INVESTING IN GLOBAL HEALTH SYSTEMS
SUSTAINING GAINS, TRANSFORMING LIVES

Committee on Investing in Health Systems in Low- and Middle-
Income Countries

Board on Global Health

Gillian J. Buckley, John E. Lange, and E. Anne Peterson, Editors

INSTITUTE OF MEDICINE
          OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu

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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by Contract/Grant No. APC-GM-0002 between the National Academy of Sciences and JSI Research and Training Institute/USAID. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.

International Standard Book Number-13: 978-0-309-31169-4
International Standard Book Number-10: 0-309-31169-1

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The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Photo credit: Front cover, Copyright 2005 Anthony Legg, Courtesy of Photoshare.

Suggested citation: IOM (Institute of Medicine). 2014. Investing in global health systems: Sustaining gains, transforming lives. Washington, DC The National Academies Press.

“Knowing is not enough; we must apply.
Willing is not enough; we must do.”     
                                               —Goethe

INSTITUTE OF MEDICINE
           OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Victor J. Dzau is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

COMMITTEE ON INVESTING IN HEALTH SYSTEMS IN LOW-AND MIDDLE-INCOME COUNTRIES

JOHN E. LANGE (Co-Chair), Retired U.S. Ambassador; Senior Fellow for Global Health Diplomacy, United Nations Foundation

E. ANNE PETERSON (Co-Chair), Director, Public Health Program, Ponce School of Medicine and Health Sciences

RIFAT ATUN, Professor of Global Health Systems; Director, Global Health Systems Cluster, Harvard School of Public Health

GEORGES BENJAMIN, Executive Director, American Public Health Association

TINA BROCK, Associate Dean for Global Health and Educational Innovations; Professor of Clinical Pharmacy, University of California, San Francisco School of Pharmacy

MARGARET E. KRUK, Associate Professor of Health Policy and Management, Columbia University Mailman School of Public Health

CHARLES MACCORMACK, President Emeritus, Save the Children; Executive-in-Residence, Middlebury College

NACHIKET MOR, Chairman of the Board, CARE India; Board member, Reserve Bank of India and CRISIL

DAVID ROSS, Director, Public Health Informatics Institute

SUSAN SCRIMSHAW, President, The Sage Colleges

NANA A. Y. TWUM-DANSO, Senior Program Officer, Division of Maternal, Neonatal and Child Health, Bill & Melinda Gates Foundation

IOM Staff

GILLIAN J. BUCKLEY, Program Officer

MEGAN GINIVAN, Research Assistant (until August 2014)

RACHEL E. PITTLUCK, Research Assistant (from July 2014)

KATHERINE M. BLAKESLEE, Global Program Advisor

JULIE WILTSHIRE, Financial Officer

PATRICK W. KELLEY, Director, Boards on Global Health and African Science Academy Development

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Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by David Challoner, Vice President for Health Affairs, Emeritus, University of Florida; and Charles E. Phelps, Professor and Provost Emeritus, University of Rochester. Appointed by the National Research Council and the Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Acknowledgments

This report is a product of the cooperation and contributions of many people. The committee and staff are especially grateful to Rebekah Hutton for her design of the report cover and graphics and to Chelsea Frakes, Greta Gorman, and Nicole Joy of the Institute of Medicine (IOM). We also appreciate the contributions that Rebecca Morgan and Ellen Kimmel of the National Academies made to this report.

The committee thanks all the speakers and moderators who participated in committee meetings, as well as others who provided information, input, and assistance. They include Karen Cavanaugh, Eric Goosby, Kent Hill, Laura Holgate, Michael Johnson, Mirta Roses Periago, and David Peters.

The committee and staff thank the U.S. Agency for International Development (USAID) for generously funding this study.

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Contents

Acronyms and Abbreviations

Summary

1    Introduction

2    The United States’ Strategic Imperative to Invest in Health Systems

3    An Effective Donor Strategy for Health

4    Conclusion

References

Glossary

Appendixes

A    Committee Member Biographies

B    Meeting Agenda

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Acronyms and Abbreviations