I just finished reading Harvard Business Review’s (HBR) “Megatrends in Global Health.” (You can read it too by clicking here) First off, as I suspected, megatrends is not a real word according Merriam-Webster’s dictionary; but let’s just assume they meant really big, really important trends. Megatrend number seven is “evidence-based medicine.” Duh, it’s better to know if your interventions work, right? But HBR had an interesting take on it:
“Data on outcomes will increasingly be used to develop standard protocols for treating many diseases, resulting in a movement away from the long-dominant “what you and your doctor decide is best” judgment-based medicine. Could this lead to health care Czars who will establish protocols and penalize physicians who deviate from them?”
In a lot of ways, this is a first-world perspective (or really the perspective of insured first-world folks). It assumes that one has a primary care physician, which isn’t true for many Americans and most of the people in the countries where VillageReach works. But I do think this applies in a broader sense to the one-size-fits-all evidence-based intervention philosophy that plagues global health. Let me be clear, I love that VillageReach puts such a big emphasis on evaluating our interventions; it’s a major part of what made me want to work here. We know that you cannot just assume that what should work, will work. That’s why in our annual evaluation of our community health program in Kwitanda, Malawi we don’t just ask if people have a mosquito net but also if they sleep under one. And when it turned out that more people have nets than use them, we changed our strategy to make sure that we our addressing the need for nets and addressing the barriers in actually using them.
But what about when a good program that everyone likes doesn’t have the outcomes they expect? Our maternal and child health hotline in Balaka District, Malawi is getting amazing feedback from the community. People love having someone who will listen to them, answer their questions, and give sound advice. We’re still waiting for our final evaluation results and I anticipate that our results will be as good as we hope. But even if if they’re not, I’m still pretty sold on the program. There has to be room in “evidence-based” to say “Ok, it may not have changed the outcome of the pregnancy, but it was comforting and made pregnancy easier and less scary for our clients” just like I want to be able to say to my doctor “I understand that the drug that you take for five days is more effective, but I want the one that I only have to take for two days because it’s easier for me.” I think evidence-based interventions are a good thing, a very good thing. We just need to make sure we do it in a way that honors what VillageReach is all about: extending the reach and improving the quality of the health system. And sometimes we do that in ways that are hard to measure.