Poorer half of the world can expect better health and prosperity within the next decade

Citation

(2001), "Poorer half of the world can expect better health and prosperity within the next decade", International Journal of Health Care Quality Assurance, Vol. 14 No. 2. https://doi.org/10.1108/ijhcqa.2001.06214bab.001

Poorer half of the world can expect better health and prosperity within the next decade

Edited by Barbara Morris

Poorer half of the world can expect better health and prosperity within the next decade

A new report Health, a Key to Prosperity: Success Stories in Developing Countries, jointly issued by the World Health Organisation (WHO), the United Nations Children's Fund (UNICEF), the United Nations Educational, Scientific and Cultural Organisation (UNESCO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United Nations Population Fund (UNFPA) and the World Bank, claims that worsening AIDS, TB and malaria epidemics are not inevitable. Many successful strategies have been deployed by several developing countries to turn back these diseases, and prevent the deaths they cause. The targets for reducing the toll of these illnesses, set by the world's leaders at successive summits over the last year, are feasible. The report says that what is needed are the funds and systems that will enable widespread implementation of actions that have shown to be effective.

The report, issued in December 2000, outlines key factors for combating AIDS, tuberculosis, malaria, childhood diseases and maternal and perinatal conditions, even in situations with poor resources.

According to Dr Gro Harlem Brundtland, director general of WHO:

The prospects of intervening to prevent death in developing countries have never been better.The evidence refutes those who doubt that the world's poorest communities can be protected from AIDS, tuberculosis (TB), malaria, childhood diseases and maternal mortality. With a concerted effort from the international community we can turn the promise of these success stories into a reality in the coming years.

The publication of the report comes shortly after a meeting in Okinawa, Japan, on 7-8 December, where representatives from the "Group of Eight" countries agreed to scale up its global work to significantly fight diseases in the world's poorest countries.

It contains success stories from 20 different countries, encompassing the widest variety of economic, social and geographic conditions. It shows, for example, how countries like Senegal, Uganda and Thailand have developed strategies that successfully can reduce HIV infection rates, how Azerbaijan and Viet Nam have cut in half the number of deaths from malaria, how China, India and Peru have cut TB deaths by half, and how Sri Lanka has drastically reduced maternal mortality.

Mr James Wolfensohn, President of the World Bank, said:

The stories illustrate many lessons. They demonstrate that success is possible even when resources are scarce. They show that inputs such as drugs or vaccines, as important as they are to improving health, are not enough. Political commitment, capacity-building, human resources, education and communication, local adaptation and community involvement are critical. They also signal that strengthening and increased financing of underlying health systems and social services is key to ensuring a large-scale and more sustainable response.

Six important characteristics of programmes that have succeeded to control diseases of poverty are identified:

1. 1.

   political commitment at the highest level is key to achieving results and sustaining programmes;

2. 2.

   successful disease and mortality prevention has often involved new ways of working, e.g. entering into partnerships with the private sector, nongovernmental organisations, and UN agencies;

3. 3.

   innovation, born out of a pragmatic approach to achieving results, has made all the difference in some countries;

4. 4.

   promoting the home as the first hospital helps reduces child deaths. In particular, the training and education of mothers has been a key to success;

5. 5.

   widespread availability of supplies, medicines and other low-cost tools at community-level is essential; and

6. 6.

   measuring results is key to planning control measures.

The report is broken down into five sections:

1. 1.

   Tuberculosis (TB). Almost 2 million people die from TB every year – 98 per cent of them in developing countries but anti-TB medicines are 95 per cent effective in curing TB and cost as little as US$10 for a six-month course of treatment. The report cites the example of Peru, where high-level political commitment has produced one of the most successful TB control programmes in the world. On current trends, the number of new TB cases could be halved every ten years. Diagnosis and treatment are provided free of charge and low-income families receive food packages to encourage compliance with treatment.In general, elements of successful TB control include government commitment to sustained TB control, detection of TB cases through sputum smear microscopy among symptomatic people, regular and uninterrupted supply of high-quality anti-TB drugs, six to eight months of regularly-supervised treatment and reporting systems to monitor treatment progress and programme performance

2. 2.

