​Improving the sustainability of public health outcomes of global health solutions

Author: Lenias Hwenda

Photo: WHO Director General Dr Tedros joins Committee A yoga breaks during the World Health Assembly in Geneva 2018, Palais des Nations.

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The majority of low and middle-income countries have evolved to become passive recipients of ideas, products and solutions towards some of their most pressing public health challenges. As a result, decades of development support has not resulted in significant strengthening of country capabilities in creating inclusive public health systems that meets the needs of entire populations. 

Solutions that empirical evidence has shown to be ineffective continue to be implemented in countries. This disconnect between what all partners agree to be the best solutions and what is actually practiced is the paradox of global health and development support. 

For example, a significant body of evidence demonstrates that vertical disease programs have a weakening effect on the goal of strengthening entire health systems. Yet, there are little signs that this approach is likely to change any time soon. National experts and development partners acknowledge the limitations of current approaches. They pay lips service to the need to change but continue to follow the same approaches nevertheless.

Low and middle-income countries can choose to continue to be passive recipients of solutions that are not optimal for meeting their national health goals. Partners are likely to continue to provide support in the way they have always done as it serves the logic and the objectives of their support.

Ultimately, it is the responsibility of those who receive support to articulate their needs and insist on a public health approach that can help them deliver wider impact by strengthening the foundation national health systems. Countries must lead in addressing their own economic, social and political determinants of health and spearhead public health approaches that mitigate against the biggest public health challenges facing their nations. They should be the strongest advocates for effective global health solutions that create sustainable public health outcomes.

This requires strong national capabilities, political will and investment in the necessary infrastructure such as local experts capable of engaging with development partners without deferring their own evidence-informed judgement of what is needed to improve impact. Open and frank conversations with ourselves and with our partners in global health forums such as the World Health Organisation are a good place to start a conversation about sustainability. These must however be followed by strong commitment to practical action taking the approached we know can bring better outcomes.
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