Saturday, January 12, 2008

A need for $38 to $45 billion ... why?

I wrote the following to the correspondent author of a paper titled "Estimated global resources needed to attain international malaria control goals".
I have the paper "Estimated global resources needed to attain international malaria control goals".

I guess I come from a different background. I trained in engineering and economics at Cambridge. I qualified as a Chartered Accountant. I worked as a cost accountant and CFO in the US corporate world for a number of years ... and only then did I start doing consulting work in the international field of relief and development ... and preparing business plans and financial projections.

I am therefore quite concerned about the financial planning dimension of the international development assistance community ... and the remarkable lack of historic cost effectiveness measurement, and therefore a terrible weakness in terms of planning and optimizing interventions.

I define management information as the least amount of data that enables optimum decisions to be made reliably and quickly.

Hardly any of the material available has this characteristic ... and, in my view, without it ... results are going to be less than optimum, or more bluntly, are likely to be unacceptably poor.

What to do? The paper talks about $3.8 billion to $4.5 billion a year! It talks about $38 to $45 billion from 2006 to 2015. These are huge amounts ... but why? In the body of the report ... costs are going up over time ... but why?

In the mosquito and malaria control model I have worked on, costs go down over time ... by working on breaking the transmission cycle ... by having good data to optimize local performance and respecting the tremendous importance of geography ... by doing only what is needed ... by doing sentinal surveillance to ensure that there is rapid intervention to stop re-establishment of the malaria crisis.

In our approach we measure costs and we measure results ... the reduction in mortality in a community ... the reduction in morbidity in the community ... the reduction in work days lost ... the number of cases of malaria ... the prevalence of parasite in the human host ... the prevalence of parasite in the mosquito population.

In our experience cost effectiveness is very variable ... averages are meaningless. Optimization is achieved by good analysis of timely relevant data ... both locally and in a multivariate broad based database. Optimization starts from what has happened, what is happenning and what needs to happen.

We do all of this more in an accounting mode than in a statistical mode ... statistics have their place. There is a professional activity called cost accounting ... I do not know one called cost statistics!

I just don't see this dynamic in what is being circulated ... what is being discussed ... what is being done.

What am I missing? Can you help?

Peter Burgess

It will be interesting to see whether I get a reply. Over the past two years there has been only about a 5% response from my attempts to contact the writers of documents. I have used different approaches to gain attentions ... but in the main none work. In many cases the writers have "moved on" and no longer seem to have a continuing interest in the malaria issue ... but more broadly there seems to be a systemic problem that might be described as the disconnect between the work needed for addressing the malaria crisis on the ground and the research community that is publishing a lot, most of which has rather little practical value.

Maybe I am wrong ... but getting an active dialog about cost effectiveness in any specific situation is almost impossible. Why? What is it going to take to get a serious interest in cost effectiveness?

Peter Burgess
The Tr-Ac-Net Organization

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