   Malaria. Malaria kills over 1 million people per year, mostly in Africa, most of them children. Women are especially vulnerable to malaria during pregnancy, when the disease can lead to life-threatening anaemia, miscarriages and the birth of premature, low birth-weight babies. More rapid and effective treatment of malaria with anti-malarial drugs could prevent malaria deaths. Anti-malarial drugs cost as little as US$0.12 per treatment. Meanwhile many child deaths from malaria can be prevented through the widespread use of low-cost, insecticide-treated bednets, but, so far, only an estimated 1 per cent of African children sleep under a bednet.Azerbaijan, Ethiopia, Kenya and Viet Nam have all shown success in rolling back malaria. In Viet Nam, for example, government commitment, largely in the form of the supplying of free insecticide-treated bednets and the use of locally produced, high quality anti-malarial drugs, reduced the malaria death toll by 97 per cent in a five-year timespan. The concerted drive against the disease involved a major investment in training and disease reporting systems, the use of mobile teams to supervise health workers, and the mobilisation of volunteer health workers.

3. 3.

   AIDS. While newly released figures show that AIDS killed an estimated 3 million people in 2000, the UN argues against accepting a worsening AIDS pandemic as inevitable. Although there is no AIDS vaccine and antiretroviral therapy is still unaffordable for most developing countries, experience in countries such as Senegal, Thailand and Uganda has shown that reduction in infection rates is possible.Effective prevention measures include access to condoms, prophylaxis and treatment of opportunistic infections including STIs and TB, sex education at school and beyond, access to voluntary counselling and testing, counselling and support for pregnant women and efforts to prevent mother-to-child transmission of HIV, promotion of safe injection practices and blood safety, and access to safe drug injecting equipment.The report cites Thailand, which shows how government determination to promote 100 per cent condom use in brothels and to ensure wide access to HIV prevention campaigns through schools, the mass media and the workplace have been key factors in lowering HIV infection rates. The report notes that by 1997, for example, HIV infection rates among 21 year-old military conscripts had fallen to 1.5 per cent, from a peak of 4 per cent in 1993. However, it emphasises that even the Thai approach may not be sustainable if the programme focuses just on heterosexuals, and if there is not continuous adequate funding.According to Dr Nafis Sadik, Executive Director of UNFPA: Girls and women are most vulnerable to HIV infection given the social and economic disadvantages they face in their day-to-day lives. The burden of caring for entire families falls increasingly on the shoulders of women as AIDS continues to devastate families and communities. Further efforts must be made to empower women and girls and create a space for female decision-making in private as well as public life.

4. 4.

   Childhood diseases. In developing countries, 70 per cent of childhood deaths – over 8 million – are caused by no more than five conditions: pneumonia, diarrhoea, malaria, measles and malnutrition. Three out of every four children who seek health care are suffering from one or more of these conditions, yet low-cost interventions are available to prevent or treat them.In Mexico, for example, determined efforts by the government to promote the use of oral rehydration therapy – which costs as little as US$0.33 – to immunise children against measles, and to improve access to safe water and sanitation have succeeded in reducing childhood deaths from diarrhoeal diseases by 60 per cent in less than a decade. Other key factors in this success have included an increase in education levels among women, investment of adequate resources and the widespread use of case management guidelines.

5. 5.

   Maternal and perinatal conditions. Every year, more than half a million world-wide die from complications of pregnancy and childbirth mainly severe bleeding, infections, unsafe abortions, hypertension and obstructed labour. Almost 90 per cent of these deaths occur in Asia and sub-Saharan Africa, and most of them could be prevented at low cost. WHO's Mother-Baby package, for example, costs no more than US$3 in low-income countries. The strategy involves ensuring access to antenatal care, normal delivery care assisted by a skilled birth attendant, treatment for complications of pregnancy, neonatal care, family planning advice and management of STIs.Sri Lanka is cited as a major success story. A third of the population is estimated to live below the poverty line, but maternal mortality rates are among the lowest in the developing world. Most deliveries take place in a health facility, with the support of a skilled birth attendant. This achievement is the result of government commitment to improving education and health in Sri Lanka, the relatively high status of women, and high female literacy rates.

Further information can be obtained from the WHO Web site: http://www.who.int/