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In October 2009, the Bill & Melinda Gates Foundation doled out nearly $8 million to fund research projects aimed at improving healthcare in developing countries. The projects, part of the third round of the foundation’s Grand Challenges Explorations initiative, weren’t exactly typical. Few had been backed by preliminary research, and some were downright bizarre. Among them was a plan by a researcher at the University of California in Los Angeles to develop a chewing gum that could detect infectious disease, a proposal by an Indian scientist to build a handheld “electronic nose” that analyzes breath samples for tuberculosis, and an investigation by Mexican researchers into whether scorpion venom could fight malaria.
Tadataka Yamada, president of the Gates Foundation’s Global Health Program, has admitted that some of the proposals they approved were “absolutely crazy.” But that, he argued, was precisely the point: standard approaches for improving health among the poor simply haven’t been successful (see “Chronic Afflictions in Emerging Regions”). Each year, nearly 10 million children, mostly in developing countries, die before their fifth birthday. To save the lives of the world’s most vulnerable, Yamada points out, we need novel solutions.
Researchers recently submitted another novel proposal to the World Health Organization (WHO) for a Health Impact Fund that would reward pharmaceutical companies if they developed inexpensive drugs for the neglected diseases afflicting people in low-income countries. “It’s a very different way of looking at the problem,” says co-developer Amitava Banerjee, a cardiologist at the University of Oxford, “but it would save lives and save money at the same time.”
Unquestionably, the developing world needs novel drugs and health technologies. Perhaps more dire, however, is the need for aid organizations in those countries to revolutionize how they provide their help—because even when workers have the right tools in hand, they don’t always deliver them to the people who most need them (see “Collaborations for Better Health”). “The key to being effective from a population perspective is actually trying to find those that are most vulnerable, and making sure that those who are at greatest risk are actually the ones that get the services,” explains David Peters, director of health systems programs at the Johns Hopkins Bloomberg School of Public Health. “For the most part, that’s still unusual.”
Peters and his colleagues, along with a handful of results-minded organizations around the world, are working to restructure the aid being provided to developing countries. They argue that by setting clearer goals, regularly monitoring and reporting progress, and working more closely with front-line healthcare providers, health organizations could make a difference in poor countries. We need “to take out the old way of doing things, remove the status quo and bring in a new level of work,” explains Brandon Bennett, an advisor for the Institute for Healthcare Improvement (IHI), an independent nonprofit organization based in Cambridge, Mass. “If we can maximize the performance of a given healthcare system within its existing resources, we’re very excited.”
Vast regional differences exist in spending as a percentage of GDP around the world. In addition to regional averages, this map includes snapshots for a sampling of nations.
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