Global Health Council 5: We ♥ Margaret Chan

Cross-post from THDBlog:

Friday ended with an impressive lineup of global health leaders discussing the disconnect between horizontal and vertical funding in the plenary session titled Meeting Along the Diagonal: Where the First and Last Mile Connect.  A webcast of this session, and 2-3 others from the Global Health Council Conference, will be available on kaisernetwork.org starting Tues-3-Jun-2008.  It’s nearly 2 hours long, but brings together ideas from the Gates Foundation, WHO, the Global Health Council, and USAID.  As much as it was about these organizations and the types of organizations (foundation, multilateral, advocacy, bilateral), it was about the individuals who spoke their minds:

• Jaime Sepulveda, Director, Integrated Health Solutions Development, Bill & Melinda Gates Foundation
• Margaret Chan, Director-General, World Health Organization
• Nils Daulaire, President and CEO, Global Health Council
• Henrietta H. Fore, Administrator, U.S. Agency for International Development, Director, U.S. United States Foreign Assistance

The session was moderated by Susan Dentzer, Editor-in-Chief of Health Affairs, and her performance - one that was witty, but neither overbearing or spectatorish - made more sense after I learned about her NewsHour and NPR roots.

Administrator Fore spoke of USAID’s accomplishments and left immediately for the White House.  The session was awash in metaphors related to the theme: diagonal (Sepulveda), fractal (Daulaire), circular (Gordon Perkin, in the audience).  Dentzer synthesized the overall position of each of the speakers in a few words (in order that they spoke):

• Fore: “horizontal aspects to vertical programs”
• Sepulveda: “integration”
• Chan: “connect”
• Nils: “fractal”

The collective message for me from the session was this: health systems are complex, we need to look at integrated solutions, and it will take time.

Sepulveda’s framework for looking at health systems requirements was his effort to “make that black box [of health systems] transparent”.  His four requirements of health systems are:

1. Stewardship
2. Financing
3. Delivery (personal and non-personal services)
4. Resource Generation (people, information, vaccines, technology)

He referred in his comments to 2 articles:

1. Walsh J A & Warren K S. Selective primary health care: an interim strategy for disease control in developing countries. N. Engl. J. Med. 301.967-74, 1979.
2. An “forgotten” article that Sepulveda wrote in the 1980s in the Bulletin of the WHOon the topic of “diagonalism”, but perhaps not in those words.  (I wasn’t able to find it, but if you know of the article, please post a link as a comment.)

Both Sepulveda and Daulaire had some interesting things to say, but I want to focus on Margaret Chan.  About 2/3 of the way through the sesssion, I was so taken by Margaret Chan’s honesty and perspective that I wrote “I ♥ Margaret Chan” in my notebook.  I passed my notebook to an NIGH colleague sitting next to me, who then showed me his notebook which had “I [heart] Margaret Chan” written atop his penultimate page of notes.  He didn’t want to draw a heart, he later told me, because he was afraid somebody might see it.  If that wasn’t weird enough, I told the story to another NIGH colleague, who responded that she too had written “I ♥ Margaret Chan” in her notebook.

Some Margaret Chan highlights (keep in mind her emphases in her tenure at the WHO have been Africa, primary healthcare, and women)

• Dentzer told her she was “the James Brown of global health”, a reference to her work ethic
• “What works for Hong Kong doesn’t work for Zambia.”  This sounds obvious, but there was quite a lot of talk at this conference about exporting successful models from one country to another.  I’m not saying you can’t learn from successes, but there is at least some better work we need to do in adapting those models to different situations.
• “Primary healthcare faded from the vocabulary of global health.”  She citedPeriago’s “crushed” comment from earlier in the day.  In fact, she brought in a lot of examples of what other people were saying throughout the day, so it’s clear that she was listening.
• One of the other examples she brought up was a Johns Hopkins professor who in a morning comment advocated for “health impact assessments” like “environmental impact assessments” prior to doing something new.  (Sorry, don’t know the name of the JHU professor.)
• “Famous soft drink”.  She didn’t name it because she didn’t want to advertise for it, but asked “why can’t we get to the same areas of the world?” (a reference to technologies like vaccines and medicines).  If we can’t do that, “we fail our people”.
• “It’s easy to blame people when you fail.”
• In referring to her 30+ years of experience: “I look young, but I’m not”.
• “Primary healthcare was alive” in places like Brazil, India, and Argentina, even though it wasn’t in the “official vocabulary”.
• “I’m not going to repeat the WHO definition of health.  To me health is a social objective.”
• In indicating that we need to train more mid-level professionals: “For the clinicians in the audience, don’t worry, there’s plenty of work.”
• “We have not listened enough.”  ”We underestimate the ingenuity of the community.” “If you say ‘talk is one thing, walk is another’, I rest my case.”
• “We are insular. We only look at the health sector.”  We need to look at safe water and sanitation, education, etc.
• “Ministry of Health [alone] cannot handle the complexity of the situation.”
• “Let’s be realistic. Even NGOs are making profits.”
• “Why is it that working with industry is seen as dirty?” “Industry is part of the solution.”  We need to work with food and pharmaceutical industries.
• Peer review is “another elephant in the room”- Chan identified most of the elephants.  It is a process by which “your friends condone your work”.

And my favorite, because it directly addresses the work I do and that we need to advocate for in the development of new technologies and services:

• “I didn’t realize that the color of bednets makes a difference.”
• “It wasn’t until we brought in the anthropologists that we found out that the color red represented death.”
• They changed the color to yellow and people started to use them.

I encourage you to watch the session if you can spare the time.  Posted from the Wi-Fi bus between DC and New York.