Scaling health innovation is a demand problem

Scaling health innovation is a demand problem

Innovation in global health is needed more now than ever — and with development assistance for health collapsing from a COVID-era peak near $80 billion to the high $30 billions and falling fast, the pressure has only intensified. In this conversation, Dr. Karlee Silver, CEO of Grand Challenges Canada, makes the case that scarcity is forcing a long-overdue shift: from supplying innovations to building demand for them within health systems. I co-founded GCC fifteen years ago and remain a board member, so I'm not a neutral observer — but I think its hard-won lessons are a pathfinder for anyone serious about getting innovation to scale. In this conversation: - What Grand Challenges Canada is, and Karlee's path to CEO (01:27) - Why scarcity drives innovation — and the "silver bullet" trap of over-focusing on AI and digital while missing social and service-delivery innovation (04:34) - Why the aid collapse is "salutary" in the long run: real country ownership, real accountability (05:35) - The new strategy and $200M from the Government of Canada: the four directions — adapt, accelerate, choreograph, connect — and the half-push, half-pull rebalance toward demand (08:25) - The three "choreograph" barriers: weak demand and procurement, high cost and low investability, and lack of system coordination (14:34) - Neopenda (Kenya) — the "mountain model" and the procurement barrier: county decision-makers choosing a newborn vital-signs monitor on its merits, funded from existing budgets (15:05) - The Gavi Innovation Scale-Up Facility, with 500 Global — the investment barrier: impact-first and commercial capital side by side in a single window (20:11) - M-mama (Tanzania) — the system-coordination barrier: an "Uber ambulance" at national scale, lifting ambulance-handled transports from one in ten to eight or nine (22:11) - The target — 700 million people reached by 2035, up from ~170 million — and the 480/120/100 million breakdown of where it comes from (27:49) - The supply/demand math: two-thirds supply (the snowball already rolling), one-third intentional demand — and why that's the "pathfinder" lesson (29:57) - Karlee's open invitation to governments, funders, and philanthropy (31:42) - What "reached" actually means — and why not every life reached is a life saved (33:18) Read the full argument at Global Health Insights: singerp.substack.com Disclosures: I am a co-founder, former CEO, and current board member of Grand Challenges Canada. I used AI (Claude from Anthropic) for research, fact-checking, and editorial feedback; the writing and judgments are my own. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit singerp.substack.com [https://singerp.substack.com?utm_medium=podcast&utm_campaign=CTA_1]

More results, less politics? “Who will be the next leader of the beleaguered WHO?”

