On Thursday, Jeremy Shiffman joined Maurice Middleberg (Global Health Council), Anne Tinker (Saving Newborn Lives), and Rachel Nugent (Center for Global Development) at a standing-room only event at the Center to discuss a framework explaining why some health initiatives attract global political priority and others are unable to do so. Jeremy developed this framework while conducting an in-depth case study of the safe motherhood initiative and supplemented the findings with research he has done on AIDS, reproductive health, and other health initiatives.
At its core, the framework posits eleven factors under four key categories (actor capability, framing, political opportunities, and issue characteristics) driving the success or failure of health initiatives (i.e. polio eradication, the AIDS movement, etc.). Advocates at the event pointed out that the framework was helpful not only as an intellectual contribution to the agenda-setting literature but as a diagnostic tool.
Of course, the framework largely addresses the question of what does happen and less of what should happen on the global health agenda. Maurice made, what I thought, one of the most poignant comments of the day in noting that the success of single issue advocacy can only get us so far in improving peoples' health, and lives, in the developing world - for example, AIDS may be a perfect case in point of the limits of a vertical campaign within dysfunctional health systems. Excluding the primary health care movement, the global health agenda has largely been a competition between a compilation of diseases and population segments for resources and attention to deliver baskets of commodities. Maurice envisioned a united global health movement focused on health institutions and systems.
While the emergence of such a united initiative may seem to be a daunting challenge, I am heartened by the success of another initiative few could have predicted would be popular with the public: HIV/AIDS. Who would have predicted not too long ago that AIDS would be high atop the global health agenda and garner billions of donor dollars a year? A disease particularly concentrated among drug users and sex workers, none too sympathetic a population in the public's eye, and integrally enmeshed in sex and sexuality is now the topic of discussion on whether it has taken too many resources. Today, the religious right often leads the charge for resources to fight HIV/AIDS and donors continue to expand the numbers of developing world patients on ARVs. How we got there is, of course, a complex story but that we got there is indicative of the realm of possibilities. If HIV/AIDS, a disease that once faced open opposition to intervention, was able to rise so prominently, then why would health systems be unable to accomplish something similar?
