7 takeways from #bestbuys4gh

In global health, there's no dearth of so-called “best buys.” The main question is which one to use, for whom, and for which purpose.

On Wednesday, thought leaders and experts in the health and development fields converged in Washington, D.C., to think about the best health investments that donors can make in 2014. The event, hosted by the Center for Global Development and supported by Merck for Mothers, formed part of a joint initiative by Devex, PSI and PATH, complementing the Devex survey of more than 1,000 health experts worldwide about global health trends as well as the challenges and opportunities to scale up promising health interventions.

Also streamed online, Best Buys in Global Health had many talking on social media. Before the end of the two-hour panel discussion, #bestbuys4gh was trending in the area, arguably the world's largest global development hub.

So what did the event tell us? Here are some of the most interesting takeaways:

1. What's a best buy? No easy answer

In the private sector, something is a best buy if someone is willing to pay for it. For development organizations, it is oftentimes the opposite, because public health, as a public good, is all about addressing market failures.

"When there's something that we know could have huge impact for the poorest, most vulnerable in the world that don't have the money to pay for it, how are we making sure that it gets developed, that it's done efficiently and effectively that it has the most affordable price and that can really reach that population despite everything that's working against it," said Amie Batson, PATH's chief strategy officer.

For donors like the U.S. Agency for International Development, it can be a challenge to determine what beneficiary countries deem as best buy. As such, it's important to reach a shared vision between donors and beneficiaries, to ensure that solutions are sustainable, according to Karen Cavanaugh, director of the Office of Health Systems at the USAID Bureau for Global Health.

2. Aid groups can learn a lot from the private sector

In many cases, the private sector is the first if not the only point of contact for consumers seeking health solutions, and many corporations, particularly multinationals, have proven to not only employ ways that are cost-effective and deliver value to consumers, but also reach a huge number of consumers around the globe.

And that could provide important lessons for how to cater to genuine needs of locals.

"If the private sector does it well, we ought to take more inspiration in the way the private sector does it because I think that is a way to get at effective and cost-effective solutions," said Karl Hofmann, CEO of PSI. "But I don't minimize the politics around that and the challenges that arise."

3. Politics always win

Unlike in the private sector, funding for best buys in global health is not just about finding the most effective and efficient solutions. It's more about what politics will allow.

As Hofmann noted, "the best buys in global health are not necessarily the politically sustainable buys in global health."

For instance, he said, a lot of funding is going to efforts combating HIV, malaria and tuberculosis, but not much to programs to prevent and treat diseases like pneumonia, diarrhea and hypertension which are susceptible to cost-effective interventions because " there's so far little political will to move the dial in the way that we would like it to move."

Anastasia Thatcher, global health lead at Accenture Development Partners, noted a disconnect between what experts believe is a best buy and what donors are funding. The latest Impact magazine indicates that nearly two-thirds of Devex survey respondents think health systems strengthening is the best buy yet last year's edition which focused on global giving cited that donors fund disease-specific interventions about 90 percent of the time. This vertical programming, she argued, may be diverting resources away from building basic health care infrastructure and meeting needs of patients and people in a holistic manner.

4. Experimentation is key

A best buy in one country may not be the best buy in another. And to find that out, there's a need to invest in implementation science, argued Cavanaugh.

The USAID official cited recent research around vouchers which showed that the interventions led women to get assisted delivery but it isn't clear which factor made the difference, whether it's because motorcycle drivers got a special bonus for taking women into health facilities or because the program eased these women's financial burden.

"We often will have very good evidence that something works but not exactly understand why it worked in that country or why it didn't work in that other country," Cavanaugh said.

Experimentation is particularly crucial especially when designing lifesaving solutions as you want to know what works and doesn't, according to Dr. Jim Cunningham, senior principal scientist at Merck Research Labs. Merck is working with the London School of Hygiene & Tropical Medicine to collect data which he stressed is critical to advocate for scaling up solutions.

5. Failure is OK and at times necessary

Experimentation and coming up with innovative solutions come with the risk of failure The ability to embrace failure will keep development organizations nimble.

Unfortunately, many development organizations are traditionally averse to taking risks.

Hofmann conceded that PSI, which has been operating for around four decades, struggles for nimbleness, although it understands the value of it. Part of the problem is that its funders, mainly governments, are not known to be embracers of nimbleness. That's why it's important to find other sources of capital such as private investors who have a long-term perspective and interest in social returns and which would allow and encourage implementing organizations to fail, he said.

USAID, for its part, has begun to embrace the importance of failure. Aside from the establishment of the Global Development Lab as a permanent institution, Cavanaugh pointed to the creation of challenge funds which have attracted creative ideas that can be the next-generation solutions and "we can fund them on a small enough scale so that if they fail it's not essentially an accountability issue without appropriators."

6. Local capacity building is a best buy

With the push for country ownership, global organizations are keen to source local best buys.

Batson noted a major concern for many international aid groups is building the capacity of their local partners in developing innovation, including helping them pick and choose which solutions would have the greatest impact, register them and have them approved in country.

"As a whole, [local capacity building is] a best buy and what would come out of it would be a whole stream of other best buys that we can look at," she said."

7. It's not always necessary to try something new

At this point, there are gold standards in global health such as bednets for malaria fight. So before jumping on new ideas, it's important to test new solutions against these gold standards, argued Dr. Mark Grabowsky, chief operation officer at the Office of the U.N. Secretary-General's Special Envoy for Financing the Health Millennium Development Goals and for Malaria.

And combining proven solutions and integrating them in existing systems is perhaps the best way to go while waiting to strengthen broader health systems.

"I think if we look at that perspective, of using the available systems in addition to while we wait to build the large systems I think we can do a substantial amount and in fact it turns out to be actually, one of the best buys is putting interventions in existing systmes in terms of achieving health MDGs," he said.

This story is part of Best Buys in Global Health, a campaign by PSI, PATH and Devex to highlight sound investments in global health. Find out more.