Elements of Success

Predictable, adequate funding from both international and local sources. Making public health programs work takes money. Steady, adequate funding is needed so that the programs can be sustained long enough to have a major impact. Almost all the successful programs managed to obtain long-term commitments of financial support (up to 20 years of funding) at levels that permitted procurement of adequate supplies and commodities and the hiring of good managers and personnel.

Political leadership and champions. Nearly all of the cases illustrate the importance of visible high-level commitment to a cause. In a few of the cases, political commitment was simply the result of a leader's particular interest in a cause. In others, political commitment came about because technical experts were able to communicate effectively that a "big win" was possible. In these instances, the ability of the technical experts to make the most of a political opening was the seed of the success.

Technical innovation within an effective delivery system, at a sustainable price. Many of the cases used a new technology - a drug, vaccine, micronutrient supplement, or pesticide - that was appropriate to the conditions of the developing world. Typically the new technology permitted an existing program to work more effectively and produce rapid health gains. Development of a new health product alone is not sufficient for success, however. Major managerial and logistical efforts were required to ensure that the new technology reached the target population through the existing public health system or through a dedicated distribution network. In many of the cases, the technological innovation led to better health only because of a concerted effort to make it available at a cost that was affordable to developing countries and donor agencies - often through a public-private partnership in which private companies provided the product at reduced prices or for free and the public sector took responsibility for distribution. Such deals have frequently been facilitated through international non-governmental organizations.

Technical consensus about the appropriate biomedical or public health approach. Agreement within an expert community about the right strategy is a central factor in the appropriate design of programs. Such expert consensus occurs through regular international meetings and investment in scientific research. With such consensus, properly presented, programs are seen as credible and worthy of the outlays required. "Branding" that expert consensus - as the tuberculosis community has done with "DOTS (directly observed therapy, short course) - helps with advocacy for greater financial and political support.

Good management on the ground. Good health service delivery requires that trained and motivated workers are in place and have the supplies, equipment, transportation and supervision to do their job well. This requires both adequate funding and good management - and in some instances strong management partially compensates for budgetary restrictions.

Effective use of information. Information is important in four ways. First, information about the extent of a health problem raises awareness and focuses political and technical attention on finding solutions. Second, research on health behaviors and on the effectiveness of different service delivery approaches can help shape the design of a program and increase its prospects for success. Third, information motivates. In several programs, program managers were spurred to higher levels of performance through the "positive competition" that comes from the knowledge that other countries or regions are making faster progress. Fourth, information facilitates mid-course corrections. Collecting information before the program begins and along the way has allowed program managers to evaluate whether the intervention is achieving its goals, and in some cases has signaled the need for changes in program strategy.