EAGER: A New Approach to Provide Effective Public Health Infrastructure in Resource Poor Settings

Virginia Polytechnic Institute And State University, Blacksburg VA

Investigators

Abstract

The objective of this EArly-Concept Grant for Exploratory Research (EAGER) project is to develop a new approach to provide effective public health infrastructure in resource-poor settings by investigating how a highly successful aid organization, Partners in Health (PIH), offers quality healthcare services in some of the most challenging regions of the world. PIH was chosen for a case study since it has implemented a successful framework for public health interventions in the very regions of the world where engineering interventions are failing. For instance, PIH has increased access to reproductive health care by over 400 percent since 2000 for its patient population. A rigorous investigation of PIH projects in Haiti, which is underpinned by two alternative theories of international development - modernization and world systems, will uncover how PIH overcomes similar project barriers that currently prevent engineers from achieving similar levels of effectiveness. Interviews with key stakeholders, complemented by analysis of organizational procedures and reports, will provide the means to understand how PIH successfully provides modern public-health related services in such a demanding environment. The project will culminate by translating PIH's approach into a general philosophy and incorporating it into an engineering framework. Five million people worldwide die every year from water-related diseases even though technologies exist that could prevent this from happening. Certainly, world leaders are aware of this problem, and the Millennium Development Goals (MDGs), a program initiated by the United Nations (UN) to end poverty, is an international effort to address, in part, this epidemic. One goal is to halve the number of people without sustainable access to clean drinking water and adequate sanitation by 2015 per 1990 baseline data. While this is admirable, analysis of data from the World Health Organization indicates that the UN?s measure of success does not ensure the elimination of preventable water-related diseases, especially in the poorest countries. This failure is not merely technical, but socio-technical. In other words, numerous socioeconomic factors beyond the usefulness of the technology itself complicate the issue. Many engineers have adopted the philosophy of appropriate technology to address this problem. However, this limits the tools available to engineers to combat water-related diseases, especially in resource-poor communities that face a disproportionate number of project barriers compared to wealthy communities. Thus, appropriate technology may not always be the most effective technology. This research has the potential to transform the way engineers think about and solve socio-technical problems. A change in philosophy will subsequently lead to changes in policy and practice that will improve international assistance efforts of US-based NGOs and reduce the associated risks taken by financial institutions when they finance engineering interventions such as the improvement of a region?s drinking water supply. More important, this initiative will define a pathway for engineers to: (a) provide a preferential option for the poor by providing effective technology, as opposed to appropriate technology, and (b) move towards the end of preventable water-related diseases in developing countries, just as they no longer persist in developed countries. Partnerships stemming from this work will open numerous avenues for NSF to build their own long-term commitments with Haiti and other international organizations working there. Additionally, this work responds directly to numerous calls to action such as those proclaimed by the National Academy of Engineers and American Society of Civil Engineers for engineers to act as social leaders engaged in interdisciplinary work that enhances the quality of life for all people, regardless of geography.