Kyle Poplin

‘Best Buys’ Depend on Who Holds the Wallet: Global health investors have different priorities, but efficiency seems to resonate with all

When health and development experts sat down in Washington, D.C., on Wednesday to discuss “best buys” in global health in 2014, they reached a consensus: There’s really no such thing.

Instead, they agreed, “best buys” depend on who’s doing the buying and if they’re public or private.

Some donors and investors prioritize lives saved in the short term, for instance. Others focus on community ownership. Some seek sustainability, or scalability, or return on investment. Still others focus on market tweaks that enable innovations to succeed.

The experts were taking part in a “Best Buys In Global Health” conference hosted by the Center for Global Development and supported by Merck for Mothers. It was timed with the release of the latest issue of Impact magazine, presented by Devex, Population Services International (PSI) and PATH, and much of the discussion was framed by a recent Devex survey of 1,500 international health development experts.

The survey showed that among those on the front lines of global health, two out of three said it is most important over the next five to 10 years to invest in health systems that provide products and care.

If there was a common theme among the panelists, it was that best buys should focus on specific efficiencies of existing systems, instead of building new systems.

The first of the two panels was about what makes an investment successful. Moderated by Amanda Glassman of the Center for Global Development, it included Karen Cavanaugh of USAID, Karl Hofmann of PSI and Kaakpema “KP” Yelpaala of, Inc. The second panel, focused on where to invest in global health, was moderated by Raj Kumar of Devex and included Amie Batson of PATH, Jim Cunningham of Merck Research Labs, Anastasia Thatcher of Accenture Development Partners and Mark Grabowsky of UNSEO.

Hofmann helped put things in perspective with his statement that “the best buys in global health are not necessarily the most sustainable buys … politics doesn’t always allow best buys.” An enabling environment, he said, includes both market forces and the regulatory environment.

Yelpaala said governments set agendas about health priorities. The result, the panelists agreed, is that low-profile but deadly diseases like diarrhea are too often overshadowed by high-profile diseases like HIV and malaria, where there seems to be more “public will.”

Grabowsky said the problem in global health is not a lack of money – “There’s enough money in the system to do what we’re trying to do” – but inefficiency. He recommended better use of existing systems, like the infrastructure to fight polio, to battle other global health problems, like maternal mortality. Or at least to use those existing system while more specific ones are being built.

A best buy, he said, would be placing interventions into existing systems.

He added that if donors merely changed the timing of their giving – releasing pledged money in, say, eight months instead of 16 months – it could add billions to the system. Addressing this matter of “float,” Batson joked, “Maybe it should be the ‘best way to buy,’ not the ‘best buy.’”

There was much discussion about appropriate overhead, after the Devex survey showed 71 percent think 10 to 20 percent is acceptable for an international NGO. Batson said new definitions should be used; that return on investment or efficiency is more informative than overhead. Thatcher said there “needs to be more focus on enabling capabilities, not overhead.”

Discussing mHealth, the panelists said it might be too early to call it a best buy. Thatcher said “the mobile revolution has taken off,” but “we’re in a stage of ‘pilot-itis’” where outcomes are far from certain.

Grabowsky argued that, ultimately, we don’t have to invent new measures to define best buys. There are already “gold standards,” like malaria bed nets, in place, he said, and new solutions should be measured against them.

There was agreement that many development organizations, and especially governments, avoid risk and aren’t nimble enough to react to innovations. The result is that many investors have lost millions of dollars. Meanwhile, there’s a need for risk-taking capital in the market, Hofmann said, “that allows implementation organizations to fail.” Failure, Cavanaugh said, can lead to next-generation solutions.

Environment, Health Care
business development, governance, impact investing