Bridging the Delivery Gap to Global Health

author: Jim Yong Kim, Dartmouth College
published: June 29, 2011,   recorded: November 2007,   views: 2766
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Jim Yong Kim and Partners in Health are paradoxically suffering from their own success. They demonstrated over the past decade that it is possible to set up effective HIV and primary care clinics in such developing nations as Haiti, and that it’s possible to cure multiple drug resistant tuberculosis. They even managed to persuade pharmaceutical companies to permit the production of generic, less expensive antiretroviral medicines so they could be affordable to the poorest people. But now, as billions of dollars flow into efforts to attack diseases that needlessly kill and maim the world’s poor, we find ourselves “living in the middle of an implementation bottleneck,” says Kim.

Whether from the Gates or Clinton Foundations, or from international government initiatives, money is flowing into new products like HIV/AIDS vaccines, TB vaccines, microbicides, anti-malarial drugs, and surgical services such as male circumcision. It could all “have a huge impact,” says Kim, helping to forestall 10 million preventable deaths per year, but for the increasingly massive logjam in delivering all the care. Why is it so hard to distribute the expertise, technology, resources, to the people in need? There are all kinds of “just answers” that Kim gets: just align incentives; just make the markets work better; just fund infrastructures adequately; just give workers the management skills.

While he agrees that these are all relevant issues, Kim really wants an integrated response. He’d like to see medical schools like Harvard, where he’s on staff, develop the kind of case studies commonly employed at business and engineering schools to dissect complex strategy problems. For instance, medical students today have no idea how smallpox was eradicated – the story of this immense project combining management and epidemiology has been lost as a teaching tool. Just as Harvard Business School was “teaching the Jet Blue meltdown three weeks after it happened,” so must medical schools capture current problems and approach them both qualitatively and quantitatively.

Kim calls on institutions like MIT Sloan to help devise new analytic frameworks for examining and improving global health delivery. “There’s room for a whole new field, health care delivery science,” says Kim, combining multiple disciplines, and developing leaders to advance evidence based strategies. We can’t alleviate human suffering caused by disease “just being the lab, or by doing clinical research.” It’s now time “to build functioning health care systems everywhere in the world.”

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