidence of disease in a particular place (spatial clustering) or tim

e (tem poral clustering).

Surveillance (cont’d)

•T he health statistics collected as part of

surveillance allow com

m unities, states

and provinces, and nations to know

w hat diseases are com

m on in their

populations and to recognize w hen an

unusual health situation is em erging.

•W ithout baseline data about incidence

and prevalence, it is im possible to

know if unusual num

bers of cases are being diagnosed.

Figure 7-6

Surveillance is the first step in a public health approach to responding to threats to health.

Data from Holder Y, Peden M, Krug E, Lund J, Gururaj G, Kobusingye O, editors. Injury surveillance guidelines. Geneva: WHO; 2001.

Surveillance (cont’d) •

Sentinel surveillance = the continuous collection and analysis of

high-quality data from a lim

ited num ber of clinics or hospitals so

that public health officials w ill be able to detect changes in health

status in the larger population from w

hich the sentinel sites w ere

sam pled.

• P

assive surveillance = reports of notifiable disease diagnoses

from m

edical laboratories. •

A ctive surveillance

= the act of public health officials contacting healthcare providers to ask about how

often they are diagnosing particular types of disease and other m

eans of collecting surveillance data.

• Syndrom

ic surveillance = the tracking of potential outbreaks or

other disease events based on reports of sym ptom

s, school absentee reports, spikes in Internet searches for particular diseases, and other types of data rather than relying solely on counts of laboratory-confirm

ed diagnoses.

E pidem

iology •

A n endem

ic disease is an adverse health condition

that is alw ays present in a particular population.

• A

n outbreak is occurring w hen at least several

people becom e ill from

a disease that is not usually present in a population. •

A n epidem

ic occurs w

hen a disease is occurring m

ore often than usual and there are m ore than a few

sporadic occurrences of disease. •

A pandem

ic is a w

orldw ide epidem

ic. •

T he term

pandem ic describes the distribution of

disease events across the globe, and it is not an indicator of the severity of the disease.

PH E

IC •

U nder the 2005 IH

R , a public health em

ergency of international concern (P

H E

IC )

can be declared w hen an infectious disease

outbreak is causing serious illness, is likely to spread to other countries, and requires a coordinated global response.

• Several events have been declared to m

eet the PH E

IC criteria:

• T

he H 1N

1 influenza pandem ic in 2009

• A

resurgence of polio that occurred in 2014 •

T he outbreak of E

bola virus disease in W

est A frica in 2014

• T

he spread of Z ika virus in the A

m ericas in 2016

• PH

E IC

status enables various international resources to be used to support the response to the disease event, and it also obligates the affected countries to act on the disease control recom

m endations

issued by W H

O .

G lobal P

artnerships 7.6

G lobal Partnerships

•D ozens of nonprofit public–private

partnerships are currently w orking to set and

accom plish goals for selected global health

issues. •

Since 2000, public–private partnerships have been increasing in popularity as a distributor of developm

ent assistance for health (D A

H ).

• D

onor governm ents use these partnerships (as

w ell as their ow

n international cooperation agencies, nongovernm

ental organizations, and U

N agencies) as channels for disbursing funds to

im plem

enters in recipient countries.

G lobal Partnerships (cont’d)

•O ne of the goals of m

any public–private partnerships is to increase access to new

technologies and other tools for health. •

A ccessibility requires the product to be

affordable and to be easily and reliably available to people w

ho choose to use it. •

Partners w ith expertise in social m

arketing can increase dem

and for products, and partners w ith

expertise in m anufacturing can ensure that there

are enough supplies to m eet dem

and. •

Social m arketing

is the use of m arketing

strategies to change behaviors in targeted populations.

Figure 7-7

The channels involved in disbursing developm

ent assistance for health (D A

H ) are

shifting in prom inence.

Data from Financing global health 2015: Development assistance steady on the path to new Global Goals. Seattle: Institute for Health Metrics and Evaluation (IHME); 2016.

G lobal Partnerships (cont’d)

• T

he tw o largest partnerships are the G

lobal Fund to Fight A

ID S, M

alaria, and Tuberculosis and G avi,

the V accine A

lliance. •

T he G

lobal Fund finances infection control and prevention initiatives in low

-and m iddle-incom

e countries. •

A pplicant countries propose their ow

n sets of projects, and they m

anage the im plem

entation of funded program

s. •

T he G

lobal Fund provides technical support and negotiates w

ith pharm aceutical com

panies and other m

anufacturers to procure m edicines and other health

products at low costs.

