The old model for global health – whether you loved it, hated it, or both – is over. Full stop.
As foreign aid budgets contract, a heated debate is underway about what the new model should look like. Already a few points are clear: Donors will no longer call the shots. Countries will be in the driver’s seat, spending their own resources and setting their own priorities. And a new approach is needed for financing, as quickly as possible.
As the dust settles, two seeming contradictions have emerged. The health challenges the world is facing are getting harder: declining aid, climate change, pandemic risk… the list goes on. Yet we are in a golden age of health solutions – some barely distinguishable from magic. These breakthrough technologies, coupled with innovative financing, have made it possible not just to “maintain the gains” in global health, but to dramatically accelerate progress. They offer us an incredible opportunity to save and improve billions of lives.
I recently stepped down as the CEO of Malaria No More to launch BillionScale Health – a blended finance organization working to find and finance solutions to the world’s biggest health challenges. It may seem ambitious, or even quixotic, to launch a new organization right now. But this moment in global health requires ambition. It requires an obsessive focus on scale. And it requires a capital stack that looks very different from the past.
The new capital stack
In the old days, donor funding dominated. But the new capital stack for global health will be defined by five Cs:
- Country spending
- Concessional debt
- Consumer spending
- Catalytic grant capital
- Commercial investment
What’s different now is that the first three C’s are all forms of country spending. That puts countries in control. They decide what problems to focus on. They decide what solutions to scale. We call it “place-based scale.”
For example, we are building a new capital stack in Indonesia, supporting the government to scale Wolbachia, a nature-based tool to fight infectious disease. Wolbachia is a naturally occurring bacteria that prevents mosquitoes from transmitting dengue. Working with the ministry of health, national universities, local foundations and business leaders, we are pursuing a plan to scale Wolbachia to 100 cities and 100 million people.
It will make Indonesia a launching pad for the region: a center of excellence, a driver of lower costs, a manufacturing hub for Wolbachia technology, and an easy example for neighbors to learn from and follow.
Last week’s “Asia Wolbachia Dialogue,” hosted in Singapore by the Asian Development Bank, was a pivotal moment on the path to scale for this technology, bringing together 200 representatives from countries, innovators, researchers and funders.
That’s the blueprint: Work with first movers to demonstrate a path to scale. Work with regional funders (like the Asian and Inter-American Development Banks) to ensure the capital and learnings are there to support other countries when they’re ready. Then expand across the region.
Scale changes everything
Global health doesn’t need another well-intentioned pilot, especially in today’s resource-constrained environment. Scale is what the moment calls for, because scale changes everything.
Scale bends the curve on cost. It bends the curve on disease burden, freeing up precious health capacity. It empowers countries and creates a repeatable model for their neighbors to follow.
So, what does it take to scale in the new global health landscape?
Self-interest. For decades, “country-led” was a slogan of international development. We’re about to see what it really means in practice. As countries pay for more of their own healthcare, they will prioritize the things that matter most to the health and wealth of their people – especially things measurable in GDP growth. This new dynamic creates a lot of momentum and opportunity for countries.
Simplicity. We need to prioritize simple, elegant tools that are easy to use. For example, we are working with SC Johnson and malaria-affected countries to scale up Guardian, a simple and effective “spatial repellent” for mosquitoes that was approved by the WHO last year. A mesh square smaller than a sheet of paper, Guardian hangs on the wall and repels indoor mosquitoes for a full year, preventing malaria and other growing diseases like dengue. It is easier to use than a bed net, addresses key gaps like daytime biting mosquitoes and lax usage, and could end up costing a fraction of nets on a per-person-protected basis. It couldn’t be simpler.
Catalytic capital. Donors will play a much smaller (but still vital) role in the new funding model. The new capital stack for health will be led instead by countries, by consumers, by lenders and investors – all enabled by new structures that align interests and incentives. When everybody’s investment is leveraged, everyone wins – especially countries and the publics they serve.
Bending the curve on cost and disease burden
The recent Artemis mission has the world thinking about moonshots again. We need to do the same in global health.
When launching moonshots, liftoff matters most. The hardest, most creative work happens up front. That’s when you figure out:
- Product improvements, rapid and incessant in the early stages, radically improve the impact profile of a solution and cut costs.
- Market shaping does the same for affordability, reducing the cost per person protected by up to 90%.
- Regional manufacturing ensures efficiency and access as countries take up solutions proven by their neighbors.
- Catalytic capital crowds in investors and supports countries to move from initial implementations to national scale.
- Delivery innovations create a playbook for reaching priority populations affordably across public- and private-sector channels.
- Proven impact gives the rest of the world the confidence to level-up their own ambitions and invest their own capital to adopt solutions.
The road ahead
Around the world, countries are adapting to the new global health landscape, setting their own priorities, spending their own money, and taking greater control of their futures. What they need is a way to bend the curve on cost and to bend the curve on disease burden. And breakthrough technologies, market-shaping and blended finance are changing the game.
None of this is guaranteed. Scale is hard. Blended finance is hard. But the alternative — retreating to smaller ambitions at precisely the moment when the tools are the best they’ve ever been — would be a tragic mistake.
When we were billion-scaling the bed net in the first few years at Malaria No More, Ray Chambers would say to us, “We’ll never do anything as important as this in our lives.” I can think of no better way to spend the rest of my career than trying to repeat that feat.
Martin Edlund is the co-founder and CEO of BillionScale Health and the former CEO of Malaria No More.
Guest posts on ImpactAlpha represent the opinions of their authors and do not necessarily reflect the views of ImpactAlpha.
Disclosure: ImpactAlpha contributing editor Kristin Kelly Jangraw is a consultant to BillionScale Health.
