Issues in Global Health Financing by Sireesh Ramesh C'22

The last 50 years have seen drastic improvements in global health. Vaccines have brought an end to smallpox and almost exterminated polio. The mortality rates of AIDS, Tuberculosis, and Malaria are dwindling across the globe. Child death rates have fallen 70 percent. And life expectancy has skyrocketed in LMICs, or low and middle-income countries.

A lot of this has been due to the work of organizations like the World Health Organization, World Bank, and USAID, as well as nonprofits like the Gates Foundation. With limited funding, these organizations have pursued the most cost-effective solutions to improve global health delivery. Thus investments in vaccinations in LMICs have been a heavy focus of NGOs as well as interventions to reduce the incidence of malaria, HIV, or tuberculosis. Dispersal of nets, condoms, and regulated distribution of antibiotics by these organizations have thus been popular interventions that have seen drastic results in relation to costs.

But, as we start to look at the scope of global health, it becomes clear that a lot of work is still left to be done. While AIDS, malaria, and tuberculosis have been the central focus of global health organizations (because of how cost-effective interventions against these diseases have been), the larger health infrastructures of many LMICs have failed to expand beyond treating these “big three diseases” (AIDS, malaria, and tuberculosis). International NGOs interested in healthcare execute their agendas by being heavily involved in the way LMIC’s health ministries distribute their money, and, because these NGOs are interested in the most cost-effective solutions to impress shareholders and potential donors, LMICs have been unable to develop a proportional focus on healthcare interventions outside of the big-three diseases. Surgery is an extremely salient example.

At current estimates, almost 5 billion people lack access to safe and affordable surgery. Many NGOs have been hesitant to invest in upgrading surgical infrastructure because it is seen as a solution that is not cost-effective. After all, why would a global health organization invest millions in building a surgical center when it could save more lives in a shorter time at a lower price (and thus impress shareholders, feel more gratified, and attract greater numbers of donors) by distributing malaria nets. This mentality, of pursuing interventions that benefit the NGO’s perceived success over the long-term benefit of the country’s health, has prevented sustainable healthcare solutions from being implemented in LMICs. While the distribution of antibiotics or vaccines is dependent on the presence of the NGO and is thus a short-term solution, building surgical centers can not only create a long-term model to distribute these drugs but also treat a much broader array of diseases including congenital defects, cesarean sections, cancers, and injuries.

It is true that a focus on providing advanced treatments like surgery can seem costly and impractical. However, studies have shown that surgery can be just as cost-effective as the distribution of vaccinations. Accessible surgery is also an indication of a developed healthcare infrastructure. Countries that can provide safe and affordable surgeries to the entirety of their population will most likely also be effective in treating AIDS, malaria, and tuberculosis among their populations. Thus, LMICs will be able to wean off of the current imperialistic model of them relying heavily on foreign NGOs to deliver healthcare to their own populations.

Another major criticism of promoting surgical interventions is that many LMICs are simply unable to provide surgeries on the scale of other countries. After all, many countries have as little as a single trained surgeon per two-hundred thousand people. And this argument is completely valid. But it also sheds light on the idea that global health interventions cannot mean simply providing treatments that make the providers feel good about themselves and that save money; it means empowering local populations to be self-sustaining and solving problems whose solutions may only be seen in the long-term. Increasing surgical output in LMICs, for example, also falls in line with investing in educational programs that can potentially create more surgeons in the future. This next generation of surgeons will work in hospitals that will need physicians, nurses, managers, clerks, insurers, and more. The healthcare industry, after all, has been one of the few industries with a sustained, increase in demand for jobs over long periods of time. Therefore, overall employment in countries could increase when raising surgical output becomes a goal for health ministries and the corresponding NGOs they work with.