Josh Ruxin, assistant clinical professor at the Mailman School of Public Health at Columbia University who currently resides in Rwanda, makes the case for more managers and for looking at and learning from business models and practices for global health in “Doctors Without Orders; To improve global health, what we need isn’t just Bill Gates’ billions, but Microsoft’s managers.”
In this summer 2008 piece published in Democracy, an online “journal of ideas,” Ruxin interviews Dr. Jim Yong Kim on the GHD project and communities of practice, GHDonline.
Excerpts:
“[…] What would a new, management-oriented approach to developing world public health look like? Ask Jim Yong Kim, a co-founder of Partners in Health, a public health NGO, and a professor at both the Medical School and School of Public Health at Harvard University. Kim has long been a fervent advocate for applying business acumen to the public health sector and to teaching public health much the way business is taught today: by case studies. He often jokes that there should be a collection of case studies on public health failures. He recently asked, “What can we learn from business and communications experts that will help us better deliver healthcare? How can we ensure that the lifesaving products and technologies are as available in poor countries as imported soft drinks?”
In response, Kim is putting together the Global Health Delivery Project (GHD), a new initiative out of Harvard in which global health meets the business world. Led by Kim, physician Paul Farmer, and business professor Michael Porter, GHD addresses the implementation gap between good plans and good execution by studying successes and failures in global health care delivery and the design and management of health care delivery systems in low-resource settings. According to them, “Practitioners of health care worldwide need effective care delivery models, support, training, information, and tools to utilize new resources in a way that will provide the best-possible care; yet no comprehensive effort currently exists to address their needs.” They plan to focus Harvard’s program in four key areas: education to teach effective methods of health delivery; interdisciplinary “communities of practice” to leverage the Internet to disperse these ideas; research to unite clinical research, operational research, and engineering science; and innovation centers, located across Africa, to provide on-the-ground research, learning, and teaching for Harvard’s affiliates and others.
This is, of course, just one effort, not a wholesale reform; on the other hand, there is no governing body of public health, and so any change will have to come through the effective demonstration of new approaches by groups like Kim’s. The key is figuring out the right curriculum and case studies to train the talent required today. The intersection of the private and public sectors is a challenge for any discipline, and public health implementation anywhere–the United States being a glaring example–has an extraordinarily difficult time getting it right. A true business approach in global public health demands that clear metrics, interventions, incentives, and feedback mechanisms be put in place to focus on health improvement just as the private sector focuses on profits. Practitioners need not have an understanding of the minutiae of health challenges. They simply need to be great managers, trained in the basics of public health, with superb strategic, organizational, and implementation skills. The next step for Kim and Harvard needs to be satellite programs across Africa; even with innovation centers, the project is still rooted in Cambridge. As Kim and others in GHD know first-hand, learning management techniques thousands of miles from the health centers of Africa risks irrelevance.”
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