Global Health "Best Buys": The Key Is in Delivery

This is a joint post with Yuna Sakuma

Successful investments in global health—or “best buys”— can be defined in many ways: a cost-effective commodity or technology, a well-trained health workforce, an evidence-informed policy, etc. We recently hosted an event in partnership with PSI, PATH, Devex, and Merck to discuss this topic, and noted a reoccurring theme:  service delivery is key. Or, put another way, context matters.

To that end, here are a few key takeaways from our panelists.

• Effective technologies aren’t enough.
  Experts are eager to see investments that enable “best buy” technologies be delivered efficiently. After all, a technology alone isn’t a “best buy” until it is delivered to the people who need it most and it produces the desired health outcome. This has been a hot topic recently, with big global health players like the World Bank and the Bill & Melinda Gates Foundation, among others, setting goals and starting new initiatives around service delivery.
• Solutions should engage multiple sectors.
  Experts underscored the importance of public-private partnerships that tap the strengths of different sectors with context-specific experience.  For instance, KP Yelpaala, founder and CEO of access.mobile—a mobile technology business operating in Uganda, Rwanda, and Tanzania—highlighted that local entrepreneurs usually have the best understanding of local demands. Partnering with them can help us find the best way to target interventions in any given setting. Similarly, PSI is franchising over 10,000 private health sector providers throughout Africa, Asia, and Central America —in the same way that McDonald’s franchises restaurants—to advance sustainable and high-quality service delivery. Through PSI’s subsidy of medical commodities, much of the population gains access to health services and the providers remain profitable.[1]
• Learn from existing systems.
  With an enormous amount of money already invested in global health, experts agree that there’s much we can learn about enabling environments from existing health interventions and programming. For instance, PEPFAR applies an implementation science model to understand variations in effectiveness and efficiency in PEPFAR-funded HIV/AIDS programs. More broadly, more often we might compare two health programs in different settings—one with stellar outcomes and one with less-than-stellar outcomes—and ask: what is one working and not the other? To do this though, more space and flexibility is needed to learn from failures.

The importance of service delivery isn’t a novel concept, but so often it’s overshadowed by pressure to roll out the newest or most promising technology.  Some donors are taking steps to balance this.  There are some novel financing approaches that might foster more impact evaluations or qualitative research on “failure”. For example, Development Innovation Ventures (DIV) at USAID provides staged funding so that innovations can be rigorously tested for impact and scale. And USAID and UK’s DFID is building a Global Development Innovation Ventures (GDIV) using this DIV model.

Will global health funding start to take off in this direction—or has it already? We’re eager to watch the landscape in the coming years.

For more, check out PSI’s Spring edition of Impact Magazine: “The Best Buys Issue: Where to Invest in Global Health in 2014.”