How millions can be saved

Posted: 7 December 2004

Author: John Rowley

Two recent reports have shown how the health of the world's poorest people, living under dangerous environmental conditions, can be improved - and millions of lives saved - if the right policies are pursued.

"Success is possible in the battle against devastating diseases in developing countries" is the conclusion of the first report by a team of global health researchers in Washington, DC, this week.

TB patients in Alem Kitmama North East of Addis-Ababa, Ethiopia, Africa. Photo: P. Virot/WHO
TB patients in Alem Kitmama North East of Addis-Ababa, Ethiopia, Africa. Photo: P. Virot/WHO
TB patients in Alem Kitmama North East of Addis-Ababa, Ethiopia, Africa© P. Virot/WHO
The report, Millions Saved: Proven Successes in Global Health, from the Center for Global Development, is the result of an 18-month study of more than a dozen, large-scale health success stories in poor countries.

These case studies challenge the popular view that health problems in developing countries are so overwhelming that major improvements are all but impossible.

Millions saved

"The world has witnessed remarkable success in global health," said lead author Ruth Levine. "Even in the poorest countries, millions of lives have been saved through public health programmes."

The research team identifies six elements of success that were common to all 17 cases studied. These offer clues for increasing the likelihood of success in current health battles, such as the fights against TB, malaria and HIV/AIDS.

"We are facing huge global health challenges now - not only AIDS, malaria and TB, but many others that affect both poor countries and rich ones," said George Alleyne, former director of the Pan American Health Organisation and a member of the working group that prepared the report. "As we work to solve these problems, we can be inspired by what has been achieved in the past - and we have an obligation to understand how to maximize the chances of success," Alleyne said. "The lessons of the past are essential as we do this."

Common elements

The common elements of success identified in the study are:

  • Predictable, adequate funding from international and local sources
  • Political leadership and high-profile "champions"
  • Technological innovation and effective delivery systems at a sustainable price
  • Consensus about the right approach
  • Good management on the ground
  • Effective use of information
The evidence is likely to surprise sceptics. Large-scale success is possible even in the poorest countries with grinding poverty and weak health systems, says the report. The benefits from successful health programmes far outweigh the costs. Health-related development assistance from the United States and other rich countries has sometimes been remarkably effective. Large bureaucracies can work together toward a common purpose with stellar results. Developing country governments can get the job done, even in extremely difficult circumstances. Health behaviours can be changed.

"The factors that were common to the tremendous health successes of the past are within our grasp," said Levine. "By learning from the past we can increase the chances of success against the diseases that are causing massive suffering in developing countries today."

River blindness

The cases documented in the study range from preventing HIV and sexually transmitted infections in Thailand to reducing guinea worm in sub-Saharan Africa and curbing smoking in Poland and South Africa.

Other cases include recent vaccination campaigns in seven African nations, combined with routine childhood immunizations. These have almost completely eliminated measles as a cause of childhood death in southern Africa. Deaths from measles dropped to 117 in 2000, from 60,000 in 1996.

Across 11 countries in West Africa, a regional river blindness programme has prevented 600,0000 cases of blindness. Eighteen million children born in the area over a 28 -year period are now free from the risk of the blinding parasitic disease.

Since 1997, the incidence in Morocco of trachoma, the leading preventable cause of blindness, has been cut by more than 90 per cent among children under 10 through a combined strategy of surgery, antibiotics, face washing, and environmental controls. Through a public-private partnership called the International Trachoma Initiative, the pharmaceutical company Pfizer has donated millions of dollars worth of its antibiotic Zithromax.

A regional polio elimination effort begun in 1985 reached almost every child in Latin America and the Caribbean. Polio is no longer a public health threat in the Western Hemisphere.

Rich-poor divide

A second report, from the US-based Population Reference Bureau, highlights the extent of the rich-poor health divide and suggests ways of improving the health of the poor.

Drawing on data from Demographic and Health Surveys (DHS) in 56 countries in Africa, Asia and Latin America, it says that a child from the poorest fifth of the population is twice as likely, on average, as a child of the richest quintile to die before the age of five.

One reason is that the poorest are less likely to have access to basic services such as immunisation, maternity care and family planning. Environment and geography also disadvantage the poor - with less access to safe water, safe housing or efficient transport. In five of seven African countries surveyed, the poorest fifth of the population receive a smaller proportion of the money spent on both primary health care and curative services.

But, says the report, such health disparties can be overcome with carefully designed programmes that meet the needs of vulnerable people. without this, it warns, they will be left even further behind. The full report from the Center for Global Dewelopment, and additional information including interactive maps and a teachers' guide, are available here

See also: PRB