To Dream a Little Bigger
Global health survives on new partnerships and collaborations. And they usually start with introductory meetings. Customarily, participants will begin with their name, designation, and affiliations followed by some background and end with where their interest lie. This short recitation is usually to inform your qualifications and throw out any potential aligned interests. I usually stop at designation (because I don’t have many affiliations) and I almost never expand on background and interests. How would ‘trained as a medical doctor’ help? Every other person in global and public health is a medical doctor and if you ask me, there are probably too many of us in this field.
So I think about my interests. And I realised I simply don’t have anything I feel particularly drawn towards. Reviewing my current and past involvement in global health projects, I work in the usual infectious diseases and non-communicable diseases space but also in very niche topics like patient engagement and in non-technical themes like science communication.
Sure, I am more comfortable in certain topics because of my background and training but I am no less ‘interested’ in the other projects which I am not familiar with. It finally hit me that what really motivates me is impact. If I believe that the project has real value and impact on its recipients, I am all in.
But looking at impact of global health programmes on a higher level, I cannot help but wonder how effective is our work. Global health programmes are typically funded by a select few and concentrate on a specific problem. And we are at the mercy of money.
These concentrated, problem-specific programmes are called vertical programmes and the debates rage on whether they are ultimately effective and impactful. Another approach to global health programmes is horizontal programmes, in which work is done to enhance health systems instead of the single-purpose machinery of vertical programmes. But a horizontal approach has its own set of problems.
The distinction between the two is really a distribution of power, where it resides in the population (or patients) for horizontal programmes but tips over to the funders in vertical programmes. It is not surprising vertical programmes dominate the global health landscape.
A middle-ground approach was also proposed, aptly named the ‘diagonal approach’, which aims to solve specific problems by health systems strengthening. This seems like a fair middle ground to adopt.
But I have another proposal.
Instead of a linear approach to impact, whether vertical, horizontal or cross-cutting like a diagonal approach, global health programmes should construct a web of impact, reaching out to influence and impact multi-sectoral outcomes like education, socioeconomics or even politics. Why not? Imagine if a programme was developed to stop malnutrition in children and by extension, also ensure they get access to education. Or programmes dedicated to not only eradicating tuberculosis (TB) but also lifting socioeconomic mobility as those with the highest risk of TB are mostly the poor and vulnerable. Impact must be targeted yet wide in breadth.
A web also reflects the global health environment better, with each strand of silk linked to each other, and any disruption will reverberate along the whole structure. But we can weave this web of impact tighter, so that if any single strand snaps, the wider structure still can compensate for the disruption. And like a real spider’s web, a wide and dense web will stop anything that tries to fly through it. In this metaphor, it would be acting as a social safety net for those who fall through the cracks in our porous health systems.
Of course, getting folks to band together to fund, develop and implement these far-reaching programmes is not easy. Funders usually encourage proposals to be distinct and we jostle around so that no two pieces of proposals are alike. Though I’d argue that even if the work overlaps, there is still a lot of good that will be done. But there will be some duplication of work, I reluctantly admit.
As global health practitioners figure out a way to align, I call to funders to align too. There is enough money to go around and plenty of work to be done. Perhaps we make the funders jostle a bit to get our attention. I’d like to review Powerpoint slides requesting us to do work instead of endlessly building decks to ask for money.
But back to my initial rumination about introductions, after thinking about this more, perhaps I will now add a short sentence on what impact my work currently or in the future I hope to have. It might go something like,
“…and through my work here I hope to have an impact on improving access to infectious disease diagnostics and treatment…”
It’ll probably never catch on and I’ll probably still stop at my name and designation. But hey, we mustn’t be afraid to dream a little bigger.