June 25, 2009 The Pump Handle 9Comment

A few recent items highlight programs and innovations that are helping improve health in developing countries:

If you’ve come across anything recently about a promising approach to tackling global health challenges, feel free to post a link in the comments.

9 thoughts on “Global Health Links

  1. It seems to me that this is basically an emrcpiial question not a normative one. Money should be spent where it’s going to be most effective and create the most benefit. If PiH is going to get greater results for their marginal dollar in Peru than in Haiti, then that’s where they should be spending their money. Where PiH’s, or any other NGO’s, money is going to be best spent is a case by case question, but it’s fundamentally one that should be driven by data not by development philosophy. Just because an NGO is already operating in a given community doesn’t necessarily imply that any additional funding they get should also be spent in that community or the neighboring one (nor do I think that’s what you’re implying). Not every NGO exists in a state of requiring more and more funding (although I doubt any would actually say that). Human/financial/physical resources are not always what a program needs and those resources can sometimes be better used expanding. Hypothetically, hiring the tenth doctor at VHW is going to have a lot less benefit than hiring the first doctor at the town across the border in Tanzania. Additionally, I think there’s a somewhat false choice underlying this argument. Frequently, the choice an NGO faces isn’t spend donor money on existing programs or spend it on expanding programs. It’s spend donor money on expanding programs or don’t get the money in the first place. The last organization I worked for tended to expand to countries where there was donor money on the table for a specific country. It wasn’t an option to take that money for existing programs. Now, how donors allocate funding and to who is a much bigger question for another day, but that’s not something NGOs always control. I don’t know anything about PiH’s funding structure, but the implication that they had complete control over the matter may not be accurate in this case, and certainly isn’t accurate in others.To the question: “Why pick up and move to Peru when there is still so much to do in Haiti?” Well, sure, there is still so much left to do in Haiti, but that doesn’t mean that PiH is the best NGO to do it. I’m not going to argue that there isn’t a monumental amount of work left to be done in Haiti, but the underlying assumption that PiH should be doing that work is one that, at the very least needs justifying, as it does in every case. Before I start hammering the same idea over and over again, I’ll just return to my initial point. This is an emrcpiial question not an ideological one. Some organizations would be more effective deepening their involvement in the communities they already work in. Some organizations would be more effective expanding their model to new communities. I think the more pressing questions are: how do NGOs decide which approach to take? What kind of data is needed to make these decisions? Finally, as an aside, to characterize the main motivation for an NGO to expand as primarily a function of vanity and selfishness strikes me as unnecessarily cynical and generally inaccurate. Independent of the question of whether to focus on scaling successful programs broadly or deeply, I think the justification given is off base. I don’t think a guy like Paul Farmer decides to take PiH to Peru and Rwanda so that he can visit new places and brag to donors any more than he went to Haiti in the first place for those reasons. Similarly, I tend to be skeptical of the argument that if Health Promotion Associates has hit upon a really successful model that they would scale up so that the founders can brag to donors and travel to new countries. This may tend towards being too idealistic, but I like to think that people get into this line of work because they genuinely care about doing good work. Obviously, good intentions are not enough, but I don’t think we get very far by questioning those intentions in the first place.

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