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Accelerating Global Health Delivery

Each year the Skoll Centre invites a small number of Oxford students to the annual Skoll World Forum on Social Entrepreneurship. Each year they share their unique perspectives of the sessions and events that unfold during this magical time in Oxford.

This session conducted by the leadership team of Partners in Health was scheduled for 7 am on the 10th of April. Hence by design it self-selected for individuals who were extremely motivated to learn from the experience of Partners in Health in Global Health Delivery.


Partners in Health (PIH) is a Boston-based nonprofit health care organization founded in 1987 by Paul Farmer, Ophelia Dahl, Thomas J. White, Todd McCormack, and Jim Yong Kim.

The organization’s goals are “to bring the benefits of modern medical science to those most in need of them and to serve as an antidote to despair.” It provides healthcare in the poorest areas of developing countries. It builds hospitals and other medical facilities, hires and trains local staff, and delivers a range of healthcare, from in-home consultations to cancer treatments.

The session was led by Dr. Joia Mukherjee, and was facilitated by her colleagues Dr. Gary GottliebDr. Abera Lotha

The session delved into a nuance in global health delivery which are often ignored. Dr. Mukherjee asserted that the successful delivery of healthcare ought to be reviewed through three lenses.

  1. A justice framework
  2. Human rights framework
  3. Social determinants of health framework

The first two are not given their due share of discussion since perhaps as healthcare professionals we feel this is beyond our scope of work however, they are essential to an equitable delivery of good health for all.

The justice framework requires retrospective reflection. Many of the inequities we observe as global health delivery agents are not just because people who we aim to benefit do not know better or that there is lack of will to correct the structural problems that exist. Instead, the source of these issues come from a history of colonization, practices of slavery and exploitation of certain regions by others. The damage from these unfortunate parts of our collective history is immense. While these chapters of history cannot be undone, it would not be prudent to completely forget about these issues as important causative factors towards why certain regions struggle to this day with diseases that the developed world has long overcome. Hence, keeping them in our purview as we think about global health would ensure such injustices are never repeated.

The second framework is the human rights framework. Today we live in a world where almost everything we do, any service we receive or any item we own has input from many different regions. This is especially more applicable to the socioeconomic strata attending this forum or can read this narrative that I write today. When we live in a globalized world of commerce then a question that arises is why our human rights are different depending on national borders. What would be considered exploitation in one country would be considered fair trading practices in another. The world is much more comfortable with utilitarian notions of healthcare service delivery for the poor but not the same yardstick is applied to the wealthy. These are deep-seated, class-based biases that ought to be brought out in the fore and the repercussions of these biases need to be corrected or else the inequities we wish to overcome will always plague us in some way or form. This philosophy of healthcare delivery is reflected in the work of Partners in Health throughout the world. They believe all that they interact within their ecosystems are owed a similar chance towards healthcare services.

Finally, the social determinants of health were also discussed. This is an area quite often discussed and debated on in Global Health conversations. The impact of where you are born, your gender, your education and such all impact health outcomes. This has been researched and well documented. Dr. Mukherjee added a nuance to this conversation though. She proposed that instead of calling it social determinants of health we should label this effect the social forces of health since these socioeconomic markers are not just a correlation but have vector component to them as well hence the relabeling to a “force” would more accurately depict the relationship.

One of the key takeaways from this session was that healthcare is clearly a political and a social issue. And in our respective communities, to enable meaningful healthcare change we must interact deeply with the social and political forces. Meaningful change requires mobilization and that’s only possible once we put our skin in the game by operating beyond our healthcare facilities and embed ourselves intimately with the wider community.

About the Author

Mohsin Mustafa

Mohsin Mustafa is an Oxford MBA candidate, a Skoll Scholar and Weidenfeld-Hoffmann Trust Scholar. He is also an entrepreneur who is passionate about the provision of quality primary healthcare. He sees the provision of quality healthcare as a way of enabling social justice and that’s what fuels his passion for work. Mohsin is the co-founder and managing director of Clinic5, an affordable healthcare delivery service for communities in Pakistan. He is currently a Skoll Scholar, Weidenfeld-Hoffman Scholar and MBA candidate at the Saïd Business School.

Scaling Health Solutions through Government Partnerships

Each year the Skoll Centre invites a small number of Oxford students to the annual Skoll World Forum on Social Entrepreneurship. Each year they share their unique perspectives of the sessions and events that unfold during this magical time in Oxford.

