A Cross-sectional Comparison of Utilization of Medical Crowdfunding for Global Health

The online solicitation of public donations has become an important financing option for health care expenses, intensified by increasing costs and deficits of universal public systems (1). With growing internet access and success of the largest social crowdfunding platform, GoFundMe, online appeals for medical causes have grown significantly over the last decade in low- to high-income countries. The purpose of this study was to qualitatively describe the use of GoFundMe as a crowdfunding platform for global health initiatives given its supremacy in the social crowdfunding market. Three different cohorts (n=100 each) of online solicitation were examined as a cross-section comparing global health appeals to those for personal health care and animal activism. Variables included the purpose for crowdfunding, the characteristics of beneficiaries and campaigns, and the factors associated with funding success. Our cross-sectional review found that global health campaigns were focused on voluntourism opportunities compared to more specific, individualized appeals for those in need. Global health campaigns appeared to be the least ambitious and generally the least successful of those reviewed. Grouping the most and least successful campaigns between the different cohorts, global health appears to be more successful when targeting a larger population to donate smaller amounts of money and relying on sharing via social media. We suggest that compared to online solicitation for personal health and animal activism objectives, crowdfunding on GoFundMe has unrealized potential as a tool for global health initiatives. More work should be conducted using different crowdfunding platforms and a more longitudinal review in order to expand on these findings and their implications on health care provision in the countries examined. Furthermore, future inquiry is needed to understand the social and ethical implications of online solicitation for global health endeavors in order to inform policy and promote discussion around equity and accessibility.

The power-trust cycle in global health: Trust as belonging in relations of dependency

Trust between actors is vital to delivering positive health outcomes, while relationships of power determine health agendas, whose voices are heard and who benefits from global health initiatives. However, the relationship between trust and power has been neglected in the literatures on both international politics and global health. We examine this relationship through a study of relations between faith based organisations (FBO) and donors in Malawi and Zambia, drawing on 66 key informant interviews with actors central to delivering health care. From these two cases we develop an understanding of ‘trust as belonging’, which we define as the exercise of discretion accompanied by the expression of shared identities. Trust as belonging interacts with power in what we term the ‘power-trust cycle’, in which various forms of power undergird trust, and trust augments these forms of power. The power-trust cycle has a critical bearing on global health outcomes, affecting the space within which both local and international actors jockey to influence the ideologies that underpin global health, and the distribution of crucial resources. We illustrate how the power-trust cycle can work in both positive and negative ways to affect possible cooperation, with significant implications for collective responses to global health challenges.

Global health Initiatives as a ‘Drunken Boat’: The Meningitis Vaccines Project Case Study

Based on an analysis of the Meningitis Vaccine Project (MVP), a public-private partnership (PPP) set up to introduce the MenAfriVac® vaccine in African countries, this article examines the failures of an accelerated disease control programme that targeted a highly infectious disease. I argue that the integration of MenAfriVac® into the World Health Organization’s (WHO) Expanded Programme on Immunisation had the effect of reinforcing inequalities in access, in particular during epidemic emergencies. I will also show how vaccine shortages during an outbreak in Niger led to political tensions and to the emergence of a parallel and unregulated ‘black market’ of vaccines.

Impact and effect mechanisms of mass campaigns in resource-constrained health systems: quasi-experimental evidence from polio eradication in Nigeria

BackgroundMass campaigns are a key strategy for delivering life-saving interventions under Global Health Initiatives, especially in weak health system contexts. They are frequently designed parallel to the health system to rapidly achieve programme targets such as vaccination coverage, but we lack quantitative evidence demonstrating their impact and effect mechanisms on health system performance at sub-/national level. This longitudinal study responds to this gap through an analysis of polio eradication campaigns in Nigeria.MethodsUsing four rounds of Demographic and Health Surveys in Nigeria between October 2000 and December 2017, we created a longitudinal dataset containing 88 881 under-5 children/pregnancies. We estimated the relationships between individuals’ campaign exposure and health system performance indices (full RI schedule attainment, maternal healthcare services utilisation and child survival) using multilevel, mixed-effects regression models applied nationally and stratified by the six geopolitical zones in Nigeria.ResultsNationally, high-frequency mass campaigns had detrimental health systems effects that potentially left 3.6 million children deprived of full immunisation. The frequency of campaigns was most concentrated in regions with weak health systems, where the operations of RI were disrupted, alongside negative effects on child survival and institutional delivery. In contrast, regions with relatively strong health systems and few campaigns experienced beneficial effects on maternal healthcare service utilisation.ConclusionsAs we provide evidence that well-functioning health systems can benefit from mass campaigns under Global Health Initiatives, our work also challenges the established wisdom to intensify mass campaigns in weaker health systems to bypass service provision bottlenecks. Mass campaigns do not inherently benefit or damage a health system, but frequent campaigns in weak health system contexts can impede service provision. We call for an additional burden of proof and active efforts to integrate mass campaigns into routine health services by harmonising implementation plans and service delivery in weak health system contexts.

Health-care Accessibility Assessment in Kazakhstan

BACKGROUND: Global health initiatives such as health for all and universal health coverage aim to improve access to health care. These goals require constant comprehensive monitoring to eliminate inequalities in the availability of health care. AIM: The purpose of our study was to assess the physical availability of medical care in Kazakhstan. METHODS: A descriptive study based on a Service Availability and Readiness Assessment (SARA) general availability index calculation that used secondary data as a source of information. RESULTS: The general availability index calculated for the regions of Kazakhstan ranged from 95% to 100%. When considering individual indicators of the index, decrease trends of the volume of inpatient care were identified. Outpatient care had fluctuations with values better than benchmark after 2009. Stable upward trend illustrates positive picture of core health personnel. CONCLUSION: According to the SARA availability index, it can be concluded that health care in Kazakhstan exceeds the threshold values and is available in all regions. Trends for individual indicators of the index should be studied in more detail, taking into account the influence of health policy and other factors.

Harnessing Canada’s Potential for Global Health Leadership: Leveraging Strengths and Confronting Demons

Despite its modest position on the international stage, Canada has been able to leverage significant influence in matters of global health. The country’s global health leadership draws on its strengths as a staunch participant in multilateral activities, a large funder of global health initiatives, a defender of a rule-based international order, and an active promoter of human rights, health equity, and global citizenship. These sources of strength, though, are being undermined by ongoing challenges to and recent deviations from the country’s traditional commitment to global health. Canada recently shifted its funding for global health initiatives away from its multilateral partnerships, recent actions have violated international law, findings from the Truth and Reconciliation Commission reveal how Canada’s Indigenous peoples still face many health disparities at home, and some Canadian businesses continue to operate in foreign markets with questionable human rights practices. While there are many reasons to celebrate Canadian contributions to global health, there is also much that can be improved. If Canada wants to harness its potential as a global health leader, it should focus on consolidating the sources of its strength, which will give it greater influence in matters of global health.