Post Number One

I’d like to tell you about a new initiative I have developed. It’s called the International Task Force Partnership for Scaling Up Innovative Financing for the Horizontal Harmonization and Diagonal Alignment of Country Led Approaches on Delivering Results for Health Systems Strengthening for HIV/AIDS, Tuberculosis, Malaria and NCDs through the Primary Health Declaration on Maternal Health and Vaccines. It’s going to be rolled out in 11 pilot countries. Five donors have signed up. We have a press release, a fancy logo, and even a conference in the works.

Am I sounding cynical and contrived? Guilty as charged. If you give me a second chance, I think I can cross the finish line without repeating a single word from the preceding paragraph. ‘But wait,’ you must be thinking. ‘If he does that, what could he possibility write about?' My experience in international health over the last few years leaves only one possible answer − Acronyms and Anarchy.

What better two words to describe the state of global health? As a young development worker I have benefited from the opportunity to coordinate and attend many high profile health meetings. Whether whispered in hushed conversations in the corridors, or proclaimed by keynote guests after a few glasses of wine, the line is always the same – things are as complicated, convoluted and confusing as ever. The current global health architecture would make the greatest topographers in the world shudder with terror.

Yes, we are talking more than ever about partnerships – but mostly in shiny reports, keynote presentations and diplomatic graces. Let’s remember what Econ 101 taught us – incentives predict behaviour. As far I can tell, the incentives for most organizations, whether bilateral donors, UN agencies or NGOs, are exactly what your economics teacher would predict – raise the profile of your disease or issue, increase your income and separate yourself from your competitors. As far as I can see, we are no closer to the mindset that ‘the job of a development organization is to put itself out of business’ than we were 50 years ago.

But anarchy? Isn’t that taking things a little far? Let’s consider the other metaphors we could use to describe the international health landscape. Unstructured plurality? Too soft for my liking. An unruly melange? Good, but this was used in 1997 before every Prime Minister had their own task force. Urban Sprawl? Not bad, but in our case, there’s no town centre. Let’s consider anarchy. The word arises from the ancient Greek "An," meaning without, and "Archos," meaning leader.

Is anarchy, all things considered, a fair metaphor to describe the current state of things? If not, at least it has a nice ring to it.