How could a report called Millions Saved contain any disappointments? Well, the truth is that we build success not only from our achievements, but also our failures.
In global health, we often fail to achieve an impact at the scale we once projected. Last year marked the end of the United Nations Millennium Development Goals (MDGs), a set of eight targets for improvements in global health and welfare.
That’s why the new edition of Millions Saved is so timely: it demonstrates that large-scale success in health is possible – and that we can still learn from failures. It gives us reasons to be optimistic that the lives of people living in the world’s poorest communities can improve faster as we work toward the new UN Sustainable Development Goals (SDGs), a more ambitious set of 17 global objectives that we hope to achieve by 2030.
As a public health champion for both handwashing to prevent diarrhea and integrated care to prevent childhood deaths, I expected programs implementing these measures would have been among the successes, based on strong evidence for their efficacy and cost-effectiveness.
But as a member of the working group for the first edition of Millions Saved, I’m pleased that the second edition of the book – which examines 22 large-scale public health programs – includes several case studies on disappointing outcomes like the lack of measurable impact from certain prevention and integrated care plans. It also highlights useful policy and program implications.
The book shows that it takes more than cost-effective interventions for a program to make an impact at scale. Deploying tactics and interventions based on the best available scientific evidence is essential, but not enough. We also need:
- Sustained global and national leadership across political cycles.
- Partnerships and coalitions to mobilize and bring together technical, financial and political resources both domestic and international.
- Continuous use of data, results, monitoring and evaluation, to improve what we do.
We learned from the case study on integrated management of childhood illnesses in Bangladesh that achieving sustained impact at scale requires community approaches and strong health systems, in addition to skilled health workers. And as we see from the handwashing program in Peru, multiple factors must be tackled to achieve and sustain behavior change. Singularly focused campaigns usually don’t work over time.
These lessons will inform how we scale up to achieve the SDGs for health. The goals form a new development framework and outline objectives that acknowledge the influence of multiple factors to drive change and impact at scale; offer a systems approach to tackle bottlenecks and the operations research needed to understand how to do so; and bring together health systems and community approaches, reminding us that there is no shortcut to development.
Millions Saved also notes that one key to meeting the SDGs is to focus on addressing the needs of the worst off, which will likely yield the greatest health gains. This is a job that governments can do and lead – as demonstrated by the success story of India’s national Aids control program.
The Avahan program teaches us that targeted community outreach in key populations can curb the spread of HIV and alter the course of India’s epidemic. And that only rigorous, prospective evaluation – bolstered by transparent measurement – can tell us to what degree this change will happen. Now the Indian government has the opportunity to sustain and expand on the advancements made during its first decades of HIV control.
The case studies in Millions Saved shed light on the urgent task of sustaining and deepening health improvements in all populations and regions of the world. If we are to reach the SDGs by 2030 and achieve greater impact in global health amid shifting challenges, we must learn from both successes and failures.
Mariam Claeson is the director of the maternal, newborn and child health team at the Bill & Melinda Gates Foundation
This content is paid for by the Center for Global Development
