When Quality is Uncertain: Ethical Dilemmas of Decision-Makers Determining Availability of Medical Products in Global Health
In 2015 the aggregate global spend on development assistance for health was approximately USD$19 billion and on average, for Low-Income and Middle- Income Countries (LMICs), provided around 30% of national healthcare-spending1. Such dizzying figures indicate the profound influence that humanitarian health actors have on global health – particularly for those in LMIC contexts. Despite this significance, the quality of healthcare provided by international Non-Governmental Organisations (iNGOs) is poorly characterised – particularly the quality of medical products distributed to beneficiaries. Regrettably, it cannot be assumed that these products are of equivalent quality to that of the iNGO’s host nation – indeed, there are many reasons to be concerned.
Each iNGO will have numerous stakeholders (donors, governments, and patients, for example), who may each have differing expectations and priorities with respect to medical product quality, quantity, cost, and speed. When faced with the exceptional challenges that arise from delivering aid in resource-poor settings (weak governance2, supply chain failures, limited capacity etc), it may be unfeasible to meet all these expectations simultaneously. This gives rise to an ethical dilemma of what to compromise: quality, number, reach? There also arises the question of who should be responsible for such decisions, on behalf of the potential beneficiary population.
Currently there is a paucity of dialogue between actors regarding this issue, possibly due to its complexity and the risk of reputational damage. Furthermore, current literature focusses on the need to maintain quality, rather than acknowledging the holistic problem. This may further disincentivise open dialogue. This qualitative, ethnographic study aims to explore this problem. By mapping stakeholders, describing their impact on medical product quality, analysing decision-making, and exploring potential solutions, it is hoped that this study will invite greater discussion on the subject – as well as benefitting complex decision-making of ethical dilemmas in global health.
Kate is a Wellcome Trust-funded DPhil student who joined the Ethox Centre in October 2019. As a member of Associate Professor Patricia Kingori's “Fakes, Fabrications & Falsehoods in Global Health” team, Kate’s research explores barriers to accessing quality assured medical products in resource-poor settings.
1. Xu K SA, Kutzin J, et al. New Perspectives on Global Health Funding for Universal Health Coverage. Geneva: World Health Organization, 2018.
2. Khadem Broojerdi A, Baran Sillo H, Ostad Ali Dehaghi R, et al. The World Health Organization Global Benchmarking Tool an Instrument to Strengthen Medical Products Regulation and Promote Universal Health Coverage. Frontiers in Medicine 2020;7(457) doi: 10.3389/fmed.2020.00457