Letter from Loyce: A 2020 Definition of Progress

If you are anything like me, you alternately feel like time stopped in March (“How is it summertime? Didn’t we just celebrate New Year’s?”) or that you have aged a decade in the span of six months (“Is it really still 2020?”). It seems like we’ve lived a lifetime in a matter of weeks and somehow appear to be standing still, struggling with a pandemic and begging for adequate resources to beat it. I suppose we are learning the hard way just how far we have to go in the fight for global health.

Let’s remember, though, progress should be measured differently today than it would be in “normal” times. 

Progress in 2020 might be measured by our ability to challenge assumptions, rethink what and how we do things, and come up with a plan for improvement. This is not to suggest that we should go back to the drawing board entirely. While the pandemic has tested U.S. leadership in global health, it shines a light on champions actively addressing core needs and priorities. We’re also witnessing many of the systems American investments have helped to create or support worldwide endure the strain of a public health emergency. Nonetheless, it’s clearly time to take stock and do some course correcting. 

Here’s the good news: we have a pretty solid head start.

As I mentioned in a recent message, GHC has been asking ourselves for some time how we should do things differently to tackle troubling trends in our line of work as well as sustain political and public support for these lifesaving programs. The discussions we’ve had with the community led to the Big Idea in U.S. Global Health, the goals of which are, broadly, preventing the preventable and increasing access to care through resilient health systems and integrated approaches. While the details are still coming together, we have determined a set of operating principles to guide related policies, strategies, and funding:

• Building on the experience and knowledge of a U.S. legacy in global health. Lessons generated over the last four decades can help countries better implement strong national health programs to both tackle primary health care and increase capacity to address noncommunicable diseases, reproductive health, and infectious disease.
• Advancing innovation. The role of the U.S. in research and development will be adapted, leveraging strengths such as market-focused sustainability initiatives, investments in data and technology accelerators, catalyzing financing and mobilizing country resources, and enlisting end-to-end research and development for medical products and system strengthening.
• Ensuring against threats. A multifaceted approach, with a broader view of the diverse issues that threaten populations, will center around preventing future pandemics, combating antimicrobial resistance, and adapting to the still unseen consequences of climate change, conflict, and migration.
• Democratizing priorities and programs in communities. Success can only be achieved through true community engagement and by ensuring diverse civil society voices are woven into all levels of decision-making in pursuit of equity and transparency for end users, with an eye toward key populations.
• Focusing on outcomes. Programs must be designed from the standpoint of those most affected to more easily coordinate on goals, primary or secondary results, data sharing, and workforce task shifting.
• Encouraging holistic programming. Without losing focus on concrete outcomes in disease areas, holistic programming and integration will be supported to ensure the most appropriate front-line care available is matched with the need on the ground.
• Synergizing health and development efforts. There is an opportunity for the U.S. to combine, rather than separate, its investments in health and broader development issues to accelerate economic growth and better strengthen health systems to meet the needs of populations in low- and middle-income countries.

It is our hope that these principles make U.S. global health programs even more strong and sound, ready for a post-COVID world. They also reflect an awareness by those of you who helped develop them of the traditionally top-down approach to U.S. global health efforts and need for overdue humility. As we continue to refine this framework, it will be informed by ongoing dialogues confronting power and privilege in our sector.

That very topic has been a featured component of our annual symposium, and this year’s summit—taking place, virtually, in November—will be no exception. I will go into more detail about the summit next month, but suffice to say it is poised to be a very candid discussion. It’s a difficult one, as well, with no easy answers. It’s understandable that, when we’ve convened dialogues in the past, some of those conversations were uncomfortable, but I applaud this community for pushing through. The same level of honesty hasn’t yet been as well received by all donors, elected officials, or other decision-makers. However, another thing that’s been made clear by the events of 2020 is that we no longer have a choice but to “go there.” We must move beyond chipping away at the barriers related to power and privilege bit by bit and dismantle them once and for all.

For those of you keeping score, it is, in fact, nearly August. It’s been quite a year so far. I hope you are taking advantage of opportunities for rest as Summer comes to an end. Each of us should be in top form to make what we now define as progress before 2020 is well and truly over. I, for one, am looking forward to that day.