Peter from the Plane : Entry #3

To China and back - take away thoughts from a week in the People's Republic.

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Our Chief Medical Officer, Dr. Peter Rohloff, has a strict schedule that usually includes splitting his time almost evenly between Guatemala and Boston, two weeks a month in each. As if he was not busy enough, this month he shook things up & flew to China to meet with Grand Challenges Canada, an organization funded by the Canadian government that supports bold ideas in global health. They are currently funding our large investigation on the quantitative effect that chronic malnutrition has on brain development.

Entry #3: October 2015.

I’m writing on my 12-hour flight back from China, where I spent the week attending two important meetings in Beijing. The first was the community meeting for Grand Challenges Canada’s Saving Brains, a small meeting for grant holders from this program, who are all focused on early child development. The second, larger meeting was the full Grand Challenges meeting, which included all the members of the consortium, such as the Gates Foundation and USAID.

I learned a ton of stuff at the meeting, and met a lot of really great inspiring people. I have a notebook of ideas that I’m planning to put to good use. But best of all, these kinds of meetings – where there are so many different points of view in play – help me to refine my own philosophy of global health delivery.

So here are just a few brief principles (with no particular order or theme) that – after this week – I am even more committed to that before.

1. Design matters. In our group here in Guatemala, we’ve been joking around about “agile global health” as a sort of riff on the “agile design” movement in the tech world. Except it’s not really a joke. Involving end users in the creative process (whether they are gamers, or tech companies – or poor patients in rural Guatemala) really is a better way to build programs. Delivering products (technology or health care) early when we are still working out the bugs is the best way to, well, work out the bugs.

2. Plan for failure. Human systems are complex. We can’t possibly anticipate all the ways that our health programs will go wrong when they are implemented. What we can do, however, is plan for rapid change when we mess something up, and have the monitoring and evaluation systems in place to detect mess-ups rapidly. And we can have the humility and courage to react and change (even when that screws up the design of our randomized controlled trial).

3. Mothers are not sitting around waiting to be part of our educational intervention. Their time is not free. Whatever behavior change intervention that we subject them to (hygiene, nutrition, micro-business skills) take away time they could be cooking, cleaning, mending, working, earning, politicking, educating, learning, socializing, resting. We had better make it worth their while.

4. We should pay our community health workers. Because, really, why wouldn’t we?

5. What is my path to scale? If you ask me, and I say, “Well, obviously we have to convince the local or regional governments to adopt our programs,” all that answer means is that I’m not serious about scale. This is not the way governments work. If we want our programs to grow, we need to have financing plans right from the beginning, and in many places in the world (such as Guatemala), this increasingly will mean private capital.

6. Respect the implementers. It is not the job of those on the front lines to know the late-breaking details of the exciting research that we academics think we are doing, nor is it their job to work out how our research is applicable to the field. That is our job. We need to help them, and support them. The ball is in our court.

7. Home-based care is where it’s at. It’s more expensive, sure, but we can address that (see 5). It overcomes the urban-rural divide, it places less time demands on mothers (see 3), and it provides so much more context for our interventions.
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