Independent Consultant, Issaquah, Washington.
Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California.
Am J Trop Med Hyg. 2020 Jun;102(6):1175-1177. doi: 10.4269/ajtmh.20-0081.
Two decades of growing resource availability from agencies and foundations in wealthy countries has transformed approaches to health in poorly resourced nations. This progress looks increasingly unstable as climate change, social unrest, and, now, disruptive pandemics present threats not only to health but also to the mechanisms that manage it, and to funding itself. The growth in "global health" schools, technology development laboratories, nongovernmental organizations and multilateral institutions in donor countries has delivered not only successes but also disappointment, and reflect a paradigm that is in many ways contrary to the principles of population-based ownership that they espouse. Although the COVID-19 crisis has underlined the importance of health access and health service capacity, we may have a limited window of opportunity in which to rethink the current model and improve both efficiency and effectiveness. With a dose of humility, we may all benefit from studying our own rhetoric on human-centered design and applying these principles across global health to ensure that our approach is effective, efficient, and defensible.
二十年来，来自富裕国家的机构和基金会的资源不断增加，改变了资源匮乏国家的卫生保健方法。随着气候变化、社会动荡以及现在破坏性的大流行病不仅对卫生健康构成威胁，而且对管理卫生健康的机制以及供资本身构成威胁，这一进展看起来越来越不稳定。在捐助国，“全球卫生”学校、技术开发实验室、非政府组织和多边机构不断增多，不仅取得了成功，也带来了失望，这反映出一种模式，在许多方面违背了它们所拥护的基于人口的所有权原则。尽管 COVID-19 危机强调了获得卫生保健和卫生服务能力的重要性，但我们可能只有有限的机会窗口来重新思考当前模式，并提高效率和效果。如果我们能够虚心一点，我们都可以从研究自己关于以人为中心的设计的言论中受益，并将这些原则应用于全球卫生领域，以确保我们的方法是有效、高效和合理的。
