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Bill Frist

Global healthcare takes more than a pill

By Bill Frist
August 13, 2009

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AS THE United States works on a comprehensive global health strategy as part of its commitment to fighting world poverty, it faces an opportune moment to move beyond tracking the number of HIV/AIDS patients treated or bed nets distributed to reduce the spread of malaria. Having worked with Senator John Kerry on the President’s Emergency Plan for AIDS Relief, I recognize the importance of saving as many lives as possible struggling to cope with this disease in developing countries. While these are important benchmarks to measure, a broader, more aggressive approach to global health is needed.

We need to expand our thinking to encompass holistic solutions that go into improving the health of the world’s poor. We need to think profoundly about our practices and the significance of sound policies to sound health. Global health must deliver more than a pill to the poor to relieve their immediate pain; it must deliver a system-wide program of rehabilitation to increase the productivity and prosperity of their communities.

Doing this requires a multi-dimensional approach. It means moving beyond the focus on high-profile diseases to also invest in overlooked, but treatable, diseases. In addition to HIV/AIDS and malaria, blindness is rampant in developing countries, where a child goes blind every minute. This means up to 700,000 children face a difficult reality, with a tragic 70 percent of them dying within the first year of going blind. Yet, such blindness, caught early, is preventable.

This new thinking - led by a strong example and commitment from the United States - should look at global health investments as interconnected parts of a complex system of care. While the 25.3 million Africans infected with HIV/AIDS certainly need treatment now, they also need an integrated approach to their illness that ensures they have passable roads to reach clinics for care and access to clean water so they do not contract other diseases to complicate their already-compromised health. Treating people can only do so much if they risk death on unsafe roads or cannot sell their goods to support their families.

As the United States and other international donors build hospitals and clinics throughout the developing world, they need to also think about building the home-grown capacity to staff these facilities. Of the 600 doctors trained in Zambia in the last 40 years, only 50 are still practicing there. Like the developed world, developing countries face a dire shortage of health professionals, which impacts the delivery of care.And, this holistic, multi-faceted way of looking at global health demands a policy environment in which healthy citizens and good governance enjoy a symbiotic relationship. A government’s commitment to health is an investment in a more engaged citizenry, deepening transparency, and accountability. However, by one estimate, African countries spend on average less than $10 per person each year on healthcare. The healthcare sector in developing countries also faces corruption that siphons resources away from those who need them most.

The US government’s Millennium Challenge Corporation takes an innovative approach to strengthening the policy environment for global health. From the outset, the corporation evaluates a country’s immunization rates, total public expenditure on health, and commitment to combating corruption to determine where to invest its development grants. This smart approach ensures that US dollars are spent wisely in countries already taking steps to do their part to strengthen the health of their citizens.

Many of the principles embodied by the corporation inform the ongoing debate about foreign aid, including a foreign assistance reform bill recently unveiled by Senators Kerry and Richard Lugar. The corporation is an incubator of sorts, testing ideas, using incentives for good policies, applying rigorous measures to evaluate projects, practicing candor. Requiring country-led development and accountability as the corporation does is difficult, but it is proving effective in delivering development assistance that is improving the lives of the poor, including their health.

Broadening the discussion on global health - from combating neglected diseases, to investing in health skills, systems, and infrastructure, to advocating pro-health policies - is not easy. Just ask Congress as it works on the monumental task of healthcare legislation to address a range of concerns that impact healthcare for Americans. The challenges, though different, are just as pressing for developing countries, as a number of factors affect the delivery of healthcare for their citizens’ productivity and ability to compete in the global economy. Thinking about - and ultimately acting upon - a systemic approach to global health, grounded in good policies, provides the best medicine for delivering tangible and sustainable results that will improve the quality of life for the world’s poor.

Bill Frist, MD, was the US Senate majority leader from 2003 to 2007. He is a member of the Millennium Challenge Corporation’s board of directors.

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