The global financial crisis began (and continues) in relatively rich places, like the US and Western Europe, and it has obviously spread to previously fast growing middle-income countries, often known as “emerging markets.”
We are also beginning to see significant effects in lower-income developing countries.
Part of this is just now becoming evident in their macroeconomies. Many of these countries are net sellers of commodities to the outside world, so they are seeing a fall in export revenue (albeit from generally high initial levels) and speed of this decline is more than a little worrying – this is the kind of shock that often throws countries’ public finances and other macro policies into some disarray. In addition, while we do not yet have hard evidence on aid flows, these typically go down when a donor country hits any kind of economic speed bump, and almost all donors are now experiencing big slowdowns. (Yes, I know that some poor countries, and many poor people, were also hit hard by high food prices earlier in the year.)
We find ourselves working these issues directly in a course at MIT Sloan on Global Health Delivery, in which students work in teams trying to help health care projects in poor countries (this year Africa is the focus) – we are usually invited to work on a business-type aspect of these projects. (It’s part of a larger set of courses, developed over the past decade, known collectively as Global Entrepreneurship Lab, or G-Lab, in which many of our students work around the world with entrepreneurial people, who invite us in to help solve specific problems. We’ve worked on health issues before, but this is the first time an entire section – about 50 students from all over campus – has focused just on health for low income situations.)
The course has a public blog, run by Anjali Sastry (head of the course), and I refer you to that and to Global Health at MIT for more details on what we are doing and with whom we work (e.g., the Global Health Delivery people at Harvard have been immensely supportive and engaged).
I’d like to flag one key issue, which happens to be the topic of class today. We have no trouble finding good projects and we work with amazing doctors and other medical professionals. But one question they usually have is: how do we scale up? The projects we see help thousands of people, but the need is to help tens of thousands or more.
What is the right way to scale up, when patients don’t have much money, when perhaps you don’t want people to pay for health care (it likely costs them a lot just to get to the clinic), and when the government never has much money? The readings for today’s class are about Smile Train, aid effectiveness, and the WHO’s work on scaling up. But we are looking at more, still small-scale models to see how exactly they could become more general – through being better run, or using money more effectively, or raising more money (remember: this is not a classroom exercise; these are the questions that leaders in this part of the global health field are asking us to work on).
And now add a global economic and financial crisis on top of all this.
Send us any relevant ideas, through comments here or through the course blog, and we (and the students) will report back on what exactly we learn from the hands-on project work, which reaches its most intense phase in January.
The Baseline Scenario 
Ultimately, the only way to scale up to such a large and wide-ranging problem is to teach people how to help themselves. It sounds trite, because when half of the problem is lack of education, prescribing more education is hardly a solution, but you’re never going to have the money and bodies to bring proper trained care to everyone.
This question brings to mind the fascinating work on mental models being done by Sendhil Mullainathan and others. The gist of it is that if you want people to make a behavioral change, you need to understand the way in which that behavioral change is affected by their mental model. So for instance, in many parts of the world it is difficult to get parents to treat children with diarrhea properly, because even when they get proper medical advice their immediate feedback is that giving the child more water produces more diarrhea, not less. To convince people on a widespread level that more water really is better, you need to address the mental model telling them to give the child less. It’s not an easy task, but it is scalable.