Counting the number of lives you save …..

Global health donor agencies, as one might expect, are in the business of improving health – often indirectly through financial and technical support to governments, NGOs and charities. However, a recent trend has seen global health agencies being held accountable for achieving real impact on the ground.

Is this a good thing?

Take the Global Fund to Fight Against AIDS, TB and Malaria – a ‘global health partnership’ established in 2002 to fund and support low and middle income countries to provide treatment and prevention programmes related to HIV/AIDS, TB and Malaria. It started off with the clear intention of being a financing agency. But over time, it stopped being just a financing agency; and started being a strategic planning and priority-setting agency; with a more hands-on operational role. Soon it started to measure the impact of its own funding in low and middle income countries.

According to its 2012 Results Report, between 2002 and mid-2012, “Global Fund–supported programmes” saved 8.7 million lives through (a) antiretroviral therapy (ART); (b) direct observational therapy, short course (DOTS) for TB; and (c) insecticide-treated nets (ITNs) for malaria.

But how does the Global Fund calculate this number? Is it accurate and reliable? And how does it determine which lives were saved by its programmes; and how do the numbers tally with the number of ‘lives saved’ by governments and other agencies or donors? And what does the selective focus on measuring the impact of only ART, DOTS and ITNs do to other elements of Primary Health Care?

A paper, written by myself and Nele Jensen, attempts to answer some of these questions. The paper can be found here:

In it, we describe and examine the methodology used by the Global Fund to arrive at the 8.7 million ‘lives saved’ figure. We criticise the Global Fund for not publishing uncertainty ranges associated with the estimated number of lives saved; and argue that the methods may produce an over-estimation of the number of ‘lives saved’ by ART, DOTS and ITNs. We also argue that the selective approach to impact measurement may have some unintended and negative consequences.

Finally, we discuss the issue of attribution. We describe how the number of ‘saved lives’ which have been attributed to “Global Fund–supported programmes” far exceeds the financial contribution of the Global Fund to overall financing. For example, while about 45% of global ART results are credited to ‘Global Fund–supported programmes’, the contribution of the Global Fund to total AIDS programme financing in low- and middle-income countries is only 10%. We therefore propose a different approach to measuring the Global Fund’s impact in terms of ‘saving lives’.

Mobilising public health action against bad legislation …

olympics opening ceremony celebrating the NHS

Public Health, by definition, works in the public interest. Sometimes this requires acting against a government that, for whatever reason, seeks to pass legislation that harms the public interest.

One recent example of this was when the public health community in England mobilised against the Health and Social Care Bill. It’s worth re-capping some of the highlights of that mobilisation. It really started when more than 400 public health professionals wrote an open letter to the House of Lords, calling on peers to reject the government’s Bill. See here and here

A further defining moment came when the Faculty of Public Health convened an Emergency General Meeting to debate the question of whether it should oppose the Bill outright. Arguments in favour of opposing the Bill on public health grounds were made and the motion calling on the FPH to oppose the Bill was eventually carried.See here for some you tube clips:–2IT6sU84–4mvIK6Y&feature=related

Unfortunately, the Bill was passed by parliament in spite of growing professional and public opposition; and in spite of evidence that the reforms would disrupt, deteriorate and disorganise health care.

But it did demonstrate the integrity, authority and courage of the public health profession.

It remains to be seen if the more damaging aspects of the 2012 Health and Social Care Act can be reversed. But we must hold onto the conviction that the public health community has the authority and mandate to speak out in the public interest and in defence of science and evidence.

The Faculty of Public Health ….

Voting in South Africa, First Democratic Election 1994

Voting in South Africa, First Democratic Election 1994

It’s election time for the Faculty of Public Health. Every three years, the  Faculty elects a new President. And somehow, I’ve been persuaded to stand for election.


The underlying reason is that I think public health professionals and the public health discipline are important – for the health system and society more generally. So it’s worth being committed to the Faculty and contributing to the on-going development and accreditation of the public health workforce. The more immediate reason is that I’ve been critical of the Faculty in recent months (mostly over its response to the dismantling of the NHS) and have been encouraged to address my concerns by working on the inside. Put your money where your mouth is. Something like that.

I’ve got a manifesto – as do four other candidates. This is what is says ..

Public Health in the UK faces unprecedented threats, including:

  • commercialisation of health and health care;
  • disintegration of the public health workforce;
  • disorganisation, fragmentation and erosion of ethical standards and trust within the health and social care system;
  • widening social inequalities; and
  • unchecked social drivers of ill health.

I am standing for President because I want to enable public health to mount robust and effective responses to these threats.

 Three building-blocks form the basis of my manifesto.

 First, better harnessing the professional mandate and skills of the Faculty membership to promote and safeguard the public interest whilst countering regressive and harmful political and commercial agendas, and more effectively influencing policy on the social determinants of health.

Second, as our discipline becomes divided (functionally and structurally), ensuring that the Faculty helps keep the public health community strong and united. This will require fresh thinking about how the FPH provides a safe and sound home for the many diverse professional, technical and interest groups working in public health, across the whole of the UK.

Third, promoting a programme of staff and organisational development for the Faculty so that it works more effectively as an organisation of which its members can be proud and for which they feel a sense of ownership. This will enable it to bring about much needed revitalisation of public health education, training and accreditation.

I’m not a typical candidate for the position. But as with all elections, the options available to voters and the pre-election discussion is as important as the eventual result.

Whoever is elected will require the support of all members to safeguard the future of the Faculty and of the wider ability of public health professionals to perform a public interest role effectively and safely.