Summary This episode explores the upcoming WHO leadership race, the challenges facing the organization, and the qualities needed in its next leader. Jocalyn Clark, international editor of the BMJ, shares insights from her recent article and interviews with global health experts. Episode description WHO is in an existential crisis, the worst in its 78 year history. It is beset by financial crisis, staff reductions, and geopolitical friction. That’s what experts interviewed by Jocalyn Clark, International Editor of the BMJ, told her, as she recounted in an article [https://www.bmj.com/content/393/bmj.s911] published today, entitled “Who will be the next leader of the beleaguered WHO.” Jocalyn Clark and I have been friends and colleagues for decades. So it was a particular joy for me to discuss the WHO Director-General election with her on my podcast. Jocalyn interviewed global experts familiar with WHO and created a composite picture at this point in the WHO Director-General race. The race has kicked off although no candidates have yet come forward — they have until September 2026 to do so. The race culminates in an election at the World Health Assembly in May 2027. She also heard from her interviewees that the desired profile of the next DG is a ‘polymath’ — someone who has technical expertise, can raise money, and has sophisticated diplomacy skills. Opinion was divided on whether DG candidates should spend time courting the US to try to get it to rejoin. We agreed that US return to the organization before the May 2027 election was unlikely but that it would be desirable for candidates to at least create the enabling conditions for a future return. My mantra for this campaign: ‘more results, less politics.’ Jocalyn and I drilled into what technical expertise really means. WHO substitutes process for results. The future leader should focus relentlessly on results [https://open.substack.com/pub/singerp/p/successful-un-80-reform-requires?r=1ytch0&utm_medium=ios]. These are achieved in country and are the primary responsibility of countries themselves. WHO should be there to help; it should be able to measure and manage its contribution in support of countries. Jocalyn and I both agreed that the “norms and standards” brigade was just not specific enough about this, too process-oriented, and maybe a bit backward looking. We also batted around what it meant to be less politicized. We agreed that diplomacy was key: the elevation of the DG’s relationships from health ministers a decade ago to also include foreign ministers, finance ministers, and heads of state and government today was a good thing. But on specific issues, like conflict, there was some disagreement among Jocalyn’s interviewees about whether the DG should ‘take a stand.’ I argued for the importance of neutrality and impartiality, a fundamental value of UN organizations. I spoke about a recent report [https://www.centerformedicalintegrity.org/publications/attacks-on-health] released by the Center for Medical Integrity on how WHO monitors and communicates on attacks against health care. I thought this report was excellent and every candidate should be pressed on whether they agree (or not) with its recommendations — including strengthening the verification methodology, increasing transparency to enable independent scrutiny, and addressing systematic bias and underreporting. Finally, we talked about the insider / outsider issue. Normally, if an organization is in crisis, you would want an outsider. In Jocalyn’s reporting, for this reason, people were tilting towards an outsider. But I don’t subscribe to the saviour theory of WHO DGs. We agreed that insider candidates should distinguish themselves from the current path and offer their prescription for improvement. It was a fun conversation between friends. We plan to do it again as the race unfolds and specific named candidates put themselves forward. I hope you enjoy the conversation too — check it out above or wherever you get your podcasts (under ‘Global Health Insights’). Read Jocalyn’s article [https://www.bmj.com/content/393/bmj.s911] in the BMJ. And let us know what you think! If we are not careful, we could get more politics and less results. Resources Jocalyn’s article in the BMJ: https://www.bmj.com/content/393/bmj.s911 [https://www.bmj.com/content/393/bmj.s911] Center for Medical Integrity Report: https://www.centerformedicalintegrity.org/ [https://www.centerformedicalintegrity.org/] Keywords WHO leadership, global health, international health policy, WHO crisis, health leadership, global health reform Chapters 00:00 The Mood in Geneva: Concerns for WHO's Future 02:49 The Process of Selecting WHO's Next Director General 05:11 Insights from Jocalyn's Research and Reporting Methods 07:55 Diverse Opinions on the Future of WHO's Leadership 10:30 The Profile of the Ideal Director General 13:13 The Role of the United States in WHO's Future 15:38 The Challenge of Balancing Politics and Results 18:10 The Need for a Results-Oriented Approach in Global Health 26:17 Building Trust and Credibility in WHO 28:26 Navigating Politics and Diplomacy in Global Health 29:55 The Fine Line of Political Neutrality 35:40 The Impact of US Withdrawal on WHO 41:05 Looking Ahead: Candidates and the Future of WHO This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit singerp.substack.com [https://singerp.substack.com?utm_medium=podcast&utm_campaign=CTA_1]

Global surgery: in disruption, opportunity?

Summary This episode explores the critical issues in global surgery, including access disparities, innovative solutions, and future opportunities. Featuring experts Dr. Dhananjaya Sharma and Dr. Kee Park, it highlights how local solutions, data, and technology can transform global health outcomes. Keywords Global Surgery, Global Health, Healthcare Innovation, Access to Surgery, Frugal Solutions, AI in Surgery, Surgical Disparities, Global Health Policy Key Topics Global surgery and health disparities Innovative local solutions and frugal innovations Barriers: data, mindset, financing Role of AI and robotics in surgery Country leadership and local ownership Chapters 00:00 Introduction to Global Surgery 02:22 What's at Stake in Global Surgery? 04:59 The Current State of Global Surgery Access 07:46 Barriers to Global Surgery 10:36 The Role of Local Solutions in Global Surgery 12:55 Financing Global Surgery 15:39 The Importance of Prevention in Global Surgery 18:16 Progress Since the Lancet Report 20:58 The Future of Global Surgery 32:54 The Evolving Landscape of Global Surgery 35:21 Local Innovations in Surgical Practices 43:24 The Role of Technology in Surgery 48:14 Future Visions for Global Surgery 53:51 Gender Equity and the Future of Surgery References Center for Global Surgical Innovations and low-cost solutions (Dr Sharma’s website including examples of affordable solutions) https://www.surgicalinnovations.in/ [https://www.surgicalinnovations.in/] Program in Global Surgery and Social Change, Harvard Medical School https://www.pgssc.org/ [https://www.pgssc.org/] This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit singerp.substack.com [https://singerp.substack.com?utm_medium=podcast&utm_campaign=CTA_1]

