“I see a system failing. It is doing something, but it is not solving the problem.” These were the words uttered by Purnima Menon, a public health researcher with the International Food Policy Research Institute and reported in a New York Times article on March 13, 2009. She was referring to the rampant malnutrition evident among children in India. Almost half of all children under three years of age are underweight or severely underweight and malnutrition among children accounts for more than one-fifth of the total disease burden. Surprisingly, this staggering rate of malnutrition is occurring in a country that has one of the fastest growing economies in the world and has shown substantial economic growth for over a decade.
Certainly prioritizing funding to this area is part of the problem both at the national (Amartya Sen, a Nobel prize-winning economist, noted that hunger was not enough of a political priority in India) and international levels (Ruth Levine noted in her blog that malnourishment is well known to be severely under-funded internationally). Yet, insufficient funding alone does not tell the whole story. India runs the largest child feeding program in the world and has a $1.3 billion Integrated Child Development Services program to combat malnutrition via financing a network of soup kitchens in slums and villages. Despite this substantial investment, the program has been, for the most part, unsuccessful largely due to the fact that the program is not well designed and does not adequately target the groups most in need of their services (i.e., children). For instance, the New York Times article noted above described one center in which there were no children; instead the food was being given to the few adults who showed up. It has been argued that this problem, which is reflected at the international level, is due to a lack of leadership and governance (see Source 3).
Many believe that the solution is greater governmental intervention. The author of a Lancet article addressing this issue back in January 2008 wrote, “The compelling logic of this scientific evidence is that governments need national plans to scale-up nutrition interventions, systems to monitor and evaluate those plans, and laws and policies to enhance the rights and status of women and children.” Likewise, a blog published on March 13, 2009 (Hanging in the Balance: Who Will Deal with Child Malnutrition?) argued for increased governmental (both at the local and international level) attention and action.
Given the demonstrated success of PDPs in the area of drug development for neglected diseases in developing countries, it is somewhat baffling why a similar approach has not been more aggressively pursued in this area. The hurdles preventing programs from successfully managing malnutrition seem to be similar to those present in developing drugs for neglected diseases. As has been noted, the primary impediment in India (and arguably in other developing countries) has been a lack of implementation and efficient use of resources. These are the very areas that the private sector excels at addressing. It has been frequently observed in the areas of vaccine distribution and health care innovations that the strength of the private sector is reaching markets and dealing with regulatory challenges (see Sources 4 & 5) while the public sector brings to the table a thorough knowledge of the needs of the country (i.e., areas that are most effected by child malnutrition).
There are some who might argue that the lack of short-term commercial returns would deter private sector involvement. We find this argument to be both unpersuasive and unsupported by the data. Regarding the funding of neglected disease projects, Mary Moran reported that commercial incentives were largely irrelevant to large companies. Rather long-term business considerations such as “positioning themselves in emerging developing country markets, or building access to low-cost, high-skilled developing country researchers” were the primary motivators.
This idea of using PDPs is not novel despite the fact that it appears to be underutilized in the area of child malnutrition. Three years ago almost to the day (March 9, 2006) a document was released entitled Tackling Child Malnutrition Through Market/PPPs: An emerging trend. In this document the director of the UNICEF Nutrition Program in India observed that “solutions from a technical point of view are known, but the lack of collaboration between government, NGOs, and companies, together with obstacles inherent in existing structures, prevent real progress. In addition, the business community’s involvement is limited mostly to providing philanthropy, rather than developing and offering market-based solutions.” In light of this, and past demonstrated successes of PDPs, one has to wonder why a greater amount of attention and resources are not being put into developing PDPs.
Additional Sources
1. What works? Interventions for maternal and child undernutrition and survival
2. Effective international action against undernutrition: why has it proven so difficult and what can be done to accelerate progress?
3. Horton, R. (2008). Maternal and child undernutrition: an urgent opportunity, Lancet, 371, 179.
4. Mahoney, R.T., Krattiger, A., Clemens, J.D., and Curtiss, R. (2007). The introduction of new vaccines into developing countries IV: Global Access Strategies. Vaccine, 25, 4003-4011.
5. Mahoney, R.T. and Morel, C.M. (2006). A global health innovation system (GHIS). Innovation Strategy Today, 2, 1-12.
6. Moran, M. (2005). A Breakthrough in R&D for Neglected Diseases: New Ways to Get the Drugs We Need. PLoS Medicine, 2, e302.
Brian Harel and Jason Kasting
Categories: Health, Product-Development Partnerships (PDP), Public-Private Partnerships (PPP) | Comments (0)
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