G lobal Partnerships (cont’d)

•G avi w

orks w ith low

-and m iddle-incom

e countries to identify priority vaccines and negotiates w

ith m anufacturing com

panies to increase production of desired vaccines. •

G avi and the recipient countries share the costs

of the vaccines, and countries pay larger shares as their econom

ies grow until they are fully

sustaining their ow n vaccination program

s. •W

hen global health partnerships are successful, all of the involved parties benefit.

T he N

onprofit Sector 7.7

T he N

onprofit Sector •

A nonprofit organization (N

P O

) is a m ission-driven

group that reinvests surplus revenue in the organization rather than distributing extra incom

e to ow ners or

shareholders. •

Som e N

PO s are led by unpaid volunteers, but m

any have paid staff.

• A

nongovernm ental organization (N

G O

), som etim

es called a private voluntary organization, is a nonprofit organization that is privately m

anaged and receives at least som

e of its funding from private sources.

• Som

e large international N G

O s (IN

G O

s) have diverse portfolios of projects that they im

plem ent in num

erous countries.

• Som

e N G

O s are faith-based organizations (F

B O

s) sponsored by a religious or religiously affiliated entity.

N G

O s

• M

ost large global health N G

O s raise funds from

individuals, private foundations, and governm

ental sources. •

O ne challenge for m

any N G

O s is balancing the goals of

donors and the desires of recipients. •

D irected donations occur w

hen a donor gives m oney and

stipulates that it m ust go to a particular cause; som

etim es

this w orks w

ell, but other tim es donors m

ay not be aw are of

conditions in the recipient com m

unity. •

A ppropriate technology is affordable and environm

entally sustainable technology that can be locally operated and m

aintained. •

D onors m

ay also w ant to have close oversight of budgeting

and operations, and they m ay insist that expatriates rather

than host-country staff m anage projects.

N G

O s (cont’d)

•N G

O s have to carefully consider the

social and political im pact of their

actions. •N

ot all “nongovernm ental” organizations

are com pletely independent from

governm

ents. •N

G O

s m ust decide how

closely they w ill

w ork w

ith officials from host countries

and how to address potential problem

s w

ith corruption and m ism

anagem ent.

N G

O s (cont’d)

• N

G O

s that successfully navigate these com plex situations

play a very im portant role in global health.

• B

ecause m ost N

G O

s are not political, they can reach populations that m

ight otherw ise be underserved.

• B

ecause N G

O s often w

ork for decades in the sam e

com m

unities, they build relationships and trust that allow

for quick responses to em ergencies, and their long-term

com

m itm

ents result in sustainable developm ent.

• N

G O

s can also serve as points of connection betw een

com m

unities and international agencies and donor organizations, using their netw

orks to help new projects

and program s quickly reach their target audiences.

• N

G O

s are often the organizations that actually deliver global health interventions to the people w

ho w ill m

ost benefit from

them .

T he C

orporate Sector 7.8

T he C

orporate Sector •

A variety of businesses play a role in global health. •

Som e com

panies specialize in project im plem

entation, and they receive contracts from

funding agencies and other global health financing channels to m

anage the delivery of global health services. •

Som e com

panies are the private partners in public–private partnerships, and they receive com

pensation for m aking the

m edicines, vaccines, and other products that are in dem

and for addressing global health priorities.

• Som

e com panies involved in global health excel at supply chain

m anagem

ent, the process of coordinating all steps from selecting

and procuring products through the logistics of transporting, storing, and delivering them

. •

M any com

panies that that are not prim arily focused on global

health play a role in influencing health behaviors and health status, w

hether they are m ultinational corporations or sm

aller businesses.

U SA

ID C

ontractors •

U SA

ID is one of the m

ajor channels for disbursing global health funding to com

panies. •

U SA

ID does not have the staff to im

plem ent all of its ow

n projects, so m

any of its projects are m anaged by outside groups.

• Several of the leading U

SA ID

contractors are for-profit com

panies. •

M ost of the other leading contractors are nonprofit organizations that

receive nearly all of their funds from governm

ent contracts and are not dependent on fundraising from

private donors. •

O nly a few

of the m ajor recipients of U

SA ID

funding are charities that m

anage large governm ent contracts but still rely heavily on

private donations for a large portion of their portfolio of projects. •

A m

ong the global health im plem

enting groups that have annual budgets of m

illions of dollars, the functional differences betw een

for-profits and nonprofits are often m inim

al.

Figure 7-8

M any of the groups w

ith the largest U SA

ID

contracts in 2015 w ere for-profit corporations.

Data from Top 40 vendors. Washington DC: USAID; 2015.

