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Suggested Citation:"Front Matter." Institute of Medicine. 2014. Investing in Global Health Systems: Sustaining Gains, Transforming Lives. Washington, DC: The National Academies Press. doi: 10.17226/18940.
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INVESTING IN GLOBAL HEALTH SYSTEMS
SUSTAINING GAINS, TRANSFORMING LIVES

Committee on Investing in Health Systems in Low- and Middle-
Income Countries

Board on Global Health

Gillian J. Buckley, John E. Lange, and E. Anne Peterson, Editors

INSTITUTE OF MEDICINE
          OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Investing in Global Health Systems: Sustaining Gains, Transforming Lives. Washington, DC: The National Academies Press. doi: 10.17226/18940.
×

THE NATIONAL ACADEMIES PRESS     500 Fifth Street, NW     Washington, DC 20001

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by Contract/Grant No. APC-GM-0002 between the National Academy of Sciences and JSI Research and Training Institute/USAID. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.

International Standard Book Number-13: 978-0-309-31169-4
International Standard Book Number-10: 0-309-31169-1

Additional copies of this report are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.

Copyright 2014 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Photo credit: Front cover, Copyright 2005 Anthony Legg, Courtesy of Photoshare.

Suggested citation: IOM (Institute of Medicine). 2014. Investing in global health systems: Sustaining gains, transforming lives. Washington, DC The National Academies Press.

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Investing in Global Health Systems: Sustaining Gains, Transforming Lives. Washington, DC: The National Academies Press. doi: 10.17226/18940.
×

“Knowing is not enough; we must apply.
Willing is not enough; we must do.”     

                                               —Goethe

img-3

INSTITUTE OF MEDICINE
           OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Investing in Global Health Systems: Sustaining Gains, Transforming Lives. Washington, DC: The National Academies Press. doi: 10.17226/18940.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Victor J. Dzau is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Investing in Global Health Systems: Sustaining Gains, Transforming Lives. Washington, DC: The National Academies Press. doi: 10.17226/18940.
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COMMITTEE ON INVESTING IN HEALTH SYSTEMS IN LOW-AND MIDDLE-INCOME COUNTRIES

JOHN E. LANGE (Co-Chair), Retired U.S. Ambassador; Senior Fellow for Global Health Diplomacy, United Nations Foundation

E. ANNE PETERSON (Co-Chair), Director, Public Health Program, Ponce School of Medicine and Health Sciences

RIFAT ATUN, Professor of Global Health Systems; Director, Global Health Systems Cluster, Harvard School of Public Health

GEORGES BENJAMIN, Executive Director, American Public Health Association

TINA BROCK, Associate Dean for Global Health and Educational Innovations; Professor of Clinical Pharmacy, University of California, San Francisco School of Pharmacy

MARGARET E. KRUK, Associate Professor of Health Policy and Management, Columbia University Mailman School of Public Health

CHARLES MACCORMACK, President Emeritus, Save the Children; Executive-in-Residence, Middlebury College

NACHIKET MOR, Chairman of the Board, CARE India; Board member, Reserve Bank of India and CRISIL

DAVID ROSS, Director, Public Health Informatics Institute

SUSAN SCRIMSHAW, President, The Sage Colleges

NANA A. Y. TWUM-DANSO, Senior Program Officer, Division of Maternal, Neonatal and Child Health, Bill & Melinda Gates Foundation

IOM Staff

GILLIAN J. BUCKLEY, Program Officer

MEGAN GINIVAN, Research Assistant (until August 2014)

RACHEL E. PITTLUCK, Research Assistant (from July 2014)

KATHERINE M. BLAKESLEE, Global Program Advisor

JULIE WILTSHIRE, Financial Officer

PATRICK W. KELLEY, Director, Boards on Global Health and African Science Academy Development

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Investing in Global Health Systems: Sustaining Gains, Transforming Lives. Washington, DC: The National Academies Press. doi: 10.17226/18940.
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Suggested Citation:"Front Matter." Institute of Medicine. 2014. Investing in Global Health Systems: Sustaining Gains, Transforming Lives. Washington, DC: The National Academies Press. doi: 10.17226/18940.
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Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

Floyd Bloom, The Scripps Research Institute

Leo Anthony Celi, The Institute for Medical Engineering & Science

Timothy Evans, The World Bank

Kent Hill, World Vision

William Hsiao, Harvard School of Public Health, Harvard Global Health Institute

Salim Abdool Karim, Columbia University, University of KwaZulu-Natal, Cornell University, Centre for the AIDS Programme of Research in South Africa (CAPRISA)

