- Field Notes
Putting pieces together.
Each year, hundreds of health policymakers, researchers, government agencies, nongovernmental organizations, activists, corporations, and foundations gather in Washington, D.C., for the annual meeting of the Global Health Council. This year, the council, whose mission is "to ensure that all who strive for improvement and equity in global health have the information and resources they need to succeed," chose as its conference theme "Health Systems: Putting Pieces Together."
When diseases like HIV/AIDS are devastating entire populations, when abject poverty pervades most of the world, and when even the most basic of health services are out of reach for the majority, it is often difficult to find anything hopeful to talk about in meetings such as this. With that in mind, I made the trip to Washington expecting to hear much of the usual "head shaking" rhetoric on the appalling state of health care systems in developing countries. I also expected to hear little by way of realistic or concrete proposals for moving forward. I am glad to say that I was wrong.
First, the program itself was a departure from the usual. For instance, skills-building workshops were built around the main program, so that in addition to lectures and presentations, exercises aimed at building technical capacity provided an opportunity for prompt learning. The most interesting of these (for me at least) was a session on the application of quality improvement models in poor countries. There is a pressing need to improve the quality of social services—even within resource-constrained settings—but such strategies have to be homegrown, relevant to the local context, and sustainable. This session provided practical examples of these approaches, particularly for HIV/AIDS treatment and care.
Second, the pool of participants was extremely diverse—and perhaps more important, they were willing to engage with each other. A session entitled "Why Trade Matters for Global Health" drew participants ranging from bureaucrats from the Office of the U.S. Trade Representative to immigration attorneys, health workers' associations, labor activist groups, pharmaceutical representatives, African entrepreneurs, and officials from various ministries of health—strange bedfellows, no doubt. Similarly, a session detailing the poor health leadership and poor governance in developing countries and heralding a new era in global health accountability was attended by a wide range of global health stakeholders—including senior government officials from some of the countries described.
Finally, several conference presentations illuminated the problem of fragmented health development activities taking place with little or no synergy or interaction among them. Time and again, funders, practitioners, and others underlined the need to streamline those activities to make them efficient and responsive to local needs. Participants were encouraged to partner, instead of working in isolated silos. No one institution can alleviate global health problems, and never has it been more critical to work together for "improvement and equity in global health." At this meeting, it was clear to me that the process has begun. Putting pieces together indeed.