Study study study ... wasting our money!

Dear Colleagues

I have just read this report titled "Private Delivery Care in Developing Countries: Trends and Determinants" written by Amanda Pomeroy(1), Marge Koblinsky(1) and Soumya Alva(2)
http://www.measuredhs.com/pubs/pdf/WP76/WP76.pdf ... 1 is John Snow Inc. ... 2 is CF Macro. As far as I can see, this study was funded by USAID.

I learned about this report from a list serve that has a dialog about health in Africa ... in the following e-mail:

November, 2010, Washington, DC-- JSI's /Amanda Pomeroy and Marge Koblinksy have authored a DHS working paper entitled, Private Delivery Care in Developing Countries: Trends and Determinants. This article used Demographic and Health Surveys (DHS) data from 16 countries to examine a) trends in growth of delivery care provided by private facilities, and b) determinants of private sector use within the health care system.

For a subset of eight countries, the authors examined determinants of a mother's choice to deliver in a health facility and then, among women delivering in a facility, their decision to use a private provider. Determinants of use were grouped by socioeconomic characteristics, economic and physical access and by actual/perceived need.

Results showed a significant trend toward privatization of delivery care over the 13 years covered in the study, but there was considerable variation in the characteristics driving this increased use across countries. The results warn against making generalizations on the effects of privatization on maternal health use.

Bluntly put ... I am not impressed ... worse I am really very disappointed. The work is almost totally something that we do not need. We need solutions not studies, especially studies that do not have much in them to move the health situation forward. The academic community and consulting community may be happy, but no change of any substance on the ground! I responded to the list serve as follows:

Dear Colleagues

I would like to see a dialog about solutions to the problems of health around the world. In my view this DHS working paper does not contribute very much to a dialog about solutions since it is 90% about "state" rather than "progress" ... and the concept of "performance" is almost totally missing.

Reports like this have been funded by various agencies in the international development community for 40 odd years ... and at the end of this time there are hundreds of reports and essentially no solutions to the core problems.

I was at a conference in New York last week at the New School where some high level people in development assistance talked about the progress that has been made. I tried to ask a question about progress achieved compared to what should have been achieved but did not get much of an answer. The problem is that the dialog is based on a whole lot of study that is subject to enormous potential for statistical interpretation ... and very little of the data has the reliability that one should be getting.

My perspective is that a very different medical care model is needed that recognizes that developing countries have little money but a lot of people ... many of whom have some training ... many of whom could do a lot with a modest amount of training ... etc. In other words there needs to be the best possible use of human capital rather than merely doing things based on welfare money that flows from donors. We also have to look at the dysfunction of the business economy in the development context ... and the resource flows that are making profit
for some while leaving most in continuing poverty.

All of this becomes clear when data a looked at carefully and evaluated with an "accountant's" mindset!

I am appalled at how much development assistance has done so little over a very long time! There is a better way.

Peter Burgess
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Peter Burgess
Meaningful Metrics for a Smart Society

It is painful to see scarce funds being used over and over again to do things that have almost no impact on the work needed to improve the health of real people in poor places!

Peter Burgess