The U.S. government and international organizations should change their approach to health care development in foreign countries, former U.S. Ambassador and U.S. Global AIDS coordinator Mark Dybul said Wednesday in a talk at the School of Public Health.
Dybul described changes he said were necessary to improve the way public health organizations work, and took questions about health care policy from an audience of over 40 people. He said he believes agencies can become too focused on procedure and forget about actually improving health care.
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“What happens, unfortunately, is people get more and more removed from the country,” he said. “People make decisions in Washington or in Geneva that actually kill people without thinking about that. All that was thought about is how much money does this organization control, are lines of procurement respected, not how many lives can be saved if we did it a different way. And that’s a big problem.”
In 2003, Dybul helped to create the President’s Emergency Plan for AIDS relief, PEPFAR, which he directed under George H. W. Bush’s ’68 administration. Dybul said PEPFAR is the largest global health program in history targeted at a single disease. PEPFAR aims to combat HIV and AIDS by working on prevention, treatment and care within target nations with high rates of the virus.
But the former ambassador said he would not speak about his hopes for PEPFAR’s future.
“I’ve never found it fair for people to tell their successors what to do,” he said, referring to Dr. Eric Goosby, whom President Barak Obama appointed in April to succeed Dybul as U.S. Global AIDS coordinator.
Still, Dybul criticized the bureaucracy and current practices within global health policy. He encouraged officials not only to look for ways to restructure organizations but also to develop completely new approaches to global health care development.
“We’re fighting upstream against 50 years of laws, regulations, practice, policies, culture and structure,” Dybul said. “But there’s no question we need to undertake that battle.”
Dybul also said organizations should move away from the “donor-recipient paternalistic approach” to development and instead work cooperatively with other countries. He said he thinks the U.S. can learn from health care programs that already exist in some developing countries.
Five individuals attending the talk declined to comment, but one audience member, Mary McEwen EPH ’11, said she agreed with Dybul’s ideas.
“I like the emphasis on a not-paternalistic form of development,” McEwen said.
Allison Bybee EPH ’11 said the talk “brought up a lot of controversial international health systems in an academic setting.”
During the question-and-answer period, one audience member asked whether PEPFAR was too focused on abstinence-only policies under the Bush administration. But Dybul said the program was never against prophylactics and provided 3 billion condoms in various countries.
Throughout his talk, Dybul said he thinks new approaches to global health care strategy are necessary.
“We can look for the new architecture, the new approach that doesn’t require a lot of painful retrofitting,” he said. “The purpose of building a health system isn’t to put up a bunch of clinics to employ people. The purpose of building a health system is to improve health and to reduce mortality.”