Recently, Barack Obama announced that Jim Yong Kim has been nominated by the United States to lead the World Bank as the next president. A surprise candidate, Kim is best known for his role in founding the NGO Partners in Health (PIH), along with Paul Farmer and a few other individuals in 1987. Kim’s nomination has made many hopeful that his new leadership might bring about meaningful change within the World Bank, and his candidacy has provided many an INDEVOUR with fodder for insightful blog posts regarding the needs of this institution. Yet I believe that a discussion about PIH’s role in global health care provision is equally necessary, and since I’ve had the opportunity to research this organization over the course of the term, I’ve decided to discuss PIH’s revolutionary approach to health care and to talk about the implications of the organization’s philosophy.
PIH is a not-for-profit that works to provide health care to people in need around the world. Throughout their history, PIH has been known for succeeding in bringing high- quality levels of basic health care to areas of the world where such undertakings were not thought to be possible. When major global health organizations like the WHO warned that providing health care in rural areas of poverty-stricken countries would require too many resources, PIH proved such criticisms false. And they continue to do so by maintaining a strong commitment to the belief that health care is a fundamental human right, and that every individual therefore deserves access to basic care.
This commitment has allowed PIH to defy critics and has changed the way many look at health care in the Global South, though it necessarily gives rise to numerous ethical dilemmas. When faced with challenges and criticisms, PIH has remained determined to bringing health care to those who need it. No matter the cost, PIH maintains a focus on providing whatever is needed to treat the needs of the people who have been left behind by other global health organizations. And these people tend to be located in remote areas, where providing access incurs an extremely high cost. This means that PIH must necessarily pay a high price for the success of their model, since they have chosen to work in areas deemed too expensive by other organizations. PIH remains committed, however, to doing whatever is necessary to help those that they work with, without considering how the resources they use might be spent to help others elsewhere.
And this is where PIH’s model draws criticism. Some argue that, because the world we live in is one of limited resources, and because only so much money is available for health care, a system of provision that does not take cost into account only ends up excluding other individuals from access to care. By choosing to provide health care at a high cost in remote places, the opportunity cost of PIH’s model is decreasing the total amount of improvement to human well-being that could be achieved through a more efficient approach to health care distribution. Yet because health care is a human right, defenders of PIH argue that it is not right to treat or not treat individuals based on such utilitarian equations, and that no individual would ever really accept such reasoning if their own life was in danger.
And this commitment is why I believe that PIH is such an important voice in today’s global health discourse. PIH has changed the way that we can talk about health care. We can no longer say, with respect to the needs of individuals in areas with limited access to health care, that it is “too expensive to reach them”, because PIH has shown that we can say in response: “Yes, it is very expensive, but it is still possible, and to do otherwise would be inexcusable”. And economic arguments against such action seem ridiculous when one considers the way that global resources are distributed. For example, in 2009, $10 billion was spent on cosmetic surgery in the US alone. In the same year, revenue for PIH totaled only $63 million. Clearly, there is no ‘shortage’ of resources available for health care. And PIH has proven that, with the proper resources, basic health care can be provided, even to those in remote areas who lack the ability to pay.
What do you think? Is PIH too idealistic? Please comment.
Dan
Hey Dan,
ReplyDeleteGreat blog post!
Quick question about PIH. Where do they get their funding from? As I understand from your post, they provide healthcare to people in remote areas, is it only a one time thing or do they have medical camps set-up there?
Hi Fatima, good questions. PIH gets there funding from the private sector. Basically, they fund-raise and receive charitable donations. Also, PIH works alongside local community health workers, providing training and salaries in some cases, and aims to establish medical facilities that remain in operation, strengthening the long term capacity of local healthcare organizations. For example, in 2011, PIH completed this hospital (http://www.pih.org/where/pages/butaro-hospital) in Rwanda. They trained and equipped the staff, and now continue to support the health workers.
ReplyDeleteOh wow, that is really neat. Thanks, Dan!
ReplyDeleteAs African economist Dambisa Moyo has pointed out, more than 1$ trillion in aid has been sent to Africa in the last 50 years, yet the countries who have rejected the international aid route seem to be doing better than those who now have aid dependency. Do you think that PIH's initiative to work alongside local health partners is an attempt to offset the phenomenon of dependency and do you think that it is effective in light of the fact that they are internationally funded?
ReplyDeleteThanks for the reflection, I learned something about PIH. I think that if you look at Canadian health care we do a little of the same. A huge amount is spent on health care for remote areas (i.e. Inuit fly in villages) and I think it is most definitely worth it even if it is necessarily taking away from the funding available for more urban areas. Just a thought :)
ReplyDeleteInteresting post. The utilitarian debate has interesting implications when applied to the number of people in need of health care. It is easy to imagine that helping more people is better than helping some when looking at numbers. However, as you point out, when we see the some as human, and understand that they are the same as us it is much more difficult to say they are not worth it. I wonder what forces keep PIH relatively small compared to other health organizations like WHO, Red Cross etc.? Why do we get enticed by the ego stroking capabilities of assumed value in large number statistics?
ReplyDeleteWhen PIH decides to work in a particular remote area as opposed to a more inexpensive city, is it assumed that this remote area is in greater need of care than the more accessible location? Or are we assuming that a more accessible location will soon be reached by another form of aid? If so, then I understand why an organization like PIH is so crucial in providing global health care to those who need it most. But if providing care to a small number in one location means that an even greater number with equal need will go without, then I have a hard time justifying this. If critics suggest that PIH should use their funds to aid in more accessible locations, I'd be curious to know more about the situations of these less remote peoples who still aren't receiving care.
ReplyDelete