The Ghosts of Global Health Initiatives Past
Today the U.N. General Assembly convenes in New York City to discuss and approve the long-planned Sustainable Development Goals (SDGs). Taking the place of the Millennium Development Goals (MDGs), which end in 2015, the SDGs set new goals and targets for a wide variety of development issues, from global poverty to healthcare, over the next 20 years. With the Ebola outbreak still fresh in the public consciousness, and with chronic and tropical diseases grabbing headlines, there has never been a better time to reassess and refocus global healthcare goals.
As the goals and targets of the SDGs are debated, however, health policy makers need more than mere words to achieve results. A recent study by Hudson Institute revealed that many global health programs failed to take into account the challenges of political will and transparency, the importance of local participation in design and implementation, and the vital role of the private sector with its diversity in financing, product development, and service delivery.
According to its own evaluations, the World Bank found that many of its health programs were poorly implemented, with unrealistic targets and limited impacts on health. The African Union's 2001 Abuja Declaration, which required signatory nations to pledge 15 percent of gross domestic product to healthcare, was upheld by just six countries due to a lack of political will. Similarly, in 2003, the World Health Organization's "3x5" Initiative set out to treat 3 million victims of HIV/AIDs by 2005. In addition to not meeting its target, the WHO allowed 36 AIDS drugs to enter the African marketplace without evidence of bio-equivalency.
The United Nations' final report on the MDGs never mentioned the contributions of the private sector or the diminishing role of official government aid in the changing landscape of global health. For example, during the first 12 years of the MDGs, Hudson Institute found that 29 companies contributed $94.8 billion in monetary and product donations, technology transfers, voluntary licenses, training of healthcare cadres, and infrastructure building projects. Merck & Company, together with the Bill & Melinda Gates Foundation, built Africa's first pediatric AIDS hospital and outpatient clinics in Botswana. Eli Lilly and Company transferred its multi drug-resistant tuberculosis (MDR-TB) production technologies and technical support staff to companies in South Africa, India, Russia, and China.
Such public-private partnerships among government agencies and non-profit organizations, independent and corporate foundations, faith-based organizations, and volunteers have improved the lives of billions over the last 30 years. To meet the many targets included in the proposed SDGs, healthcare practitioners should take a careful look at not only what worked, but at how the world has changed. Private financial flows dominate the economic relationships between developed and developing countries, and private players deliver a large portion of healthcare services throughout the world.
Rather than regard the private sector as an "institutional conflict of interest," a draft resolution at the 2015 World Health Assembly, the multilateral institutions undertaking global health initiatives must embrace the growth of civil society and the diversity, choice, and prosperity that democracies and economic growth create in order to carry out the important health goals and targets of the SDGs.