Finding the Best Value for Dollar in Global Health

In these tough economic times, funding discussions tend to focus on cost efficiency: what's the best value? Global health spending isn't usually front-and-center during these discussions, but I'd like to make the case that it should be.

From my experience working in global health for almost a decade, numerous organizations -- some for-profit, some not-for-profit -- operate in low-income countries to improve health there. These organizations do different work in different ways, but three traits rise to the top among effective and cost-efficient organizations. These traits are: country-led, performance-driven, and multilateral.

Country-led: countries that have a strategy and an implementation plan for improving health are the ones best equipped to use funding assistance. For example, governments across Africa have created individual national malaria control plans, and then organizations like PMI and the Global Fund to Fight AIDS, Tuberculosis and Malaria work with each country to help it achieve its goals according to its national plan. With the national government coordinating all partners, money does not get used at cross-purposes, and everyone is accountable to each other to reach the common goals. In other words, the sum is more than the parts alone.

Performance-driven: programs that are funded based on proven results. It's a straightforward concept, but it's surprising how many programs don't set goals and measure their progress toward those goals.

Multilateral: multilateral programs, loosely defined as a partnership working together on a given issue, have also proven to be extremely cost-efficient because a multilateral pools the money of all partners, often sharing resources and responsibility both at an organizational level and on the ground. Multilateral approaches to disease control, for example, typically work to build health systems in-country, creating infrastructure -- distribution systems, health care providers, clinics -- not just to combat a particular disease but also to combat other health problems.

Are all of these characteristics necessary for an effective and cost-efficient program? No, but it's a powerful combination.

The Global Fund, for example, mandates all three of these approaches, and while its had its challenges, its success has been tremendous. Today, just seven years after it was created, the Global Fund is the world's largest financier of malaria programs. It's already provided $1.8 billion in financing to country-led, performance-driven malaria programs in low- and middle-income countries, and it's promised another $5 billion more in 83 countries. The impact on the ground is astounding. Families, communities and even entire countries are healthier and more productive because of the Global Fund's work.

This Saturday, April 25, is World Malaria Day. It's a day to note the accomplishments the world has made in fighting malaria and the distance we still must travel to eliminate this disease. The U.S. government has been a leader in this fight, recognizing the value of investing in cost-effective programs like the Global Fund.

Malaria might not be something that most of us in the U.S. think about every day, but people in places like Nigeria and India -- two countries that bear the weight of most of the malaria cases in their respective areas of the world -- think about it daily. Each day, they face the reality of malaria, from sleeping under mosquito nets to searching for effective medicines to watching people needlessly suffer and die from this disease. Thanks to the U.S. government's continued investment, the momentum to eliminate malaria is reaching a critical mass. And thanks to effective and important organizations like the Global Fund, the U.S. government can rest assured that its dollars are being used well, saving lives around the world.