Sheila Leatherman, UNC Gillings School of Global Public Health

Anne Mills, London School of Hygiene and Tropical Medicine

Muhammed Ali Pate, Duke Global Health Initiative

David H. Peters, Johns Hopkins Bloomberg School of Public Health

Prashant Yadav, William Davidson Institute, University of Michigan

Winnie Yip, University of Oxford

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2014. Investing in Global Health Systems: Sustaining Gains, Transforming Lives. Washington, DC: The National Academies Press. doi: 10.17226/18940.
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Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by David Challoner, Vice President for Health Affairs, Emeritus, University of Florida; and Charles E. Phelps, Professor and Provost Emeritus, University of Rochester. Appointed by the National Research Council and the Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Investing in Global Health Systems: Sustaining Gains, Transforming Lives. Washington, DC: The National Academies Press. doi: 10.17226/18940.
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Acknowledgments

This report is a product of the cooperation and contributions of many people. The committee and staff are especially grateful to Rebekah Hutton for her design of the report cover and graphics and to Chelsea Frakes, Greta Gorman, and Nicole Joy of the Institute of Medicine (IOM). We also appreciate the contributions that Rebecca Morgan and Ellen Kimmel of the National Academies made to this report.

The committee thanks all the speakers and moderators who participated in committee meetings, as well as others who provided information, input, and assistance. They include Karen Cavanaugh, Eric Goosby, Kent Hill, Laura Holgate, Michael Johnson, Mirta Roses Periago, and David Peters.

The committee and staff thank the U.S. Agency for International Development (USAID) for generously funding this study.

Suggested Citation:"Front Matter." Institute of Medicine. 2014. Investing in Global Health Systems: Sustaining Gains, Transforming Lives. Washington, DC: The National Academies Press. doi: 10.17226/18940.
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Acronyms and Abbreviations

AIDS acquired immune deficiency syndrome
ART antiretroviral therapy
CDC Centers for Disease Control and Prevention
DOTS Directly Observed Treatment, Short-course
G8 The Group of 8: Canada, France, Germany, Italy, Japan, Russia, the United Kingdom, and the United States
GDP gross domestic product
Global Fund The Global Fund to Fight AIDS, Tuberculosis and Malaria
HIV human immunodeficiency virus
icddr,b International Centre for Diarrhoeal Disease Research, Bangladesh
MDG Millennium Development Goal
MDR-TB multidrug-resistant tuberculosis
MEPI The Medical Education Partnership Initiative
NGO nongovernmental organization
PEPFAR The President’s Emergency Plan for AIDS Relief
PMI The President’s Malaria Initiative
SARS severe acute respiratory syndrome
Suggested Citation:"Front Matter." Institute of Medicine. 2014. Investing in Global Health Systems: Sustaining Gains, Transforming Lives. Washington, DC: The National Academies Press. doi: 10.17226/18940.
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TB tuberculosis
UN United Nations
USAID U.S. Agency for International Development
WHO World Health Organization
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The United States has been a generous sponsor of global health programs for the past 25 years or more. This investment has contributed to meaningful changes, especially for women and children, who suffer the brunt of the world's disease and disability. Development experts have long debated the relative merits of vertical health programming, targeted to a specific service or patient group, and horizontal programming, supporting more comprehensive care. The U.S. government has invested heavily in vertical programs, most notably through the President's Emergency Plan for AIDS Relief (PEPFAR), its flagship initiative for HIV and AIDS. PEPFAR and programs like it have met with good success. Protecting these successes and continuing progress in the future depends on the judicious integration of vertical programs with local health systems.

A strong health system is the best insurance developing countries can have against a disease burden that is shifting rapidly and in ways that history has not prepared us for. Reaching the poor with development assistance is an increasingly complicated task. The majority of the roughly 1 billion people living in dire poverty are in middle-income countries, where foreign assistance is not necessarily needed or welcome. Many of the rest live in fragile states, where political volatility and weak infrastructure make it difficult to use aid effectively. The poorest people in the world are also the sickest; they are most exposed to disease vectors and infection. Nevertheless, they are less likely to access health services. Improving their lot means removing the systemic barriers that keep the most vulnerable people from gaining such access.

Investing in Global Health Systems discusses the past and future of global health. First, the report gives context by laying out broad trends in global health. Next, it discusses the timeliness of American investment in health systems abroad and explains how functional health systems support health, encourage prosperity, and advance global security. Lastly, it lays out, in broad terms, an effective donor strategy for health, suggesting directions for both the manner and substance of foreign aid given. The challenge of the future of aid programming is to sustain the successes of the past 25 years, while reducing dependence on foreign aid. Investing in Global Health Systems aims to help government decision makers assess the rapidly changing social and economic situation in developing countries and its implications for effective development assistance. This report explains how health systems improvements can lead to better health, reduce poverty, and make donor investment in health sustainable.

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