Methodological and Policy Limitations of Quantifying the Saving of Lives: A Case Study of the Global Fund's Approach

McCoy, David; Jensen, Nele; Kranzer, Katharina; Ferrand, Rashida A; Korenromp, Eline L.

doi:10.1371/journal.pmed.1001522

Cited by 33 publications

(33 citation statements)

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“…However, it is very difficult to attribute health improvement to specific global-level initiatives; the attribution of ‘lives saved’ to specific PPPs is not only prone to overestimation, but might also negatively affect the overall governance of health systems and reinforce vertical programmes (McCoy et al 2013). …”

Section: Discussion: a Global Health Success?mentioning

confidence: 99%

“Lives in the balance”: The politics of integration in the Partnership for Maternal, Newborn and Child Health: Table 1.

Storeng

Béhague

2016

Health Policy Plan.

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A decade ago, the Partnership for Maternal, Newborn and Child Health (PMNCH) was established to combat the growing fragmentation of global health action into uncoordinated, issue-specific efforts. Inspired by dominant global public-private partnerships for health, the PMNCH brought together previously competing advocacy coalitions for safe motherhood and child survival and attracted support from major donors, foundations and professional bodies. Today, its founders highlight its achievements in generating priority for ‘MNCH’, encouraging integrated health systems thinking and demonstrating the value of collaboration in global health endeavours. Against this dominant discourse on the success of the PMNCH, this article shows that rhetoric in support of partnership and integration often masks continued structural drivers and political dynamics that bias the global health field towards vertical goals. Drawing on ethnographic research, this article examines the Safe Motherhood Initiative’s evolution into the PMNCH as a response to the competitive forces shaping the current global health field. Despite many successes, the PMNCH has struggled to resolve historically entrenched programmatic and ideological divisions between the maternal and child health advocacy coalitions. For the Safe Motherhood Initiative, the cost of operating within an extremely competitive policy arena has involved a partial renouncement of ambitions to broader social transformations in favour of narrower, but feasible and ‘sellable’ interventions. A widespread perception that maternal health remains subordinated to child health even within the Partnership has elicited self-protective responses from the safe motherhood contingent. Ironically, however, such responses may accentuate the kind of fragmentation to global health governance, financing and policy solutions that the Partnership was intended to challenge. The article contributes to the emerging critical ethnographic literature on global health initiatives by highlighting how integration may only be possible with a more radical conceptualization of global health governance.

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Section: Discussion: a Global Health Success?mentioning

confidence: 99%

“Lives in the balance”: The politics of integration in the Partnership for Maternal, Newborn and Child Health: Table 1.

Storeng

Béhague

2016

Health Policy Plan.

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“…In the end, it is the only thing that really counts. The causes of a child's death from diarrhea are related to infrastructure, sanitation, education, and nutrition, all 'upstream' factors that are typically not the focus of PPPs in the global health arena (McCoy et al 2013). Might our continued focus on innovative delivery mechanisms, technical fixes, and scaling interventions further medicalize poverty, perpetuating a global climate in which health care is continuously championed at the cost of trying to make it less necessary?…”

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confidence: 99%

NGOs, partnerships, and public-private discontent in Nepal’s health care sector

Mahat¹,

Citrin²,

Bista³

2018

MAT

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Public-private partnerships (PPPs) have become increasingly popular models of collaboration in the global health arena to deliver, scale, and evaluate health care services. While many of these initiatives are multicountry, large-scale partnerships, smaller NGOs play increasingly central roles in new forms of privatization. This article draws on our collective experiences working in a PPP between the nongovernmental organization Possible and the Ministry of Health in Nepal to ethnographically examine the fragile and contested nature of these arrangements in the Nepali context, amidst an increasingly privatized health care landscape that is resulting in widespread discontent and distrust throughout the country, as well as financial hardship. We discuss the Possible PPP as one approach that simultaneously seeks to strengthen public-sector health care systems, yet still taps into some of the promises, anxieties, and blind spots -such as the broader social determinants of healthinherent in new forms of public-private global health work.

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“…The Global Fund, together with WHO, UNAIDS, and scientists from the article by McCoy and colleagues [1],[2], have published simple peer-reviewed methods to calculate the lives saved from a restricted set of HIV, TB, and malaria interventions that have known mortality outcomes [3]–[7]. Our method includes only those health interventions with known, documented mortality effects: ARV treatment; directly observed treatment, short-course (DOTS); and ITNs.…”

mentioning

confidence: 99%

“…To strengthen these direct country data and to put global commitments made with WHO and other partners into practice, we are also investing in five components of data systems: surveys, health information systems, vital registration, financial tracking, and country analytical capacity [10]. These investments in country data and analysis will form a basis to implement some of the recommendations to global modeling provided by McCoy and colleagues [1]. Our initial country reviews provide direct evidence of impact.…”

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confidence: 99%

“…The need for improved country data does highlight some of the weaknesses we see in the paper by David McCoy and colleagues [1]. Their analysis provides very little additional country data on uncertainties, or on the significant changes in child mortality and mortality among adults of working ages, associated with the impact of HIV, TB, and malaria on Millennium Development Goals (MDGs) 4 and 6.…”

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Saving Lives in Health: Global Estimates and Country Measurement

2013

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Methodological and Policy Limitations of Quantifying the Saving of Lives: A Case Study of the Global Fund's Approach

Abstract: David McCoy and colleagues critique the dominance of “lives saved” models of assessing the impact of health programs, using The Global Fund as a case study. Please see later in the article for the Editors' Summary

Cited by 33 publications

References 33 publications

“Lives in the balance”: The politics of integration in the Partnership for Maternal, Newborn and Child Health: Table 1.

“Lives in the balance”: The politics of integration in the Partnership for Maternal, Newborn and Child Health: Table 1.

NGOs, partnerships, and public-private discontent in Nepal’s health care sector

Saving Lives in Health: Global Estimates and Country Measurement

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