Global Health Delivery Project

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The Challenge

The FXB Center was founded on the belief that each individual has a fundamental human right to health care. Yet, in much of the world, health systems fail to effectively treat conditions that could be prevented or remedied with existing — and sometimes relatively simple — interventions. Access to preventive interventions is often scarce, and new treatments often take time to be adopted and accepted, even when they could clearly save many lives. The beneficial tools and resources of modern medical science rarely reach the world’s poorest, even those who live in affluent countries.

In recent years, policy makers have made bold commitments to improve the health of populations in developing countries. There is a substantial flow of new resources that are being channeled into global health. Yet effective delivery remains the most significant hurdle that faces medicine and public health at the outset of the twenty-first century. This delivery challenge is largely and ultimately related to management. Global health delivery will require skills, research methods, and educational tools that differ from those that exist in most medical schools and even in health care provider organizations.

Toward a Science of Global Health Delivery

In 2007, Professors Jim Yong Kim, Michael Porter, and Paul Farmer — representing Harvard Medical School, Harvard Business School, Harvard School of Public Health, and Brigham and Women’s Hospital — initiated a joint venture to create the Global Health Delivery (GHD) Project. This unique partnership aims to tackle the challenge of closing the delivery gap in global health.

The goal of the Global Health Delivery Project is to systematize the study of global health delivery and rapidly diffuse new learning to practitioners. By preparing practitioners at all career stages to provide effective health care in resource-constrained settings, the project aims to dramatically improve the value of health care delivery, measured by the health outcomes achieved for patients per dollar spent. The project’s approach involves careful analysis of actual global health delivery organizations and the creation of analytic frameworks that can guide the design of care delivery systems.

Project activities are concentrated in five areas, illustrated in Figure 1: in-depth field-based case writing; framework development and interdisciplinary research; educational programs; partnerships with Centers of Excellence; and web-based communities of practice. Leading the development of this new field of global health delivery science, faculty, researchers, and case writers are developing novel teaching materials, academic courses that focus explicitly on health care delivery, as well as innovative residency and fellowship opportunities for in-country practitioners.

Figure 1. Global Health Delivery: A Systems Perspective

The project team has developed more than a dozen case studies that are used for practical classroom training in medical education. Global health topics include HIV testing in Haiti, HIV care in rural Rwanda, the 100% condom campaign in Thailand, tuberculosis control in Peru, and polio elimination in India. In January 2008, the project launched the Introduction to Global Health Delivery course at the Harvard School of Public Health. The course uses the Harvard Business School case method to bring the complexity of real-world decision-making into the classroom.

The Global Health Delivery Project aims to serve as a catalyst in the creation of the field of “global health delivery.” This interdisciplinary field will move beyond the traditional focus on biomedical research and patient-specific clinical interventions to a broader understanding of the delivery of health care from a systems perspective. Engaging both scholars and practitioners, the science of global health delivery uses both qualitative and quantitative methods to capture the full complexity of cycles of care, the managerial challenges of delivery organizations, and the influence of local context on system design and patient care.