Laurie Garrett writes in the current edition of Foreign Affairs about the Challenge of Global Health:
Few of the newly funded global health projects, meanwhile, have built-in methods of assessing their efficacy or sustainability. Fewer still have ever scaled up beyond initial pilot stages. And nearly all have been designed, managed, and executed by residents of the wealthy world (albeit in cooperation with local personnel and agencies). Many of the most successful programs are executed by foreign NGOs and academic groups, operating with almost no government interference inside weak or failed states. Virtually no provisions exist to allow the world's poor to say what they want, decide which projects serve their needs, or adopt local innovations. And nearly all programs lack exit strategies or safeguards against the dependency of local governments.
The analysis emphasizes the difficulties caused by relentless focus on individual diseases (AIDS, malaria etc) and not enough on investment in the underlying health systems that are needed to deliver treatments and provide health care services to men and women in poor countries:
Which outcome will emerge depends on whether it is possible to expand the developing world's local talent pool of health workers, restore and improve crumbling national and global health infrastructures, and devise effective local and international systems for disease prevention and treatment.
According to the World Bank, while investment in disease-specific programmes (such as the Global Fund) have increased sharply in recent years, investment in health systems has fallen by 50%.
In this context, the Scaling Up for Better Health initiative (see pdf) is a very high priority.