Leadership in global health — with Katri Bertram

Summary In this conversation, Katri Bertram shares her insights on leadership in global health, discussing the lessons learned from her extensive experience in various organizations. She emphasizes the importance of accountability for results and humility in leadership. We discuss the lack of progress in Universal Health Coverage as a case example calling for leadership. Katri also reflects on the future of global health, and offers advice for young people entering the field. We also talk about the desired leadership traits of the next WHO Director-General. More: singerp.substack.com Keywords global health, leadership, accountability, universal health coverage, future of health, leadership lessons, health systems, mentoring, results-driven leadership, health equity Takeaways Katri Bertram emphasizes the importance of knowing what you want as a leader. Purpose is crucial for effective leadership in global health. Authentic buy-in from staff is essential for success. Leaders must appreciate the value of their team members. Letting go of control is a significant challenge for leaders. Accountability is key to achieving results in global health. The global health landscape is becoming increasingly fragmented. Young professionals should be encouraged to speak out and ask questions. The golden era of global health funding is over, requiring new leadership approaches. Health is inherently political, and leaders must take responsibility for their actions. Sound Bites "Health is a political choice." "The golden era is over." "We need more people speaking out." Chapters 00:00 Leadership Lessons in Global Health 07:16 The Essence of Effective Leadership 14:31 Best and Worst Leadership Experiences 21:20 Accountability and Results in Global Health 27:53 Accountability in Global Health 28:48 The End of the Golden Era? 29:55 Future of Global Health Leadership 33:47 Fragmentation and Competition in Leadership 36:50 The Role of WHO in Global Health 41:26 Existential Questions for WHO 42:34 Unifying Goals in Global Health 45:22 Health as a Political Choice 47:54 Leadership Roles in Global Health 50:34 Advice for Young Global Health Professionals Links Katri Bertram’s blog on leadership https://katribertram.wordpress.com/2025/11/24/lead-the-ship/ [https://katribertram.wordpress.com/2025/11/24/lead-the-ship/] Peter Singer’s blog on leadership in global health Singerp.substack.com This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit singerp.substack.com [https://singerp.substack.com?utm_medium=podcast&utm_campaign=CTA_1]

Tobacco Harm Reduction — with Derek Yach and Mark Tyndall

Keywords tobacco harm reduction, public health, vaping, smoking cessation, nicotine alternatives, epidemiology, health equity, tobacco control, global health, harm reduction strategies Summary This conversation delves into the complexities of tobacco harm reduction, exploring its definition, the science behind safer alternatives, and the significant public health implications. The speakers discuss the epidemiology of smoking, the potential lives saved through harm reduction strategies, and the challenges faced in promoting these alternatives. They also reflect on personal experiences within the public health community and the impact of the Framework Convention on Tobacco Control. The discussion highlights successful global models of tobacco harm reduction and emphasizes the need for continued dialogue and innovation in this field. Takeaways Tobacco harm reduction is a critical public health strategy. Vaping and other alternatives can significantly reduce health risks. The tobacco industry has the potential to innovate and reduce harm. Epidemiological data shows the severe impact of smoking on health. Three million lives could be saved annually through harm reduction. Public health must engage with the tobacco industry to promote safer products. Health equity is essential in addressing smoking rates among marginalized populations. The Framework Convention on Tobacco Control has shaped current tobacco policies. Open dialogue is necessary to address misconceptions about harm reduction. The movement towards tobacco harm reduction is gaining momentum globally. Chapters 00:00 Introduction to Tobacco Harm Reduction 01:47 Understanding Tobacco Harm Reduction 07:26 The Science Behind Safer Alternatives 11:15 The Epidemiology of Smoking and Its Impact 20:24 Lives Saved Through Tobacco Harm Reduction 26:10 The Uphill Battle for Acceptance 36:29 Pioneering Tobacco Control Efforts 38:31 The Origins of Distrust in Tobacco Industry 41:42 Framework Convention on Tobacco Control 45:46 The Impact of Public Health Policies 48:19 Navigating the Stigma of Harm Reduction 52:05 The Future of Tobacco Harm Reduction 56:49 Global Perspectives on Tobacco Regulation 01:05:06 Health Equity and Tobacco Products 01:09:38 Advice for Smokers and Future Directions Links Dr Mark Tyndall's book "Vaping" https://drmarktyndallauthor.com/ [https://drmarktyndallauthor.com/] Dr Derek Yach's report on 100 m lives https://tobaccoharmreduction.net/global-lives-saved/ [https://tobaccoharmreduction.net/global-lives-saved/] This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit singerp.substack.com [https://singerp.substack.com?utm_medium=podcast&utm_campaign=CTA_1]