We believe that systems thinking and complexity science can be transformational in global health by increasing local capacity and shared learning, and minimizing unintended consequences.
A man in Haiti has a seizure. His family and friends stand beside him, nodding in agreement that this is not the first time. When the man regains consciousness his wife stands beside him, begging him to seek medical attention. In the past these episodes would have been over-looked, ignored. but not this time. Time has brought many changes. the man now has a daughter. and the seizures need to stop. With no money, the man is forced to walk. leaving behind his wife and child. hoping he will see them again. and again soon. He travels long distances to St Michael’s Hospital, the only public hospital, serving 500,000 people. Even if the man could call for help, the hospital has only one ambulance. only one. so he walks. and upon his arrival he learns that he is HIV negative. but this is not a moment to celebrate.
You see, the hospital is understaffed, has no x-ray machine, and is financially unstable. In one corner of the hospital, the place is fully equipped, with computer operated record systems, ambulances, and a full array of well paid staff. This one corner offers free treatment, radiology equipment, and a variety of medications. But this corner is for HIV positive people only. and this young man is not HIV positive.
Vertical funding, disease-specific funding, creates a gap in the medical facilities around the world. As an example, Haiti has the highest rates of infant mortality in the world (UNICEF), but mothers without HIV receive very little support. In haiti the main hospital is understaffed as medical personnel compete for an opportunity in the HIV clinic, noting that global funding will help pay their salaries. The main hospital lacks a medical director, and this generates a lack of control and organization. People go months without pay and many people are left untreated.
The story of this man is not a story that has been told to me directly. But it is a story that represents the survivors. This story tells the tale of the disparities and inequalities generated by global donors. It tells the story of inadequate resources, insufficient funds, and the inability to see the whole picture.