C orporations and H

ealth Prom

otion •

Food, beverage, and nutrition com panies, pharm

aceutical com

panies, m anufacturers of m

edical devices, m anufacturers of

hygiene supplies and personal care products, and other corporations that produce health-related goods and provide health- related services play an im

portant role in facilitating health for populations around the w

orld. •

T hese businesses are typically not part of the funder–channel–

im plem

enter pathw ay for large-scale global health initiatives, but

they are key contributors to achieving global health goals via m

arket-based strategies. •

A ny com

pany m ay play a role in influencing health via m

arketing, lobbying, and corporate social responsibility strategies. •

C orporations can also play a role in health prom

otion by protecting the health and safety of em

ployees and the com m

unities w here they

w ork, producing and selling healthy products, and participating in

public health alliances.

R esearch and the

A cadem

ic Sector 7.9

R esearch and the A

cadem ic

Sector •

U niversities in countries across the incom

e spectrum

play several key roles in global health. •

Teaching: T he m

ost im portant role is education.

• R

esearch: T he process of system

atically investigating a topic in order to discover new

insights about the w

orld. •

Service: Som e universities also accept contracts to

im plem

ent global health program s and subcontracts

from other im

plem enters to participate in som

e aspects of program

im plem

entation. •

M any students, trainees, professors, staff, and other

m em

bers of university com m

unities are also active in voluntary service that contributes to global health.

M easuring Im

pact 7.10

M easuring Im

pact •

M any public health intervention packages w

ould increase the quality of life of m

illions of people at a relatively low

cost per person, but all of these interventions together add up to a lot of m

oney. •

Together, trillions of dollars each year w ould be

required to im plem

ent global health strategies for all of the various causes of disease, disability, and death in every region of the w

orld. •

D ifficult decisions have to be m

ade about how to

allocate lim ited resources.

• Funding recipients usually are expected to dem

onstrate to global health financers that their resources are being used w

ell.

M onitoring and E

valuation •

A typical project passes through planning, im

plem entation, and

evaluation stages, but assessm ent strategies should be applied

throughout the project cycle. •

M onitoring

is a process of ongoing assessm ent of a project or

program to track progress tow

ard achieving predefined targets. •

E valuation is an assessm

ent of how w

ell a project, program , or

policy has m et its goals.

• Together, m

onitoring and evaluation (M &

E )

is the system atic

collection of inform ation about an ongoing intervention (process

evaluation) and the determ ination of w

hether the intervention achieved its objectives (im

pact evaluation). •

M ost contracts for global health im

plem entation w

ork m andate

that the recipient group have a robust M &

E plan.

E ffectiveness A

nalysis

•E ffectiveness

is a m easure of the

success of an intervention under real- w

orld conditions (as opposed to efficacy, w

hich m easures success in

ideal, laboratory-controlled conditions). •E

fficiency is an evaluation of the cost- effectiveness of an intervention that is based on both its effectiveness and resource considerations.

E ffectiveness A

nalysis (cont’d) •

C ost-effectiveness analysis (C

E A

) is a type of econom ic

analysis that com pares the health gains from

an intervention to the financial costs of that intervention. •

T he goal of C

E A

is to confirm that the funds spent on a

health initiative are achieving the planned outcom es and are

m aking efficient use of financial and other resources.

• T

he m ost cost-effective global health interventions tend to

be relatively inexpensive, can be easily distributed to lots of people, focus on prevention rather than treatm

ent, and are targeted tow

ard children and young adults so that they can avert m

any potential years of life lost to long-term

disability or prem ature death.

• O

ne lim itation is that cost-benefit analyses tend to prom

ote interventions that have already proven to be successful rather than new

technologies.

E ffectiveness A

nalysis (cont’d)

•C E

A , continued

•W hen it is expensive not to address

public health problem s, C

E A

s can dem

onstrate the long-term savings

associated w ith disease prevention

and control initiatives. •C

E A

often requires the analysts to m

ake judgm ents about w

hat a healthy life is w

orth.

T he H

um an Side of M

& E

• G

lobal health statistics, budget details, and progress reports tend to hide individual hum

an beings behind num

bers, reducing real people to nam eless, faceless

m asses. •

Statistics cannot capture the profound grief experienced by fam

ilies w ho lose a child, just as they cannot fully express

how life-changing a new

w ater w

ell can be. •

E ven w

hen m onitoring and evaluation activities appear to

be coldly quantitative, em pathy and shared hum

anity are central to the process. •

M any groups include photographs in their annual reports

and other publications as a rem inder that their w

ork is about real people w

hose lives are being affected in very real w

ays by health problem s and health interventions.