GHDonline member Alanna Shaikh has been a strong force in the international development field for over a decade. Her blog Blood and Milk, portrays her personal thoughts behind the importance of creating stable and effective international development programs. We were honored to receive the opportunity to hear about her work in with TB and HIV programs in Central Asia.
Share your thoughts with Alanna and the GHDonline community.
You’ve been working in global health and development for a long time now—tell us about your current role, and how you got there?
I figured out shortly after finishing my undergraduate degree that global health was my true passion. I got my MPH in international health and studied Central Asian languages at the same time, so I’d have a regional hook for potential employers. Fifteen years ago, I managed to network my way into an unpaid internship with UNFPA in Uzbekistan. Once I was on the ground in Tashkent, I was able to start meeting people and applying for paid work.
Currently, I work for USAID as acting health and education office director for the Kyrgyz Republic. After spending the vast majority of my career implementing donor-funded projects, it has been really interesting to be on the donor end. I was worried I would hate it, but I really love the work I do. My colleagues are amazing, and I feel like I am shaping things for the future.
You mentioned that much of your current work focuses on TB & HIV programs—can you share a bit about the delivery challenges you see in these areas, and how the programs you work with are trying to address those?
Broadly, for both HIV and TB our challenge in the Kyrgyz Republic and the former Soviet Union is moving away from obsolete approaches to care. Nobody wants to spend 12 months in a hospital, and it is not required for TB care. It has been a very hard sell to ministries and TB specialists who were educated in older systems. By the same logic, it’s hard to convince health care providers that community testing and adherence support for HIV is actually okay. Physicians and hospitals don’t want to relinquish their traditional forms of control over care. The issue is that these kinds of traditional approaches are not sustainable any more. Even if you have all the funding you need, the old approaches don’t actually work as well. When you want people to stay on medication for many months, as in TB, or even the rest of their lives – like with HIV – people need to be partners in their care. Doctors aren’t always ready for that kind of relationship but it is essential.
What cross-vertical lessons can you share from working to evolve service delivery for TB and HIV?
You have to follow the money. There is data everywhere that shows that financial incentives influence provider behavior, even when the provider isn’t consciously doing it. Health systems provide the care they get paid to give. Period. If you want to change how care is provided, or what care is provided, you have to change the financial incentives baked into the system. There was a lot of unsupervised money in HIV care in the early days of the Global Fund and PEPFAR. To this day, we are still sorting out the impact of that money. It is possible to do the same tracing and untangling for any high-impact health issue. Think about Ebola – where is the Ebola money going? What is that money incentivizing for the future?
What questions do you have for colleagues in the GHDonline community?
How do you stay up to date on all the things that affect global health but aren’t actually health related? I know how to stay current on global health issues. GHDonline is one of my favorite ways to do that! But what about everything else that impacts global health? Environmental science, psychological research, micro and macroeconomics, labor laws – I could drown trying to track everything that’s going to matter to global health. How do other people prioritize what they need to know most and then how do they find it?