Freeman Spogli Institute for International Studies Program on Energy and Sustainable Development Stanford University


January 1, 2007 - CDDRL, CHP/PCOR News

CHP/PCOR and CDDRL: Collaborating to Improve Health and Governance

By Sara L. Selis

Modern medicine has produced interventions that seem almost miraculous in their ability to prevent and treat deadly diseases. The use of chemically treated mosquito nets can drastically reduce malaria infections, for example, while powerful antiretroviral drugs can give HIV/AIDS patients added years of life.

While these advances are cause for great optimism, they’re not necessarily enough to bring about promised health improvements, particularly in developing countries. Experience has shown that good governance—stable, accountable political systems that can manage resources responsibly and take care of their citizens’ needs—may be crucial to the success of disease-fighting efforts. Health programs run by incompetent, corrupt, or illegitimate governments will likely falter, no matter how well-equipped or well-intended they may be. In 2002, for example, the World Health Organization launched its “3x5 campaign” to get 3 million HIV/AIDS patients in developing countries on antiretroviral treatments by 2005. While the initiative made significant headway, it fell far short of its goal, due in part to some nations’ ineffective management and weak health-care infrastructure.

To explore this issue in depth and to improve developing nations’ responses to infectious diseases, FSI’s Center for Health Policy/Center for Primary Care Outcomes Research (CHP/PCOR) is collaborating with the Center on Democracy, Development, and the Rule of Law (CDDRL) on a new Health and Governance Project involving physicians, economists, political scientists, engineers, and nongovernmental organizations (NGOs). The researchers, supported by a generous private donation, are examining these key questions: What are the limitations of providing technical health-care solutions in developing countries? How do governments help or hinder the implementation of these solutions? When governments fail to help, how and when should NGOs step in? When are NGOs effective, when are they ineffective, and what lessons can be learned from their experiences?

The project—believed to be the first multidisciplinary scholarly examination of the relationship between governance, development, and health—is important because “medical discoveries can produce wonderful interventions, but if you can’t get them to the people who need them, it’s not worth much,” said CHP/PCOR core faculty member Paul Wise, a lead investigator for the project.

Wise explained that while some simple interventions, such as giving a one-dose vaccination, can succeed without much government help, other interventions, such as administering complex multi-drug regimens over several months, seem to depend much more on elements of good governance, including well-trained health workers, government financial support, and a network of clinics that serve people even in remote areas.

In an extreme example of what happens when supportive governance is lacking, government officials in South Africa have at times undermined NGOs’ efforts to administer antiretroviral therapies to AIDS patients there, by failing to provide financial support and by spreading dangerous rumors that the drugs actually cause AIDS.

In cases like these, Wise said, however dysfunctional or corrupt a country’s government may be, “lack of adequate governance is no excuse for inaction. You can’t sit around and wait for good governance while people are dying—you’ve got to struggle through it and demand appropriate government action.”

For the Health and Governance Project, researchers will gather and analyze data from case studies focused on various diseases and interventions in different parts of the world. Potential case studies include malaria and HIV/AIDS in Africa, air pollution in China, and tuberculosis and HIV/AIDS in Russia. Details were reviewed at a planning workshop at Stanford in November 2006, which brought together faculty from several Stanford departments, including medicine, political science, economics, and engineering. Additional conferences will be held this spring and summer, featuring outside experts and NGO leaders as well as the Stanford investigators.

From their analyses, the researchers aim to uncover general lessons and develop policy recommendations on how best to combat disease in the developing world. They will present their findings in workshops and white papers, and by next fall they plan to pursue a major grant from the Bill and Melinda Gates Foundation, to continue the work on a larger scale.

The Health and Governance Project grew out of discussions between faculty at CHP/PCOR and CDDRL over the last year and a half. Kathryn Stoner—CDDRL’s associate director for research, senior research scholar, and a lead investigator on the project—became interested in a possible collaboration when she attended CHP/PCOR’s 2004 annual retreat and heard Wise speak about his work on health disparities among different socioeconomic and racial groups and the question of whether new medical technologies narrow or widen those gaps.

“A lot of the problems Paul was talking about had to do with politics and government, not just health care,” Stoner-Weiss said. “I realized that fit in very well with much of what we do at CDDRL,” studying how and why states fail and what the consequences are for their citizens.

After further contact between Stoner-Weiss, Wise, CHP/PCOR executive director Kathryn McDonald, and Jeremy Weinstein, an assistant professor of political science who has studied insurgent violence in Africa and Latin America, the four began discussing the idea of a research proposal focused on the intersection of governance and health. The project became a reality late last spring when Howard and Karin Evans, Stanford alumni interested in improving health in developing countries, had a similar interest and offered to support the effort with a seed grant.

“Who better to do a project like this?” Wise said. “We have world-class health policy experts at CHP working with world-class experts on governance and democracy. It’s a no-brainer.”


Topics: Democracy | Economics | Governance | Health and Medicine | Health policy | HIV/AIDS | Institutions and Organizations | Rule of law and corruption | China | Russia | South Africa | South America