10 Global Health Trends from 2015 and What They Mean for the New Year
At Dalberg, we recently took the time to reflect on some of the most exciting moments in global health in 2015 and what’s to come in 2016. Last year, our health team went to hospitals in rural Ethiopia to conduct human-centered design research; to the World Health Organization (WHO) headquarters in Brazzaville to help improve organizational effectiveness; to mobile network operators’ boardrooms in Liberia to unlock greater digital connectivity as a tool to prevent future outbreaks … to name just a few projects. Here are the key trends and emerging topics that we saw along the way. Overall, these reflect a fundamental transition toward local ownership of health priorities, financing and implementation; a growing need to understand and target specific segments of populations, including a deeper knowledge of the human aspects of “beneficiaries” or “consumers”; and a shift in focus to several emerging areas of opportunity which are new to the global health agenda. We hope these will spark new ideas, collaborations and debate.
1. The need for financial innovation is increasingly local. The most urgent areas in need of financial innovation are continuing to shift downstream and include local supply chains and local consumer finance and risk protection to support health and wellness. These needs are more grounded in local, country-specific context, and thus, at times, less scalable than past global “architecture”-level financing plays. We see some very promising bright spots of local financial innovation, such as Linda Jamii in Kenya or Naya Jeevan in India, expanding access to health insurance for expecting mothers and the working poor. However, the unmet needs and outstanding areas remain great, and more innovation is needed, particularly at the national and sub-national levels.
2. The first wave of “graduates” are coming; precedents are being set and there is huge potential for learning from their experience. With the prospect of looming “graduation” of countries from a variety of donor financing and support as they reach middle-income status, individual funders and institutions including Gavi, the Global Fund, Unitaid and PEPFAR have been grappling with the policies and mechanisms to best facilitate this process or more optimally allocate their funding while ensuring that public health gains are not lost. In June 2015, we watched with excitement as the Gavi board approved access to appropriate pricing to Gavi-graduated countries via discrete vaccine tenders and an extension of pre-financing support. In the coming year, these global health institutions should focus on investing in the evidence base and learning which policies can best support countries as they transition out of donor funding to ensure sustained positive public health outcomes.
3. A one-size-fits-all approach to influence doesn’t work. Over the past decade, opportunities to influence key global health decisions were in large part focused on global events such as the World Economic Forum or the UN General Assembly meetings. While those continue to be important moments, the reality is that achieving health impact often requires advocacy and policy efforts in a much more fragmented, local, ministerial space. For example, the Disease Control Priorities Network (DCPN) supported by the Bill & Melinda Gates Foundation sits on a wealth of global health data. But at times there is almost too much data to parse through and the key points don’t reach decision-makers at the global or local levels. While working with DCPN earlier this year, we found ourselves wondering how to break this divide. Ministries of health are increasingly looking to evidence, expert advice, proven models and local input to determine their priorities and programs. However, what influences leadership in Addis Ababa is often distinct from what influences leadership in Kano or Kaduna State in Nigeria. More and more, we have been partnering with both global and local organizations to understand local geopolitical landscapes and potential pathways to influence.
4. We should segment target users and tailor solutions to continue progress, such as a focus on the distinct reproductive health needs of adolescent girls. Dalberg has been supporting the Children’s Investment Fund Foundation and Bill & Melinda Gates Foundation to convene a call for donors working on adolescent sexual and reproductive health. We’ve found ourselves wondering why this call has only just now come about. In the early years of the Millennium Development Goals, progress in maternal mortality and infant mortality was rapid, in part given the ability to target issues with solutions that had broad relevance, such as vaccines. Beyond that progress, however, certain segments of users are being left behind because solutions have not been tailored to their context. For example, adolescents age 15-19 are twice as likely to die during pregnancy or childbirth as those over age 20; girls under age 15 are five times more likely to die.
5. Funders are finally bringing the human into design for development. After years of experimentation – and a number of high-profile product failures (need we reference the female condom?) – funders and product developers alike are finally getting serious about human-centered design. Both the Gates Foundation and USAID have made positive strides in building out their own capacity and networks in human-centered design, and are beginning to integrate some its methodologies into their approaches. The next hurdles will be to ensure that supply of design capabilities in target country contexts is sufficient to meet the growing demand – and that this demand is sufficiently reflected in product and program budgets.
6. There’s a welcome and emerging interest in the link between environmental degradation and human health. On the heels of the Paris climate negotiations, there is growing interest in building the field of “planetary health” focused on the systemic relationship between environmental issues and human health. This could represent a leap forward in addressing some of the looming risks associated with environmental degradation and climate change, and the root causes of growing health issues from malnutrition to autoimmune diseases and cancers. The main questions on the horizon are how/whether this will be embraced by vested interests in public health, and how to meaningfully move from conceptualization to action.
7. Surgery is finally starting to get the global attention it deserves. Surgery has traditionally been seen as “the neglected stepchild of global health,” but in 2015 surgery finally gained prominence in discussions around global health. A Lancet Commission publication found that 5 billion people lack access to surgical care, and that scaling up access to surgical care could save 1.5 million lives per year in low- and middle-income countries. As a result of this research, the World Health Assembly passed a resolution to strengthen emergency and essential surgical care. However, further funding will be required to test and refine programming to close the gap.
8. There’s more and more evidence for increased investment in mental health. Mental health issues account for 23 percent of the years lived with disability around the globe – more than the combined total for cancer, infectious and cardiovascular diseases. Despite this, mental health remains woefully underfunded. Thankfully, the past year has seen some of the first in-depth cost-effectiveness analysis for mental health interventions. The results reveal an important message: Mental health interventions have attractive cost-effectiveness profiles and merit far greater investment from donors and national governments.
9. The big service delivery bottleneck: managerial capacity. We can’t seem to have a conversation about global health these days without discussing managerial capacity – essentially, the capabilities and skills to effectively problem solve, manage a team and entrepreneurially shepherd resources to address critical gaps in health programs and service delivery. This gap exists at all levels of the health care system, from a nurse or surgeon at the facility level, to a state health officer, to a minister of health. Luckily, there’s recent innovation in this space that we can continue to watch and learn from, including the GE Safe Surgery 2020 approach to leadership development for surgeons; the Aspen Management Partnership for Health focus on creating a culture of problem solving for last mile delivery; and models like the Global Health Corps, focused on bringing young talent into public health. The larger question is: Are more systemic changes needed to attract, cultivate and retain managerial capacity at the scale required, particularly within stretched ministries of health?
10. Despite urgency on global health security, leadership capacity remains in question. This past year, the Ebola outbreak in West Africa brought a heightened sense of urgency and magnitude to the risks and issues associated with global health security. Yet, despite near-term mobilization of resources and support, there are significant doubts about WHO’s capacity to provide needed leadership to prevent, contain and otherwise respond to future threats. One path forward may be the emerging leadership of local hubs, such as the Emergency Operation Centers in West Africa. These locally owned institutes focus on early detection and response of outbreaks and other emergencies and may be a critical missing ingredient.
We look forward to seeing how these will continue to define the field – and evolve – in the year ahead.
- Health Care