[afro-nets] Call for Applications: First AMANET Workshop on Advanced Health Research Ethics for Investigators (2)

["Peter Burgess" <peterbnyc@gmail.com>]

Dear Colleagues

I am glad that AMANET is addressing the issue of Health Research Ethics (HRE) ... but rather less enthusiastic about the modality that has been funded.

I am an old corporate cost accountant and former chief financial officer (CFO) ... my expertise is in the analysis and understanding of how much things cost and what sort of value is being achieved. I have applied this in both the corporate setting and in the international relief and development sector ... and have used it to develop an analysis framework called Community Impact Accountancy.

In the global health sector, and in the malaria sub-sector, there are some very substantial fund flows, but rather little that shows that the funds are achieving good outcomes. Bluntly put, the cost accounting is notable by its almost total absence ... and results are more often than not broad generalizations about impact from very small (tiny) surveys.

In the malaria arena the scaling up of fund flows has resulted, it appears, in some improvement in the malaria burden situation ... but hardly any of this is being done in ways that ensure sustainability. This is a crisis waiting to happen. Costs are being incurred in many parts of Africa with funding from various donors (GFATM, PMI, etc) but the feedback about results tends to be much more about how much was done with the money (bednets delivered, for example, or number of houses sprayed, or drug doses administered) than it is specifics about the reduction in malaria burden. It is interesting that Eritrea or Zanzibar results are frequently being used to indicate how the funding is having success ... but why so little from all the other locations.

>From a professional cost accounting perspective this is totally inadequate. From this perspective, the first thing that is needed in order to get improvement in ethics is to start working with decent data about costs and results so that high cost and low result activities can be eliminated and the resources better used for the reduction in malaria burden in African society.

With good (old fashioned) cost accounting it will become apparent that there are quite distinct performance issues in different geographic areas ... not just the mapping being done that relates weather and geography ... but other characteristics of the area that include people, housing, physical environment, vegetation, water. mosquitoes, history of past interventions, and on and on. ALL these characteristics and more are needed to determine what should be done in a given location ... to get the best outcomes and to do it at least cost.

The idea that cost accounting is expensive needs to be addressed. Cost accounting is NOT costly when it is done correctly ... though it becomes very expensive when it is done using international staff with little of accounting background and experience. Cost accounting is not a subset of a monitoring and evaluation exercise, but is, or ought to be, a part of any management structure.

Cost effectiveness is a big issue in the ethics of health ... and health research. It is not the only issue, but it does tend to be off the table ... and it is pretty clear that there are major ethical issues around the fund flows and their use.

Sincerely

Peter Burgess

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Peter Burgess
The Transparency and Accountability Network: Tr-Ac-Net in New York
http://www.tr-ac-net.org
IMMC - The Integrated Malaria Management Consortium Inc.
Community Impact Accountancy http://tracnetoncia.blogspot.com
The Tr-Ac-Net blogs ... start at http://tracnetvision.blogspot.com
+1 917 432 1191 or +1 212 772 6918 
mailto:peterbnyc@gmail.com