Theme 7: Global Delivery Frameworks, Interventions, and Governance

Global Delivery Frameworks, Interventions, and Governance

Global health programs differ in how they deliver care, who makes decisions, which health problems they prioritize, and whether they address immediate disease or broader social conditions.

What is global health delivery?

The way healthcare and public health services, resources, and interventions are organized and provided to populations across the world.

What is primary healthcare?

An approach associated with the 1978 Alma-Ata Declaration that emphasizes accessible, affordable, community-based healthcare, prevention, and participation by local communities.

What is selective healthcare?

An approach associated with the Bellagio conference that prioritizes a limited set of interventions based partly on cost-effectiveness and measurable results.

What is a horizontal health approach?

An approach that builds broad healthcare systems and services for a community rather than focusing on only one disease.

What is a vertical intervention?

A targeted program focused on a particular disease or health problem, such as a malaria-control campaign or a vaccination program for one disease.

What is appropriate health technology?

Technology that is suitable for a community's needs and resources, practical to use, affordable, and sustainable.

What is medical elitism?

An approach in which medical experts or highly trained professionals are treated as the primary authorities, potentially overlooking local knowledge and the contributions of community or traditional providers.

What is medical tourism?

Traveling to another country to obtain medical or dental care, often because of differences in price, quality, or availability.

What is an NGO?

A nongovernmental organization: an organization that operates independently of government as an organization, although it may receive government funding.

What is missionary medicine?

Medical work connected to religious missionary activity, historically involving both healthcare provision and efforts to promote religious conversion or cultural change.

What is “intelligent motherhood”?

A course term describing efforts by twentieth-century Western medical missionary societies to reshape maternal care and domestic life according to Western biomedical ideas.

What is the difference between healthcare as a human right and healthcare as a commodity?

• Human right: Healthcare is something people should be able to access as a matter of basic entitlement.

• Commodity: Healthcare is treated as a good or service that can be bought and sold, with access influenced by ability to pay.

What was the Alma-Ata Declaration?

The 1978 declaration associated with the WHO and UNICEF that promoted primary healthcare as an approach to improving health and supporting social and economic development.

What were the main ideas of primary healthcare at Alma-Ata?

• Healthcare should be accessible to everyone.

• Communities should participate in healthcare decisions.

• Governments have responsibility for population health.

• Prevention and affordable services matter.

• Healthcare should be scientifically sound and socially appropriate.

• Health improvements should connect to broader social and economic development.

What was the Bellagio approach?

The course presents the Bellagio approach as emphasizing selective healthcare: prioritizing interventions according to cost-benefit or cost-effectiveness calculations and their measurable results.

Primary health care

• Broad approach to community health

• Emphasizes access for everyone

• Builds community based health systems

• Emphasizes prevention and participation

• Associated with Alma-Ata

Selective Health care

• Focuses on selected interventions

• Prioritizes interventions with measurable benefits

• Often targets specific diseases or problems

• Emphasizes cost effectiveness and measurable results

• Associated with Bellagio

What does GOBI stand for?

• G — Growth monitoring

• O — Oral rehydration therapy

• B — Breastfeeding promotion

• I — Immunization

What does GOBI-FFF stand for?

GOBI plus three additional components:

• F — Female education

• F — Family planning

• F — Food supplementation

Why is GOBI associated with selective healthcare?

It focuses on a selected set of interventions intended to address major health problems using approaches that can be measured and evaluated.

What is a potential advantage of selective healthcare?

Resources can be concentrated on interventions that produce measurable health benefits, potentially allowing more people to be reached with limited funding.

What is a potential limitation of selective healthcare?

Focusing on selected diseases may leave broader issues—such as poverty, education, infrastructure, and healthcare access—unaddressed.

What is a potential advantage of primary healthcare?

It can address a broader range of community needs and build lasting local healthcare capacity, rather than focusing only on specific diseases.

What is a potential limitation of primary healthcare?

Building comprehensive healthcare systems can require substantial funding, trained personnel, infrastructure, coordination, and time.

What does the CDC do?

The U.S. Centers for Disease Control and Prevention works on disease surveillance, outbreak investigation, public health data, and training and supporting public health professionals.

What does USAID do?

The U.S. Agency for International Development has supported international development programs, including infrastructure, rural development, clinics, and maternal health outreach.

What is the difference between the CDC and USAID in the course examples?

• CDC: More closely associated with disease tracking, outbreak response, surveillance, and public health expertise.

• USAID: More closely associated with development assistance, funding, infrastructure, and broader development programs.

What is Partners In Health?

An NGO that works to improve healthcare systems and provide long-term care, including work related to HIV and tuberculosis. The lecture describes funding from donors, foundations, and government grants.

What is Médecins Sans Frontières (Doctors Without Borders)?

An NGO that provides emergency medical care in conflict zones, disasters, and epidemics. The lecture emphasizes its reliance on private funding to help maintain independence.

What is the International Red Cross?

An international humanitarian movement whose activities include disaster relief, visiting prisoners of war, and reuniting separated families.

What is UNICEF?

The United Nations Children's Fund, an international organization involved in children's welfare and health. The course connects UNICEF with WHO in the Alma-Ata primary healthcare initiative.

What are philanthropic foundations in global health?

Organizations that provide funding for health research, programs, and development. Examples from the lectures include the Rockefeller Foundation, Gates Foundation, and Wellcome Trust.

What is the role of the NIH?

The U.S. National Institutes of Health supports biomedical and health-related research.

What is the role of the International Red Cross compared with Doctors Without Borders?

Both provide humanitarian assistance, but the course highlights different emphases: the Red Cross has roles including disaster relief, family reunification, and visits to prisoners of war, while Doctors Without Borders emphasizes emergency medical care and independence in conflict and crisis settings.

What are examples of proximate interventions?

Interventions aimed at immediate or specific causes of illness, including:

• Vaccination

• Bed nets

• Condoms

• Vector spraying

• Cookstoves

• Disease surveillance and tracking

• Quarantine when appropriate

What are examples of structural interventions?

• Building hospitals and clinics

• Improving infrastructure and access to supplies

• Training healthcare workers

• Expanding education

• Universal healthcare

• Paid sick leave and family leave

What is the difference between treating a disease and changing the conditions that cause it?

Treating a disease addresses the immediate health problem. Changing the conditions that cause or sustain it may require action on poverty, infrastructure, education, working conditions, or access to healthcare.

What does it mean to evaluate the success of a global health intervention?

• Adherence/adoption: Are people using the intervention?

• Coverage/reach: How many people receive or use it?

• Knowledge and attitudes: Have awareness or beliefs changed?

• Equity: Has the gap between groups narrowed?

• Health outcomes: Have cases, deaths, or DALYs decreased?

• Cost-effectiveness: How much health benefit is achieved relative to cost?

• Biophysical markers: Have relevant physical or biological measures changed?

Why should global health programs consider both immediate and structural causes?

Immediate interventions can reduce specific risks, but broader conditions may continue to produce illness. Combining the approaches can address both the immediate problem and the circumstances that sustain it.

Remember “WHO, WHAT, HOW, and WHY?”

• WHO delivers the program—government, NGO, foundation, or international organization?

• WHAT is targeted—a single disease or broad community health?

• HOW is care delivered—vertical, horizontal, primary, or selective?

• WHY was it designed that way—equity, prevention, cost-effectiveness, emergency response, or another goal?