Global health events of 2014 — particularly the Ebola epidemic in West Africa — seemed to shock many in the mainstream media, but no one working in development is surprised when health systems in weak states show their limitation.
Looking back in order to look forward is a time-honored tradition and if we are smart about what we learned last year, we can begin to prepare better for the future.
Here are four “crystal ball” notions to consider as we focus on the year ahead.
1. We won’t be ready for the next pandemic.
Despite the searing experience of Ebola in West Africa, it won’t be possible to close the performance gap among national health systems in the most fragile parts of the world. All of the institutions are simply weaker there. Our global health and pandemic response infrastructure, despite years of investment and the particularly robust previous decade, remains weaker than it should be. Therefore, Médecins Sans Frontières and other first responder institutions won’t have a quieter 2015 than 2014.
2. Local will matter less than effective.
The pendulum seems timed to swing back a little in 2015 from the extreme focus on “local development solutions” of recent years. This parochialism compares poorly with the way the international private sector has organized itself for increasingly networked and globalized responses to challenges. Development thinking can’t overlook this for much longer.
3. “Closing the gap” will become the global health catchphrase.
Ending polio, meeting the unmet need for modern contraception, driving toward an AIDS-free generation, cornering and eventually eliminating the crucial malaria reserve where drug resistance grows in remote Southeast Asia — all of these global health developments and more will increasingly require a strategic, sometimes scientifically managed “closing the gap” exercise. In 2015, we will need to delve deeply into who is receiving care and how many more actually need it, find what works to get from 98 percent to 100 percent, or make hard choices between mainstreamed and targeted interventions. The biggest health impact will come in the smallest spaces.
4. Development funding will hold its own.
Europe is slowing economically, and the BRICs are as well for a variety of reasons, but U.S. economic growth is picking up. Energy prices are low and holding. The political events of the last year have reinforced the inevitability of global engagement for any country hoping to protect its interests or promote its values. So, fiscal pressures will constrain but not significantly cut official development assistance spending in 2015 versus 2014. (OK, this is more of a hope than a projection.)
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