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[afro-nets] NGOs and health systems strengthening (or weakening) (3)

Dear Colleagues

I am glad this subject has come up.

Work that I have been doing over the last five years to understand the progress 
and performance of the global health malaria control sub-sector suggests that 
way too much of the global health money is being consumed at the "top" of the 
sector and far too little funding is getting to strengthen community level 
healthcare. This is the same issue in many different parts of the health sector 
... many different diseases ... and in both rich developed countries and poor 
developing countries. Most decision making about resource allocation is driven 
by the goals of management, whether it is a big NGO, pharmaceutical company, a 
health ministry, a hospital or a network of doctors.

The needs of beneficiaries are poorly represented in part because the 
prevailing systems of metrics do not include any metrics about the "value loss" 
associated with poor health status of a single individual and in aggregate for 
the community. This gets addressed in The Burgess Method of True Value Metrics.

The good news is that there are thousands of NGOs interested in health care 
activities ... but they are not delivering their services very effectively 
where they are most wanted. Bottom line, nobody knows where they are working 
and what they are doing. Nobody seems to know where they would be most needed 
and could be doing the most good. If there were metrics that showed at the 
community level what the needs are, and what health care services including 
government and NGOs are present ... and what they are doing ... and what still 
is left needing to be done, we might make some meaningful progress.

This should not be an idealogical argument about public or private sector ... 
free or paid ... but about needs, resources and how to get the best possible 

As it is ... there will be a meeting in Amsterdam of this network of NGOs. I 
hope that they enjoy themselves ... and look forward to learning of any steps 
forward to better performance that they are able to make!


Peter Burgess

Peter Burgess
Meaningful Metrics for a Smart Society (being phased out!)
tel: 212 744 6469
twitter: @peterbnyc
skype: peterburgessnyc
Books: Search Peter Burgess at
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