Eritrea: An Answer for Global Health

By Filmon Bekit Hagheray
June 16, 2008

Harvard University held a high-level private workshop last Thursday and Friday that dealt with “Institutions for Closing the Knowledge- Action Gap in Global Health.”
The workshop featured a “who’s who” list of prominent scholars, experts and policymakers in global health. In order to share a prime case study, the organizers invited the honorable Minister of Health, Saleh Meky (of Eritrea).
Considered an exemplary case, the Eritrean model of combating malaria is widely considered remarkable by many of the leading figures within global health, and as such, the workshop’s participants were all eager to discuss Eritrea’s success and the issues faced by the world at large.

Marked and elaborated by the workshop’s attendees, Eritrea has demonstrated considerable success and future potential in its strategy and implementation of a nationwide program to combat, control and manage malaria. How exactly does Eritrea effectively tackle malaria? As most participants noted, the Eritrean case’s success is exemplified by a comprehensive coordinated effort spearheaded by the Ministry of Health, but more importantly, the efforts of the entire nation. The bulk of issues debated within global health traditionally deal with a general lack of funding.

That is, the general idea that the reason global health dilemmas are not adequately addressed in developing countries is – the country in question does not receive or maintain sufficient funding. However, the Eritrean case demonstrated a growing voice within global health that alludes not to a lack of funding, but rather the absence of effective management and a holistic approach that involves numerous domestic stakeholders and Ministries. As Minister Meky explained more fully, “Leadership [of the program] by the Ministry of Health was important, but the full commitment of the government and state is vital as well.” The Minister’s views conveyed that the current international milieu in global health must do a better job at transferring control of programs to their respective national governments. He further asserted that much of Eritrea’s success would not have been possible without lessons learned from Vietnam (which faced similar issues) and the determined efforts of not only his Ministry, but also the full backing and participation of the government and Eritrean people. Much of the workshop’s dialogue consisted of delineating control of programs between international players in global health (i.e. UN, WHO, the World Bank etc.) and the national governments they influence via technical and financial assistance. Renowned pediatrician and head of the Institute of Healthcare Improvement, Dr. Donald Berwick was quite vocal in his assessment and praise of Eritrea’s success. Dr. Berwick noted, “The Eritrean case is a fabulous case. Local systems need aims, measurements and a normative process on what to do and what not to do. Local communities must be able to study from one another so as to diminish the obstacles faced.” He was one of many that echoed Minister Meky’s assertions that international global health backers and architects should focus on strengthening nations’ respective institutions by developing and advancing domestic initiatives of training, program design and implementation. The underlying view here is that stewardship and accountability are better placed with the state since national governments maintain the knowledge, relationship and accountability to interact and benefit their people most effectively and efficiently.

Apart from the refined action-oriented approach global health issues should undergo, many participants found that a series of regional networks for knowledge to action would benefit developing countries greatly. Panelists such as Dr. Jim Yong Kim, Dr. Julio Frenk, Dr. Srinath Reddy, Dr. Hiroki Nakatani and Dr. Adel Mahmoud all stressed the need to create sustainable partnerships so that countries are better positioned to learn from one another, and that a systematic approach is more beneficial than addressing global health in a divided and fractionated fashion.

The takeaways from the workshop were plentiful and there was a general consensus among participants to strengthen ties, increase dialogue and enhance academia’s role in furthering solutions on matters of global health. It was quite evident from individual analyses that Eritrea’s experience is changing the manner in which global health scholars and agencies conduct research and address global health initiatives. Considering the myriad of social and political problems that are present in global health, the Eritrean
case not only signifies individual success, but also illustrates lessons to be learned and embodies a way forward. The world excitingly and anxiously awaits the theoretical and practical applications of such a model to assist and save countless lives.

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