Dear Nabeel
The Community Systems Strengthening Framework (CSSF) has serious weaknesses in concept that need to be addressed. The CSSF is very much a product of the "establishment" that overseas the global health environment that is taking over more and more the global economic product.
In the USA, the idea that 17% of the economic product is now the "cost" of healthcare is an indication of how worrisome this matter has become.
Another issue is that modern health interventions require international subsidy at a multi-billion dollar level ... and it has now become the norm for the world to accept this. At some point, there is going to be a disruption in this norm, to the detriment of the health of beneficiaries.
India has shown some very good initiatives ... there are many areas of health where the costs of medical products and procedures have been reduced by an order of magnitude because medical professionals broke out of a mold that treated established high cost methods as sacrosanct.
Some experience I have in various parts of the world suggest that there can be major improvements in healthcare delivery cost by rethinking training and the way in which personnel are used to engage in healthcare activities.
As far as I can see the CSSF is a methodology that strengthens the health "silo" and the totally unsustainable status quo. If the CSSF initiative was a move to strengthening the multi-disease integrated community level interventions with a view to low costs and high performance healthcare, I would be happy ... but it does nothing of this. Bluntly put, it is another top-side overhead that will just divert attention from what really needs to get done.
If you look at the recent history of global health, there has been a huge increase in funding ... and some improvement in outcomes. Relative to what is needed the health improvement has a long way to go ... but the money funding is pretty much maxed out. Someone needs to start bringing together what is possible scientifically with some reality about what is going to be able to be funded ... this is not about profit but about humanity ... something sadly lacking in modern society and its metrics. There are enough people to do the work ... but most of the people don't have a chance to get the training they need, and therefore cannot do the work. When medical staff get trained ... they migrate to where money is maximum. Makes sense for the individual but not good for society. A worthwhile CSSF would address issues like this in a serious way ... but it does not.
Lots of issues ... CSSF needs a big rethink ... as does the work of the Global Fund for AIDS, Malaria and Tuberculosis (GFATM) which has extremely weak knowledge of how well the work it funds actually perform. Like so much of the official development assistance (ODA) world, GFATM does a lot of analysis before the fact and before fund disbursement, but very little after the disbursement to ensure that the funds achieve good outcomes. This is classic ODA methodology which allows money to be misused without anyone being much the wiser ... and this is no accident ... unless the leadership of the ODA community is less intelligent than I would give them credit!
This is not the first time I have raised these issues ... it has been an ongoing effort for many years ... and will not stop. But it gets more and more urgent. It is time to have serious accountability on the front burner.
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Peter Burgess
Tr-Ac-Net Inc ... The Transparency and Accountability Network
Community Analytics (CA)
Integrated Malaria Management (IMM)
Microfinance Focus Magazine in New York
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