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Sustainable Solutions are Key to Making Health Care More Accessible

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Across the developing world, health facilities sit vacant - now padlocked and crumbling buildings - while the people who once counted on their services struggle to thrive without them.

Why? Despite great intentions, the organizations that built these facilities lack adequate funding to cover annual operations. Philanthropy alone cannot possibly solve the problems facing the world's poor. The number of people who need help seems to grow as philanthropic budgets shrink. Donors who were delighted to help build a hospital or clinic move on to other causes, and eventually the doors close, leaving communities with broken promises.

Living and working as a clinician in the developing world proved to me without a doubt that the need will always outweigh the charitable dollars available. Additionally, the people with whom I was working in Africa and Southeast Asia did not necessarily want another handout from someone far away; they wanted to help themselves. I realized that the greatest philanthropic gifts support local empowerment - partnering with local communities and enabling them to become part of their own solution.

Experts in global health care are currently searching for ways to deliver services in a more responsible way, to harness the power of local markets to sustain services and alleviate the burden of annual philanthropic fundraising. Empowering communities to support their own health care by sharing costs with them means that nonprofit service delivery organizations can direct philanthropic aid to growth instead of annual operating costs, and also opens the door to for-profit social enterprises.

We already know that the poor are paying for health care, much of it provided in distant central facilities or in unsanitary, under equipped clinics. According to the United Nations, more than half of Africans and four-fifths of South Asians pay for their health care. Self-reported data from Northern Haiti show that many families are spending 50 to 60% of their household income on health events - including transportation to and from distant clinics, doctors' fees, and pharmaceuticals.

If people are willing to share the cost of the services provided and the public sector is unable to adequately respond to the demand for basic primary care, we must try a different tack. Funders and investors alike must support the growth of creative solutions that combine the agility of free market capitalism with the social mission of the nonprofit and the public mandate of government agencies. As Michael Porter notes, companies and nonprofits working together can create "Shared Value" while addressing society's social problems. In global health care we strive to provide proven, inexpensive life-saving health care with cost-sharing models that ensure long-term sustainability. Organizations pursuing these priorities include Containers 2 Clinics (Haiti), Jacaranda Health (Kenya), North Star Alliance (Kenya), Smiling Sun Franchises (Bangladesh), and Vaatsalya (India).

The United Nations set eight Millennium Development Goals in 2000 - to be achieved by 2015. Three of the eight focus on health: reducing child mortality, improving maternal health, and combatting major diseases. Much progress has been made against these goals, particularly in reducing childhood mortality, but much is left to do. Only by leveraging the very best aspects of the public, private and government sectors will we find solutions that have the durability and social impact to provide health care to vulnerable communities worldwide.