Achieving universal health care through collaboration between funders, social entrepreneurs, and government

Frustrating. Slow. Fundamental. Scale. These were the words that came to mind to attendees when Erin Worsham of the Center for the Advancement of Social Entrepreneurship asked them to describe working with government. The balance between the challenges of working with government, and the potential impact and scale that could be achieved through collaboration was immediately apparent.

In the next hour and a half, we heard candid conversations from two partnerships between social entrepreneurs and governments. One was between Last Mile Health and the Government of Liberia. The other was between Partners in Health and the Kingdom of Lesotho. Through these conversations, there were three themes that kept coming up:

  1. Collaborative target setting and evaluation between social enterprises and governments
  2. Demonstrating impact to inspire scale up
  3. Funding for comprehensive primary health care, rather than particular diseases

Collaborative target setting and evaluation

Thabelo Ramatlapeng of the Kingdom of Lesotho kicked off this theme when she mentioned one of the major challenges for governments was working with organizations who brought their own missions, and their own objectives, and were inflexible about setting these objectives collaboratively. In both partnerships, there was a concerted effort made to understand the government’s priorities and ambitions, and design the work and evaluation according to these, rather than organizational agendas.

Lisha McCormick of Last Mile Health drove this home when she mentioned that in her experience, the Government of Liberia wasn’t concerned with RCTs, and evaluation; they had very practical questions- how do we implement, and how do we pay for it?

Demonstrating impact to inspire scale up

Another recurring theme was social enterprises demonstrating impact to government in smaller use cases, and government building on this momentum to scale up what is proven to work. Partners in Health by building seven comprehensive primary care clinics in the most isolated and difficult to reach areas of Lesotho, and Last Mile Health by implementing a community health worker model in three counties of Liberia. Each have now scaled rapidly in close collaboration with government, with comprehensive primary healthcare now reaching 40% of the population of Lesotho, and community health workers operating in 15 counties of Liberia.

This to me, seems like the ultimate theory of change around working with government. Innovators prove that work can be done differently and more effectively, and the value of government is in recognizing and scaling this innovation so that it has massive impact. The innovation would not have been recognized, however, if the respective teams hadn’t engaged government in setting the objectives and defining success at the very earliest stages.  

Delivering comprehensive primary healthcare

There was a third stakeholder in the conversation between panelists that wasn’t a speaker, but whose presence was felt- the funders. A major challenge emphasized by Abera Leta of Partners in Health was that funding for health is often in verticals, designated to treat HIV vs. malaria vs. a vaccination, rather than funding that can be used for comprehensive care that treats communicable and noncommunicable diseases, and makes true universal healthcare access a reality.

Again, the importance of following the government’s lead was emphasized. In countries like Rwanda that insist on autonomy in how they use donor money to fund healthcare, comprehensive primary healthcare can be prioritized. Just like with social enterprises, when funding reinforces and enables the government agenda around comprehensive primary healthcare, rather than trying to force its own, the potential of this collaborative relationship is realized. Every speaker, from the government and the social enterprises, was unanimous in calling for funding that could be used to build the primary healthcare systems that countries need.

As we think about these themes, it’s important to keep the individuals at the center, who are the reason that  all three players- governments, social entrepreneurs, and funders- do this work. S. Olasford Wiah of the Government of Liberia brought us back to these individuals when he shared what inspires him to work in community health. He shared the story of one of his former patients. A woman who had a healthy pregnancy, but experienced complications during the delivery. Her community came together to try and bring her to a health center, walking and carrying her for hours in a hammock, but by the time they reached the center, she had passed away.

This is the injustice experienced by the 50% of the world that doesn’t have access to essential health services. And addressing this injustice is what motivates us and demands that we collaborate to achieve a world with universal access to health care.


About the Author

Puja Balachander

Puja Balachander is a social impact designer following the lead of vulnerable communities to help solve their most intractable problems. Throughout her career so far, she has worked on designing sustainable, equilibrium-shifting solutions with end-users. Puja believes in working with end-users in their language and in their community, therefore she practices and teaches design in French, Hindi, and Tamil, and has worked all over the US, India, and Madagascar. Currently undertaking her MBA degree at Saïd Business School, she is also co-founding Devie, a social enterprise that aims to improve access to quality early childhood development.