Malaria ... reinventing the wheel

Dear Colleagues

I was copied on this message because the value dimension of our work is included in the Integrated Malaria Management (IMM) initiative of Dr. Novak.

"Low-Cost Cell Phone-Based Applications for Priority Global Health Diseases"
On Thu, Aug 19, 2010 at 2:21 PM, Robert John Novak wrote:

Kate, the recent Gates call for a "Low-Cost Cell Phone-Based Applications for Priority Global Health Diseases" was a operational part of the LOI that we submitted to you. We already have a operational system. Why are you re-inventing the wheel! I guess the next thing that will be solicited is a applied GIS based surveillance system to manage malaria control operations.
Regards, Bob
Robert J. Novak, Ph.D.
Professor of Medicine
Division of Infectious Diseases
William C. Gorgas Center for Geographic Medicine
University Alabama at Birmingham School of Medicine
220 Bevill Biomedical Research Bldg.
845 19th Street South
Birmingham, AL 35294-2170
205-975-7614 FAX 205-934-5600

I think my response is self explanatory:

Dear Dr. Bob

I would like to add my "two cents" to your message.

As you know I have been active in the international relied and development industry since the 1970s ... and before that was the CFO of a company operating in 26 countries around the world. I think I know something of how good information can make a huge difference in operational performance ... and I would argue that good information improves performance in almost any environment by a factor of 10 or maybe 100. It is no wonder to me that government execution of almost any works is high cost and low impact, simply because the management information dimension of the work is usually missing ... whether it is the Government of the USA, or the UK or France or Russia or Nigeria!

I have been attracted to Integrated Malaria Management that you have initiated because it is an initiative that is based on the best possible use of data for planning, operational execution and performance assessment.

I am amazed at how little information based work is being done by the global health community which has adopted more than anything else what I refer to as the UN model for management. In this model a lot of work is done assessing what is going to work based on academic papers and historical studies, and then virtually nothing is done to check that the work done conforms to the suppositions made at the outset. When assessments are done they are usually done by "friendly" independent organizations who know the rule that you only get the next assignment if this current assignment produces the results that are wanted! With this structure not very much can be trusted!

As a fully independent observer of the international relief and development sector ... and with considerable practical experience in the sector ... I am appalled at the waste of money both within the official development assistance (ODA) organizations and the increasingly important private philanthropy organizations. The sad reality is that the money is not actually wasted but diverted to "special interests" of all sorts. As an old accountant I learned to "follow the money" as an audit clerk ... and I am not impressed by the "leakiness" of almost all the financial control systems in place that allow funds to flow to self-serving interests at the expense of beneficiaries.

I cannot for the life of me understand why a world where information technology is now a million times more powerful than when I started my career and the accounting is many times worse. There is a systemic dysfunction here that should be cause for great alarm.

From what I know of the global malaria sub-sector, things are not encouraging and I would suggest that the money will run out a long time before the malaria problem is controlled unless there are some serious rethinks of the approach to allocating resources into this sector.

While I am incredibly disappointed at the progress that has been made with the IMM initiatives and the deployment of meaningful metrics for planning and assessing malaria control interventions ... I am confident that those of us who are committed to a world with better metrics are going to prevail. It is human nature to want to win ... but scorekeeping has never been trusted to the players alone ... scorekeeping has an independent dimension that is essential for trust.

Peter Burgess