Transparency International. If you’d asked me yesterday about this organization and their annual corruption index, I would have gushed. Sunlight is the best disinfectant I would have replied, or some similar aphorism.

But I was challenged to think differently by this article, to examine more closely how the mechanism of exposing theft and what we call corruption in poor countries reinforces an unhelpful and unjust paradigm of under-emphasizing rich countries and their power as a major part of the problem.

This article makes the case very strongly that it isn’t specific interventions that are key in driving global health outcomes, but building the strength of global health systems.

What are the best buys in global health? While many may automatically think of key interventions that are both cost effective and save lives, the best buy in global health overall turns out to be health systems strengthening.

“What we found particularly interesting is the acknowledgement that more than new technologies, it’s service delivery innovation that’s the provides the greatest bang for your buck.”

Our work with Engineers Without Borders in adaptive public services suggests this is the case across all public service provision.

This quote is particularly striking:

“With bed nets, all you do is distribute them,” says Segbaya. “With indoor residual spraying you have to hire people, train them in managing the pump, mixing insecticide, handling people’s property, all of which require more skill.”

Another factor is the cost – a net to protect one or two people costs £2-3. “Currently it costs around $400,000 (£238,000) to spray one district, which is maybe $10-15 (£6-9) per person. This is almost three times the cost of providing bed nets.”

Translation: It is easier and cost less. But it’s also less effective.

What’s disturbing is that this article insinuates that public sector spending must be augmented by private sector spending in order to afford the most effective Malaria control. I’m not sure how one can come to that conclusion, especially if you look at the net present cost including future health care costs and lost economic activity. And this doesn’t even begin to include the moral issue associated with human suffering from being infected with Malaria, which is totally preventable.

The journal article below covers how using both bednets and indoor spraying together gets massive reductions.

http://www.malariajournal.com/content/12/1/62

Conclusion: At ~$15/per person, and 700 million people, we could basically get rid of Malaria in Sub-Saharan Africa for $10 billion. To put that in perspective, that’s only about 55% of what US consumers spent on pet food in 2011.

(Source: http://www.statista.com/statistics/185577/us-dog-and-cat-food-product-shipment-value-since-2002/)

Africa is not poor. Africa is a rich continent inhabited by poor people. Once we fix the people problem, everything else will fall into place.

How would you develop any country when the dream of  the majority  of its youth and elite is not entrepreneurship, innovation, education and self-sufficiency, but the dream to have a job with a humanitarian organization or to get their project financed by some International aid Agency or proxy.

http://www.siliconafrica.com/africa-top-10-problems-not-the-ones-you-were-thinking-about/

This article is brash and bold, filled with a lot of truths though not a lot of nuance.

It definitely pushes one to think hard about perceptions and systemic issues in Africa, and how those are really global issues that all of us (in ‘Western’ countries and in African countries) have contributed to.

(Thanks to @PeterAwin for the link.)