Slum Doctor Programme

International Health Conference
February 24, 2007, 6:16 pm
Filed under: Uncategorized

The Slum Doctor Programme concerns itself with hope. Hope for the world to live in health and safety. It is our favorite thing to do. However, after sitting through classes on human trafficking, the suffering of war veteran’s after war, the roadblocks NGO’s face set up by governments for no other reason than money–the object of my hope becomes a little more distant and the afront to my motivation to hope tempts me to despair. A couple days out now, I have recovered from my first experience of facing world health head on and the temptation to despair has returned to where it belongs.

Despite my emotions, what I learned gave me a very practical vision for the direction world health needs to take and I hope it has begun a process of finding a place in that mission. The question of America’s role in world health is one that I think bears a greater importance than many outside of the health, social justice, NGO circles realize. Forgive me if I am stating the obvious, because to some it may not be. America seems to be caught between two roles and the outcome of both seems to be blatantly insufficient. The first role is that of the knower and therefore the fixer. The sort of omniscient force that sees the problem with greater clarity than anyone else and therefore the power that is necessary to fix it. The second role is America as the funder, the economic engine that drives all the smaller independent moving parts. I am not about to tackle both of these roles, but I want to discuss the second, recalling some of the main themes from the conference.

Dr. Jim Kim who is the former CEO of the World Health Organization and started Partners in Health with Paul Farmer gave a keynote presentation on the first day of the conference. He spent quite a bit of time talking not about the specific health issues in the world but the funding for the infinitely varitous entities that respond to those issues. He used the agricultural analogy of a silo as a accurate representation of the current state of funding in the US and throughout the world. The silo is a means of containing and restraining the distribution of funding into different organizations, strictly regulating the use and rate of expenditure. This inturn slows and restricts many organizations ability to meet the needs of those it serves.

HIV/AIDS has caused so many social, political, and physical disparities to come to the surface that treating the virus means much much more than just treating the virus. Meaning, the cause of the pandemic is so multi-valent that to only address the treatment of HIV/AIDS misses the source of its success. So, if funding for the programs that wish to address these issues only allows money to be spent on one aspect…say ARVs and testing…then that program has only been able to treat a symptom(HIV/AIDS) and failed to treat the cause(poverty, gender inequality, education,etc).

According to Dr. Kim the silo system must then change if we are to consumate the end of HIV/AIDS along with all the other symptoms the world is suffering from. As the network of issues that each organization is attempting to address increases in complexity the ability to find funding for each specific problem decreases. So it is now necessary that funds from the US (NGO and government) be dispersed for general operation as opposed to specific programming with specific quantifiable outcomes. This is all a gross oversimplification but it brings up many interesting issues. I wonder where we go from here.



3 Comments so far
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It does all seem overwhelming because you are right, a target solution to only one aspect to an issue as complex as HIV/AIDS is not sustainable in the long run. I love the book “An End to Poverty” by Jeffrey Sachs because he recgonizes this, yet makes it all seem very doable. He talks about the Big Five development intervenitons that if instituted as a package can become self sustaining, raising people out of extreme poverty. He believes that programs need to be multi faceted and provide jump starts in 5 areas simultaneously: Agricultural inputs, Investments in basic health, Investiments in education, as well as Power, transport and communication, then finally in safe drinking water and sanitation. The extreme poor lack six major kinds of capital: Human capital (health, nutrition and skills), Business capital (machinery, transportation , industry and services), Infrastrusture (roads, power, water and sanitation, communitions systems), Natural capital (arable land, healthy soils, biodiversity, healthy ecosystems) and Public institutional capital (commercial law, judicial systems, goverment services and policing) and Knowledged capital (scientific and technological know how). One of the weakness of development programs is that people think there is one magic bullet a decisive investment that will turn the tide when actually they need investment in all six types of capital. No one NGO can tackle all this, but multiple NGO’s with various areas of expertise can band together and create an “investment package” for a village and succeed in sparking permanent change at the grassroots level. That is why I really love that SDP is playing a role in Rabour Village and Cura Village where there are others working together to create a more holistic multifaceted solution to end the root causes of HIV that you mention: poverty, gender inequality, lack of education and economic opportunities, etc, etc etc.

Comment by Diane Staves

Jesse , you should start an email list serve or something. You told me a while ago that you were starting a blog, but i don’t think i knew you had actually completed it. Now it’s been up for a while and this is the first i’ve seen. Thanks for educating us on slum doctor programme.

Comment by stephen


It seems this type of solution would be logical and obvious. I had to tell a group of students the other day that funding agencies are just starting to figure this out. In order for a village to heal, it needs to heal all its wounds not just one. Why has it taken so long?

Comment by slumdoctor

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