Degrees of engagement: Family physicians and global health (original) (raw)
Related papers
2007
CM CCFP MHSc Véronic Ouellette MD MSc CCFP FRCP Francine Lemire MD CM CCFP FCFP From the International Health Committee, College of Family Physicians of Canada
2012
The rationing problem is common to all health systems-the challenge of managing finite resources to address unlimited demand for services. In most low-and middle-income countries, rationing occurs as an ad hoc, haphazard series of nontransparent choices that reflect the competing interests of governments, donors, and other stakeholders. Yet in a growing number of countries, more explicit processes, with strengths and limitations, are under development that merit better support. Against this background, the purpose of the Center for Global Development Working Group, which is to examine how priorities are set currently, and to propose institutional arrangements that promote country ownership and improve health outcomes by more systematically managing this complex process of politics and economics, is discussed. Current global and national priority-setting practices in low-and middle-income countries, the potential for strengthened national institutions, and increased global support are reviewed. Recommendations for action are provided. A fundamental challenge for all health systems is to allocate finite resources across the unlimited demand for health services. This is a rationing problem, regardless of whether it is explicitly addressed as such, because it requires active or passive choices about what services are provided to whom, at what time, and at whose expense. Inevitably, some demand goes unmet, which is a source of the intense pressure to provide more services within any given resource envelope. Efforts to reduce waste, increase quality, and improve efficiency are all responses to this pressure. Expanding healthcare costs are another reflection of the same forces. A recent Organisation for Economic Cooperation and Development (OECD) report [1] found that health spending growth exceeded economic growth in almost all OECD countries over the past 15 years. In the context of worsening fiscal positions in the global recession and greater demand for services because of aging populations, as well as more complex and expensive health technologies, the pressure on OECD health systems to deliver more care with greater efficiency is unprecedented. Policymakers and analysts working in low-and middle-income countries (LMIC) are concerned with the same issues. In many middle-income countries, economic growth is also accompanied by a greater proportion of gross domestic product devoted to health. This has led to a significant increase in health spending, often because of costly technologies of marginal benefit while most of the population remains without access to basic and The authors have reported that they have no relationships relevant to the contents of this article to disclose.
Ethics for International Medicine
2012
ne of the most striking characteristics of international medicine in developing countries is the vast array of limitations faced by medical aid workers and their patients. Many medical aid workers serve in clinics that are barely functioning and have little to offer in the way of supplies. Limitations in facilities, supplies, and equipment in developing countries often force medical aid workers to perform procedures or prescribe treatments that deviate from the standard of care they would adhere to in the developed world. In addition, medical aid workers often have an explicit need to ration medications because the demand is much greater than the supply. Beyond limitations in resources, medical aid workers in developing countries often serve patients who otherwise have little or no access to health care. The majority of people in developing countries live in severe poverty, with many surviving on less than one dollar a day (Who 2008). Moreover, developing countries are plagued by a higher burden of disease than developed countries. An additional factor that contributes to patients' limited access to health care is the paucity of well-trained health care providers in developing countries. Beyond the limitations of developing countries, medical aid work itself has inherent limitations, the most apparent of which is time. Medical aid workers only serve temporarily, for weeks or months, before returning to their home practice. The nature of international medicine requires medical aid workers to leave the areas where they are serving before they can treat all the patients in need of care, or follow up with the patients they have already treated. Limited resources The limitations encountered in international medicine create, or contribute to, a myriad of clinical ethical issues. One issue that comes up chApt Er 4
The Health Crisis in the Developing World and What We Should Do About It
2012
The most notorious example of poor decision-making in this regard is the failed effort of USAID to stimulate the development of a malaria vaccine. During the 1980s, the agency spent over $60 million on a project that, in its judgment, would likely lead to an effective vaccine. In the end, the initiative produced nothing of value. See Robert S. Desowitz, The Malaria Capers: Tales of Parasites and People(New York: W.W. Norton, 1991). In truth, the probative value of this example is limited. The principal investigator, it turned out, was lining his own pockets, and the agency's project director was receiving kickbacks. Thus, this particular episode may reveal more about the potential for a few corrupt actors to waste a great deal of money than it does about the merits of "push" programs in general.
Priority-Setting Institutions in Health
Global Heart, 2012
The rationing problem is common to all health systems--the challenge of managing finite resources to address unlimited demand for services. In most low-and middle-income countries, rationing occurs as an ad hoc, haphazard series of nontransparent choices that reflect the competing interests of governments, donors, and other stakeholders. Yet in a growing number of countries, more explicit processes, with strengths and limitations, are under development that merit better support. Against this background, the purpose of the Center for Global Development Working Group, which is to examine how priorities are set currently, and to propose institutional arrangements that promote country ownership and improve health outcomes by more systematically managing this complex process of politics and economics, is discussed. Current global and national priority-setting practices in low-and middle-income countries, the potential for strengthened national institutions, and increased global support are reviewed. Recommendations for action are provided.
Case studies in global health: Millions saved
Global Public Health, 2009
Case studies in global health: millions saved is well worth reading by anyone interested in learning about successful categorical health programmes in developing countries. The 20 cases presented are important, informative and provide a good complement to Skolnik's (2007) textbook on Essentials in global health. The cases are told in an easy style and with a consistent approach that includes pertinent data and interpretations, making the collection particularly good for the non-specialist reader and for use in an undergraduate course on international public health. The discussion questions provided for each case are thoughtful, and the lessons drawn for each case are relevant and important. Some of the key lessons that emerge across the cases include the importance of both national political commitment and local leadership, as well as the role of strong management of programmes that include well-specified actions and the use of information and research to guide programme implementation. There are also a number of features of the book that limit the learning potential of the case studies, and, therefore, its immediate utility for a graduate level course. Because the cases are very clear, they leave little room for uncertainty or ambiguity. The lessons learned are explained simply in each case, and more detailed data are not made available for students to investigate and discover more nuanced lessons. Students and teachers could dig deeper into health policy and programme implementation issues by seeking out additional information on health conditions, programmes and perspectives, though this would essentially involve creating different case studies. A more important limitation is that the cases included in the book are a biased sample with a narrow perspective Á they only deal with 'successful' programmes on a national or larger scale, and all involve special campaigns or projects. All but one case involve categorical programmes for a single disease, risk factor, or intervention, and all limit themselves to a narrow set of outcomes (the one exception involves the Progresa, now Oportunidades, programme from Mexico). By failing to examine how other countries or programmes have not succeeded in replicating these programmes, readers are restricted in their ability to identify and transfer the lessons from one setting to another. Although some of the cases involve crosscountry disease-control programmes, or cite successful examples of similar programmes from other countries, the cases do not move much beyond their narrow foci to see why, or how, successful programmes are able to influence other parts of the health system in the same country. As a group, the cases and discussion questions do little to consider issues of how the selected programmes were influenced by other programmes in the country, or how they