The global health community needs innovation and reform
Authors: Yucheng Feng
Journal: The Lancet Global Health (2020)

The global health community has been silent for too long. Everyone has seen the problems, but few have the interest or the audacity to speak up. In 2019, The Lancet published a Lecture by Patricia García1García P Corruption in global health: the open secret.Lancet. 2019; 394: 2119-2124Summary Full Text Full Text PDF PubMed Scopus (29) Google Scholar concerning corruption in global health. As remarked by Richard Horton, it was truly “brilliant and brave”.2The Academy of Medical SciencesThe Academy of Medical Sciences and The Lancet international health lecture.https://acmedsci.ac.uk/more/events/the-academy-of-medical-sciences-and-the-lancet-international-health-lecture-2019Date: 2019Date accessed: November 28, 2019Google Scholar Nevertheless, when calling attention to corruption, there is also an imperative need to address the inefficiency and the systemic failure in the global health community more broadly. When I visited Kenya several months ago, I witnessed the results of broken promises made by local government and international organisations—dirt veiled the broken bednets in the corner, community health workers were unpaid and undertrained, and marginalised communities were neglected. These disparities between global health goals and reality could have been improved upon if, like the Alma Ata Declaration, the Millennium Development Goals had been followed through with national effort. Yet, one goal after another, the global health community fails to fulfil any of them. Of course, this is not to neglect the tremendous progress that has been made over the past two decades. Since 2000, the global mortality of children aged 5 years or younger has decreased by half, and life expectancy has increased by 5·5 years.3UNICEFUnder-five mortality.https://data.unicef.org/topic/child-survival/under-five-mortality/#:~:targetText=Under%2Dfive%20mortality%20rate%3A%20Probability,expressed%20per%201%2C000%20live%20birthsDate: September 2019Date accessed: November 28, 2019Google Scholar, 4WHOGlobal Health Observatory (GHO) data: life expectancy.https://www.who.int/gho/mortality_burden_disease/life_tables/situation_trends_text/en/Date accessed: November 28, 2019Google Scholar Although the increasing prevalence of successful interventions such as oral rehydration therapy, exclusive breastfeeding, and immunisation had an incontestable role, technology to tackle the challenges upfront is also better than ever. But, unfortunately, the global health community is not on track to meet the Sustainable Development Goals (SDGs) by 2030. Even if the newly rolled out Global Action Plan (GAP) leads to progress, most goals will still be unmet, even with the most optimistic projection.5WHOStronger collaboration, better health: global action plan for healthy lives and well-being for all.https://www.who.int/publications-detail/stronger-collaboration-better-health-global-action-plan-for-healthy-lives-and-well-being-for-allDate: Sept 1, 2019Date accessed: November 28, 2019Google Scholar It is time to reflect: with unprecedented dedication and a pressing timeline, is it time to explore a different approach to accelerate progress? The apt leadership in global health is reassuring. Tedros Adhanom, the Director-General of WHO, deeply understands the vision of the Alma-Ata Declaration and has the potential to revitalise the long-stalled primary health-care movement. In a 2018 interview, he explained that “another meeting won't help: we have to get on the ground and try to do something.”6Jack A Dodd D FT Health: health for all or health for some?.Financial Times. Oct 26, 2018; https://www.ft.com/content/46f2d448-d85f-11e8-a854-33d6f82e62f8Date accessed: December 12, 2019Google Scholar Although Adhanom was able to precisely pinpoint the problem, the something that needs to be done is regrettably vague. If what is done is to launch another multilateral plan, it would be a disappointment. The global health community has identified what the problems are, but not how to solve them. Section 4.4 of the GAP outlined “what we will do in the next year”,5WHOStronger collaboration, better health: global action plan for healthy lives and well-being for all.https://www.who.int/publications-detail/stronger-collaboration-better-health-global-action-plan-for-healthy-lives-and-well-being-for-allDate: Sept 1, 2019Date accessed: November 28, 2019Google Scholar yet the equivocal language left room for different interpretations, misinterpretations, and eventually inefficiency in implementation. Seeing that the actionable points only covered two pages of a 132-page plan is painful, as is seeing the ambiguity in the plan. But it is more painful to see that leading international organisations have not changed the way that they work, even though existing practices have failed to help meet the SDGs. Pages of exquisitely crafted language and graphics are just paper until improvement reaches everyone. The commitment from diverse international organisations to improve health for all should be commended, and the need for guidelines and goals to work towards should be acknowledged. But would more high-level collaboration fundamentally bring wellbeing for all, or even help to reach SDGs within a decade? The bureaucracy in global health is lethal to progress; changes must happen on the ground with the people who are affected by inequalities in global health. In 2018, WHO initiated its first Africa Innovation Challenge,7WHOWHO Africa Innovation Challenge.http://innov.afro.who.int/innovation-challengeDate accessed: December 12, 2019Google Scholar which could be upscaled to every region. Policy development should be brought out of offices and conference rooms to the general public, and the next generation brought into the conversation. Local communities should be listened to and their ideas acted upon. The cycle of goals and disappointment must not persist. The global health community is at a turning point, with renewed energy and dedication from all sectors. There is one decade left to achieve the SDGs and there is undoubtedly the potential to do so. Nonetheless, more gallant pioneers like García are needed to speak up about what has stagnated global health: about corruption, the need for innovation, the gap in implementation research, and the absence of local research acknowledgement.8Hedt-Gauthier BL Jeufack HM Neufeld NH et al.Stuck in the middle: a systematic review of authorship in collaborative health research in Africa, 2014–2016.BMJ Glob Health. 2019; 4e001853Crossref PubMed Scopus (45) Google Scholar Key stakeholders in this conversation have been silent for too long. It is time for a change. I declare no competing interests.