Quote Originally Posted by ganulv View Post
Personally, I feel that worthwhile attempts at real improvement in public health must be framed at the level of grand strategy.
I wonder about that. A small vignette to illustrate why...

Every municipality in the Philippines has a government-run health center, or Rural Health Unit (RHU). Many of these are barely functional. The staff are underpaid and often lethargic to the point of being comatose. Medicines and equipment are routinely sold. Statistics are invented. Little or nothing gets done.

The town I now live in has the most effective RHU I've seen in this country. Same pay, same equipment, same supplies, totally different result. The staff are incredibly proactive: if a pregnant woman hasn't showed up for a checkup or a kid has missed a vaccination, they go out and find them, even if that means chasing them down in the fields or home visits after working hours. Home visits are routine, someone comes by quarterly checking blood pressure, making sure the salt is iodized (we're far from the ocean and goiter is common), checking on sanitary facilities, talking over health and nutrition issues.

Overall the system works extremely well, despite being the same system that works so poorly in so many places. That's partly because this is a tribal community, all the staff are local people, and there's a strong sense of looking after their own. It's also because the doctor in charge is a rather formidable woman of enormous competence and integrity, who tolerates no slacking and takes no scheisse from man or beast.

The lesson of the tale, to me, as that at the end of the day it's about the people. With the right people, even a flawed system can work. If the people on the implementing end aren't motivated or capable, all the grand strategy on earth will get you nowhere.