Where should global health dollars go? The good news is that more funders are investing energy into devising ever-more-sophisticated ways to allocate health spending. When priorities are aligned, such as the international commitment to reducing maternal and child mortality rates through the Millennium Development Goals, these sophisticated allocation methods can assist in deploying scarce resources to greatest effect.
Here’s an example: the Child Health Epidemiology Research Group (CHERG), funded by the Gates Foundation, just released a new tool called LiST (Lives Saved Tool). The tool uses years of research as the source data for scenario-planning, determining which interventions will avert the largest number of deaths. The idea is that LiST will allow foundations, aid agencies and practitioners to invest more wisely in interventions, ultimately having the most impact in saving lives. Johns Hopkins Bloomberg School of Public Health has dedicated its April issue to use of this tool. (Interested in the company who developed this tool? I was too – check out the Futures Institute.)
Things get trickier, however, when goals are not aligned. Case in point: food aid has largely been the playground of political grandstanding rather than wise investing. And it suffers greatly because of it. Earlier this year, the US suspended food aid to Somalia for fear of feeding terrorists (see the NYTimes reporting). As my colleague at FPA’s Global Food Security points out, food “dumping”, or using excess crops as food aid, continues to be controversial. The most disturbing part is that solving malnutrition could be one of the easiest home-runs for international development. In fact, solving hunger underpins much of the global health dilemma (Andrew Green at Change.org makes this case compellingly). Simply put, hungry people can’t fight off disease.
Why is one of the “low hanging fruits” of the development and health sectors so poorly administered? (Proof of poor administration? Two billion undernourished people on a planet where rich countries are suffering from diabetes and obesity is evidence enough for me.) I would argue that we know what to do, and even where to put the money, but we just haven’t found the global political will to do it.
The energy being put into developing impact measurement methodologies and tools – by aid agencies, foundations and private agencies – is welcome and good. But I believe that we equally need to pour energy into developing the critical mechanisms to align global goals (a belief which stems largely from the last chapter of Jeffrey Sachs’ Common Wealth). Only then will world-class allocation strategies be effectively deployed, and our aid dollars wisely invested.
