We in the global health community have been successful during the past decade in advocating for additional funding for health. We saw huge increases in development assistance for health, and our work has attracted support from political leaders, celebrities, and taxpayers alike. But now in 2011 we face a number of challenges, with donor governments facing significant fiscal pressures to reduce their aid budgets, and increasing scrutiny on how we measure the real impact of these investments.
Last week I was pleased to brainstorm with several of our key health partners to discuss what we can do.
During the past few years, the World Bank and leading global health agencies have relied on a fairly simple but compelling metric–lives saved–to demonstrate the impact of our work. Of course, talking about lives saved is compelling, and it has helped make global health work better understood by non-health experts. But there are a few challenges with this approach thus far.
First, the way we currently measure lives saved tends to downplay the importance of a well-functioning health system in saving a person's life. Measuring lives saved as a result of specific commodities such as a bednet, vaccine, or antiretroviral treatment only tells us one part of the impact story. For these commodities to be effective, we need the full value chain of a good health system, including the motivated and trained health worker, the well-equipped clinic, the cold-chain storage, the affordable financing, clean water and infrastructure, and the right policies, logistics and more–all of these things must be in place to achieve the desired health impact.
So the bottom line is: We need a better way to measure our results. We need to take more of a “value chain” approach, looking at all the different elements in a health system that contribute to one healthy life. We also must be much more rigorous in our estimates, measuring changes in health outcomes attributable to each of the various parts of the health value chain. To start, it makes sense to focus on what it takes to achieve the health Millennium Development Goals. We are starting work on this new approach, and I’ll keep you apprised of our progress periodically. Please stay tuned–and I hope you will join us.