The CGD Podcast Episode Summary

Episode Title: Hospitals for Health – Amanda Glassman
Date: September 22, 2014
Host: Lawrence MacDonald (Center for Global Development)
Guest: Amanda Glassman (Senior Fellow, Director of Global Health Program, CGD)

Episode Overview

In this episode of the Global Prosperity Wonkcast, Lawrence MacDonald interviews Amanda Glassman about the CGD’s new initiative: the Hospital Collaborative for emerging markets. The discussion centers on the overlooked role of hospitals within health systems in developing countries, the need for better data, and the launch of a global collaborative to improve hospital performance and policy. The podcast also highlights lessons from the Ebola epidemic and encourages a more holistic approach to global health development.

Key Discussion Points & Insights

1. Why Focus on Hospitals Now?

• Past international aid has prioritized primary health care in developing countries, addressing preventive and easily treatable health needs.
• Glassman points out that while this "low-hanging fruit" of primary care is largely picked, health systems now need to advance to provide more complex care, in which hospitals play a crucial role.
  • [00:42] Amanda Glassman:
    “We’ve pretty much picked that low hanging fruit and now we’re talking about thinking about the health system in a more integral way. And the hospital plays a really important role in producing health. And it’s also what people really want to use.”
• Hospitals are essential for emergencies, maternity care, and conditions unsuited to primary care facilities.

2. Hospitals in crisis: The Case of Ebola

• The devastating Ebola outbreak in West Africa highlighted the dire shortage of functioning hospital beds; families were turned away due to lack of capacity.
  • [01:42] Lawrence MacDonald:
    "These terrible stories about families going back and forth across the city and taxis and wheelbarrows being turned away because there are just no beds for them."
  • [02:08] Amanda Glassman:
    "The hospital has a really important rescue function, emergency response function, and there’s just been an incredible amount of underinvestment in hospitals."
• Glassman critiques donor approaches that focus on building hospitals without ensuring sustainability, staffing, and operational effectiveness.

3. The Challenge of Data and Measurement

• The current global data on hospital capacity is inadequate, using simple metrics like beds-per-population and average length of stay, which may obscure crucial performance issues.
  • [03:07] Amanda Glassman:
    “We have these basic ratios of beds to population, but that’s not a really informative indicator… In some countries, they're using old technologies […] then you’re in the hospital for seven days because maybe they’re being reimbursed on a bed day basis.”
• There’s a need for more nuanced hospital performance data, including quality and efficiency metrics.

4. Examples and Equity Concerns in Hospital Provision

• Glassman describes successful hospital models in low- and middle-income countries, often in the private sector or through public-private partnerships.
  • [04:31] Amanda Glassman:
    "There are lots of great examples of hospitals that have made it work in low and middle income settings... The trouble many times people are concerned about that the poor don't have access to those services. And that's a really important issue."
• The importance of building functioning facilities, even if initially accessed mostly by those able to pay, is discussed—with the caveat that public policy should ensure poor people get access through subsidies.

5. The “Hospital Collaborative” Initiative

• The CGD’s working group seeks to reframe hospitals as central to health systems and develop tools to compare and benchmark hospital performance across countries.
  • [06:46] Amanda Glassman:
    “First a worldview that places the hospital right in the center of the health system. So it articulates a role for the hospital that can be health and equity enhancing.”
• Hospital sector diagnostics and comparable analysis are part of the recommended approach.

6. Model for Global Collaboration

• MacDonald draws a parallel to CGD’s earlier work on impact evaluation (3ie), which led to a global entity.
  • [08:33] Amanda Glassman:
    “I absolutely do. I think it’s a great model. I could imagine such a mechanism being placed in an organization such as the World Bank that actually has an enormous amount of demand for lending on hospitals and needs these resources.”
• Discussion on potential hosts for the new collaborative (e.g., World Bank, universities, WHO), but consensus that it needs to be flexible and data-focused.

7. Not About Funding, But About Knowledge and Policy

• The goal of the collaborative is not to directly fund hospitals but to provide better information, benchmarking, and policy advice.
  • [10:37] Amanda Glassman:
    “There’s plenty of money in hospitals. The issue is really not the financing, although of course, you can always spend more. The issue is about what’s the kind of policy, advice and support that’s required to make the hospital work for health in those countries.”

8. Interest and Multisectoral Engagement

• The initiative sparked significant interest, bringing together experts from eight countries, public and private sectors, NGOs, and global health organizations.
  • [12:32] Amanda Glassman:
    "We have private sector leaders, the chairman of one of the largest private sector hospitals in India, but we also have person in charge of health reform and hospital policy in Indonesia. We have people from Colombia, Brazil... We just have an enormous group, an incredible amount of expertise, and we've really benefited from that."

Notable Quotes & Memorable Moments

• On the neglect of hospitals:
  “There’s just been an incredible amount of underinvestment in hospitals. Although some donors love to give hospital buildings, they don’t always think about everything else that needs to be in place to make the hospital work.”
  — Amanda Glassman, [02:08]
• On the need for empirical data:
  “We have these basic ratios of beds to population, but that’s not a really informative indicator.”
  — Amanda Glassman, [03:07]
• On the importance of hospitals:
  “Hospitals matter, hospitals matter.”
  — Lawrence MacDonald, [06:58]
• On the approach for strengthening hospitals:
  “Trying to benchmark what's happening in different places. I think there's probably first a need to establish some kind of baseline for what's going on because we really don't have a lot of the information we need.”
  — Amanda Glassman, [07:00]
• On equity and system design:
  “If you don’t have any infrastructure at all to provide, maybe it’s better to have facility that actually works and then put in subsidies so the poor can use rather than trying to generate a hospital from nothing.”
  — Amanda Glassman, [04:31]
• Closing reflection:
  “I would just ask all of us that work in the field of global health and development to reflect on themselves and where they would need or want to seek care if something serious happened to them. Because something serious will happen to all of us sooner or later, unfortunately. And to not have a good hospital or urgent care available when you have an emergency or you need more sophisticated services is really a tough situation.”
  — Amanda Glassman, [14:05]

Important Timestamps

• 00:42 – Why focus on hospitals now?
• 01:42 – Hospitals during the Ebola crisis
• 02:08 – Donor neglect beyond hospital buildings
• 03:07 – State of hospital data and metrics
• 04:31 – Examples of successful and equitable hospital provision
• 06:46 – Unbundling the “hospital problem” and the worldview shift
• 07:38 – Benchmarking and data needs
• 08:33 – The model for a hospital collaborative and institutional hosting
• 10:37 – Primacy of knowledge over funding for this collaborative
• 12:32 – Composition of the CGD working group
• 14:05 – Glassman’s closing reflection on the need for hospitals

Final Thoughts

Amanda Glassman calls for a reevaluation of how the global health community supports hospitals, urging that hospitals be recognized as indispensable elements of robust health systems. She invites broader participation and feedback in shaping the CGD’s forthcoming recommendations:

“Please stay tuned for the consultation draft of working group report. We welcome comments and input from anyone, regardless of background and how we can improve it, how we can make our recommendations more practical and more actionable. All of that is welcome.” [14:43]

For listeners interested in global health or health systems development, this episode offers a rich, empirical, and highly relevant discussion on the evolving needs and strategies for strengthening hospital care in low- and middle-income countries.