Why don’t we fund more health systems instead of just interventions?

As if we needed any more evidence that centering advocacy and funding around specific diseases was a bad idea, the New York Times reports:

Diarrhea kills 1.5 million young children a year in developing countries — more than AIDS, malaria and measles combined — but only 4 in 10 of those who need the oral rehydration solution that can prevent death for pennies get it.

….lies at the heart of a wider debate over whether the United States and other rich nations spend too much on AIDS, which requires lifelong medications, compared with diarrhea and the other leading killer of children, pneumonia, both of which can be treated inexpensively.

International commitments to combat HIV and AIDS rose at an average annual rate of 48 percent from 1998 to 2007, reaching $7.4 billion and making up almost half of donor financing for global health, according to Professor Shiffman’s analysis of data from the Organization for Economic Cooperation and Development.

For as long as we direct funding vertically towards specific outputs, we’re going to see this sort of imbalance. We need to be investing more in health systems (be they public or private or in-between) that can respond appropriately to needs on the ground and make the optimal allocation decisions that are nigh impossible on a global scale. I have extremely mixed feelings about this quote from the article:

Jeffrey D. Sachs, the Columbia University economist, countered that wealthy donors still spent far too little on global health and rejected what he called the wrong-headed idea that “we need to make a terrible and tragic choice between AIDS or pneumonia.” The United States has invested heavily in the fight against AIDS, and other wealthy nations should pick up more of the cost of other global health priorities, he says.“Rather than tearing down what’s working, we should continue to invest in what’s needed,” he said.

Perhaps it is best that the US sticks to fighting AIDS – life might actually be better if donors bothered to specialise more; this is difficult, as no one wants the unglamorous problems, even if they are the crucial ones. At the same time, think about what Sachs is saying: the components of essential health package that the poor should get should be funded and provided by different groups of people. That’s a recipe for disaster – we should all be putting money into systems instead, not trying to cobble together different health intervention.

Health systems just aren’t sexy enough. We need a celebrity to start endorsing them.