GLOBAL HEALTH SYSTEM:

Global Health Organizations

and Movements
 Outline
• Who pays for public health?
• Types of global health programs
• Implementing programs
• Challenges of global health organizations
 Paying for Public Health
• Global public health is funded by a variety
of contributors
– Not just global rich aiding the global poor
• Global health funding aims to address
shared health concerns and achieve
mutual goals

Jacobsen chapter 12. Global health payers and players.

 Government Funds
• The majority of public health initiatives
around the world are funded by the
governments providing those services

Ex. Public Health Foundation of India

Jacobsen chapter 12. Global health payers and players.

Jacobsen chapter 12. Global health payers and players.
 Bilateral Aid
• Bilateral aid: money given directly from
one country to another
• Major donor nations (>$10 billion each in
2010): United States, United Kingdom,
France, Germany, Japan
• Major donor nations as % GNI (>0.8%):
Norway, Luxembourg, Sweden, Denmark,
Netherlands
– United States: <0.2% GNI

Jacobsen chapter 12. Global health payers and players.

Jacobsen chapter 12. Global health payers and players.
Jacobsen chapter 12. Global health payers and players.
 The World Bank & IMF
• Multilateral aid: money pooled from many
donors and given as loans that have to be
repaid or as grants (gifts)
• World Bank: makes loans to developing
countries, usually for infrastructure projects
• IMF (International Monetary Fund): makes loans
to any country that could not otherwise pay the
interest on their other loans
• Heavily Indebted Poor Countries (HIPC)
Initiative aims to forgive some loans

Jacobsen chapter 12. Global health payers and players.

 Private Foundations
• Private foundations are making an
increasingly significant contribution to
spending on global public health
• Example: The Bill & Melinda Gates
Foundation provides more than $1 billion
each year to support health technologies

Jacobsen chapter 12. Global health payers and players.

 Businesses
• Pharmaceutical companies donate >$1
billion in products each year
• Other companies make in-kind and
monetary donations as part of their
corporate social responsibility plans

Jacobsen chapter 12. Global health payers and players.

 Personal Donations
• Millions of individuals make donations
each year
• Americans donated nearly $300 billion to
charity in 2011
– 73% from individuals rather than
foundations or corporations
– Represents about 2% of disposable
income

Jacobsen chapter 12. Global health payers and players.

Jacobsen chapter 12. Global health payers and players.
 Types of Global Health
Programs
1. Research and education
2. Clinical services
3. Relief
4. Community development
5. Advocacy
6. Logistics

Jacobsen chapter 12. Global health payers and players.

 Implementing Programs
• Thousands of governmental, corporate,
and nonprofit groups implement global and
local public health projects and programs

Jacobsen chapter 12. Global health payers and players.

 Governments
• National governments provide the bulk of
health services and payment for health
• Other roles
– Create and enforce health and safety
guidelines and regulations
– Sponsor health research
– Shape public policies to address health
disparities
– Oversee projects sponsored by outside
organizations
Jacobsen chapter 12. Global health payers and players.
 United Nations Agencies
• The United Nations has 193 member
nations
• The World Health Organization (WHO) is
the primary UN health agency
• Examples of other UN agencies
– UNICEF
– World Food Programme
– UNIAIDS

Jacobsen chapter 12. Global health payers and players.

Jacobsen chapter 12. Global health payers and players.
 International Cooperation
• Most developed countries have a
governmental division dedicated to
working with developing countries
• USAID (U.S. Agency for International
Development) focuses work on 3 areas
– Democracy, conflict prevention,
humanitarian aid
– Economic growth, agriculture, trade
– Global health

Jacobsen chapter 12. Global health payers and players.

Jacobsen chapter 12. Global health payers and players.
 Partnerships
• Nonprofit public-private partnerships
(PPPs) are working to set and accomplish
goals for a variety of global health issues
• Many PPPs focus on technology
development

Jacobsen chapter 12. Global health payers and players.

Jacobsen chapter 12. Global health payers and players.
 NGOs
• Nongovernmental organizations (NGOs)
are privately managed and receive at least
part of their funding from private sources
• Challenges: Directed donations, Autonomy
for local workers, politics, and neutrality
• Benefits: ability to do important on-the-
ground public health work, especially in
the neediest areas

Jacobsen chapter 12. Global health payers and players.

 International Red Cross
• The ICRC (International Committee of the
Red Cross) provides humanitarian aid to
people affected by war and other armed
conflicts
• Sanctioned under international law to
provide certain services like visiting
prisoners of war (POWs)
• National Red Cross and Red Crescent
societies are autonomous from the ICRC
Jacobsen chapter 12. Global health payers and players.
 International Businesses
• Some businesses receive contracts from
governments and foundations to
implement global health programs
• All businesses can contribute to public
health by facilitating the health and safety
of employees and their families and
communities

Jacobsen chapter 12. Global health payers and players.

 “The Challenge of Global Health”
--Laurie Garrett
• Large rise in public and private giving to combat
health challenges

• Much of the money is used without results

– Most successful programs from local NGOs

• Still need for sufficient health care workers in

country
– Preventing brain drain in countries

Garrett L. The challenge of global health. Foreign Affairs. 2007;86(1);14-38.

 From “Marvelous Momentum” to
“Health Care for All”
-- Paul Farmer
• A commitment to social justice is necessary to
understand the global health outcome gap
– Why did it happen? Why does it continue to
worsen even with efforts to improve?

• Though Garrett’s critique offers valid points, we

should re-examine the badly designed programs
– Good results can be achieved

Farmer P. From "marvelous momentum" to health care for all. Foreign Affairs. 2007;86(2):155-161.