Course 4: Module 1: Introduction

Picture a typical Western hospital. The buzzing of the fluorescent lights, the rows and cabinets chock-full of medicines, the dozens of physicians hurrying about making notes on their smart phones, the sounds of ambulances and emergency teams bringing in patients, the beeps and hums coming from large and complex machines. These are universal traits to hospitals in the developed world, public or private, big or small. Healthcare delivery in the developing world, however, evokes a completely different image. Hospitals can be pitch-black at nightfall, the medicine cabinets empty, physicians absent, the pavilions bathed in silence. Yet patients in these resource-poor settings are oftentimes in far greater need of medical attention for acute, infectious diseases, for childbearing, and for injuries. Clearly, the ability of healthcare workers in the developing world to deliver effective therapy to patients is constrained by their limited resources.

In this course, we will examine how different strategies have been used to overcome the obstacles of limited resources in the developing world in order to deliver quality care to patients. Limited resources can be broadly divided into three different forms: limitations on expertise, limitations on medical and technological supplies, and limitations on basic supplies.

These limitations can be further subdivided into the following categories:    

• Human resources/availability (brain drain)
  

• Electricity
  

• Stock-outs
  

• Transportation
  

• Equipment and medical devices
  

• Telephones, communication
  

• Nutrition
  

• Water and sanitation

To address these challenges, a number of strategies have been developed by various nongovernmental organizations and nonprofits. This module incorporates many examples of these strategies in the form of case studies. Increasingly, these strategies are becoming more central because many governments have failed to meet their financial commitments to the developing world. Despite a commitment by the Group of 8 in 2005 to raise aid to Africa by 2010, they have only generated 61 % of their promised increase.(1) Furthermore, the world population continues to increase at a breakneck pace, and by 2050, the world population is projected to increase by 3 billion, 90 % of which will occur in the developing world.(2) With this change in demography, it is increasingly important for developing world countries to become more resourceful and creative in the ways that they use their resources to maximize the health of their populations.

A few common threads emerge from studying the multiple limitations of resources in the developing world. The first is that donations of products to the poor are not sustainable. Instead, it is important to sell the products at an affordable price—if there is value in the product, people will buy it. We must also consider health holistically and move beyond an exclusive focus on healthcare or pharmaceuticals. Going forward, the global health community must not only identify different categories of non-medical commodities essential to healthy populations, but to also use those categories as prerequisites to any health intervention. Some of these categories include food, water, sanitation, and education.(3) Additionally, in order for nonprofits to become more cost-effective, there needs to be more transparency in budgets to show how money is allocated. Increased transparency will allow more scientific evaluation of best practice principles and allow donors to distribute their money accordingly.

Footnotes

(1) The Economist. “Aid to Africa: Failing to Deliver.” 29 May 2010. The Economist. https://www.economist.com/middle-east-and-africa/2010/05/27/failing-to-deliver.

(2) World Health Organization. “Population Newsletter.” June 2009.

(3) Yang, A., Farmer, P.E., McGahan, A.M. “’Sustainability in Global Health.” Global Public Health. 5.2 (2010): 129-135.