Rethinking Global Health

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Michel Sidibe, Executive Director of UNAIDS, made an important speech on Novermber 11th, outlining his vision for a new approach to Global Health.  He is joining a growing chorus calling for the lessons of the global response to AIDS to inform an approach to health that emphasises a more people-centred approach.  Moreover he calls for an approach that convinces Ministers of Finance that health is not a cost, but an investment.  An approach that considers improving health as a question of justice: “AIDS forever changed the focus, role and participation of affected communities as essential partners in global health responses.”

The speech should be welcomed; personally though I agree that the response to AIDS can be an inspiration, we need to be clear that it has not been an unmitigated success.  Learning from the AIDS response also means learning from the mistakes.  In particular, the considerable amount of effort and money that has been poured into not only unproven, but also implausible responses.  And the massaging of egos of national and community leaders just because they talk about AIDS, irrespective of the validity of what they are saying.

What most stands out for me in Sidibe’s speech, however, is this section:

Most critically, it means completely rethinking our approaches to delivery. We can gain real advantages through community-based and task-shifting approaches, and by tapping into non-conventional capacities and alternative delivery mechanisms. We must no longer think of a community health worker as a nice person who helps out. We need to try and make them an integral part of the structures of health. 

He’s right. And yet most health systems thinking is stuck in the dark ages: a focus on doctors, nurses, clinics, drugs and policies, that continues to ignore the social and structural factors such as gender inequalities and human rights violations that can impede health.  I’ve spent some time recently discussing with colleagues how to define and more effectively support the broader version of health systems that Michel Sidibe is talking about. It’s going to take a lot more than adding the word “community” to every health systems document.  There’s work to do.

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