Tracey Koehlmoos: Good Health at Low Cost: the importance of political commitment

Tracey KoehlmoosAlmost any student of global public health will be familiar with the seminal work Good Health at Low Cost.  In honor of the 25th anniversary of the release of the original book, the Rockefeller Foundation has commissioned an updated version of the book that includes five new countries or states: Ethiopia, Tamil Nadu, Kyrgyzstan, Thailand and Bangladesh as well as updates of the previous studies: China, Costa Rica, Kerala and Sri Lanka.

The book is unique in that it evaluates inputs from both health systems and other systems inputs and their influence on health improvements in the poorest countries of the world.  The multinational team, headed by the London School of Hygiene and Tropical Medicine, assembled in the Rockefeller Foundation’s lovely Bellagio Centre on the shores of Lake Como in Italy.

Within each of the countries, including Bangladesh, case studies were built from document reviews, interviews with key informants, and focus group discussions in order to produce a detailed description of the development, innovation and contextual factors that changed the health and circumstances within the nation.  Health outcomes and indicators that we were reviewing  revolve around the more traditional big ticket items like maternal mortality, infant mortality, and childhood immunisation rates.

On the first day of the three day meeting, each country gave an overview that included the key messages emerging from their work. Over and over again, the countries noted that “Political Commitment” or political will was an important contributor.

Four countries – Ethiopia, Bangladesh, Kyrgyzstan, and Thailand—have seen political parties and leaders come and go as well as drift in and out of different less-than-democratic forms of government, yet amazingly  the interest in improving the health of the population was constant.

“Political will” is a vague statement. The challenge is how to break it down into the individuals, institutions, policies and contextual factors that create the right environment for continued improvement in the health sector. How do you create political will if it does not exist—and are there examples of countries that have political will for health improvement but have not been successful in improving health outcomes?

Of course, there is no neat solution—and the writing and synthesis will go on for the next several months. We hope that the book will be launched globally before mid-2011 so that the lessons of creating health improvements with limited financial resources can be shared.

Tracey Koehlmoos is programme head for health and family planning systems at ICDDR,B and adjunct professor at the James P. Grant School of Public Health, BRAC University.