Learning From Each Other to Achieve Global Health

Very interesting ideas...

Gurinder Shahi

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In Race For Better Global Health, Let’s learn from Each Other

Published in The Bangkok Post, February 1, 2008 By Joy Phumaphi is Vice President of the World Bank’s Human Development Network; a former WHO Assistant Director General for Family and Community Health; and a former Minister of Health in Botswana For millions of the world’s poorest people, ill-health and disease too often go hand in hand with grinding poverty and blunted national aspirations. In looking for solutions to this troubling state of global health, we can learn a great deal from Thailand. Given that most of the world’s development thinking cascades from wealthy OECD countries in the North, to countries in the South, we need to hear more from Thailand, and other countries like Cambodia, Ethiopia, Rwanda, and Vietnam which have achieved breakthroughs in primary healthcare, to export their development experience in a South-South dialogue, to show their neighbors in South Asia, and Africa, and other regions, what works, what doesn’t, and why. This experience should not stay confined to national borders. Show others what you have done, and the world will learn from you. At the Prince Mahidol Awards Conference here in Bangkok this week, we have heard yet again that weak health systems are a significant roadblock to improving the health of people in developing countries. Thailand, by contrast, has focused on strengthening its health system and this has allowed the nation to cope with and contain other epidemics of global significance such as avian influenza and SARS. This a clear case of how a stronger national health care system can not only protect the people of Thailand, but the greater worldwide community as well. Thailand has also shown the world that HIV/AIDS could be confronted with well-financed prevention, care, and treatment programs. These programs, initiated in the 1990’s, may have prevented as many as 7 million new cases of HIV infection by 2006. Thailand is in select company here. Only a handful of other countries have been able to reverse an HIV epidemic in this way. Sadly, for millions of other people in South Asia, Africa, and other regions, this level of healthcare is a distant mirage. Despite some notable examples of success, we continue to see unacceptable levels of sickness and death that abandon people to grinding poverty and desperation…. Almost 11 million children die every year, mainly from preventable causes such as pneumonia, diarrhea and malaria. More than 500,000 women die during pregnancy and childbirth every year. In 2006, almost 3 million people died from HIV/AIDS. Tuberculosis is curable, yet 1.7 million people die from it every year. Nearly one-third of children under five in the developing world remain underweight or stunted, leading to irreversible brain and physical damage. Prevention is therefore a long-term investment which greatly benefits both present and successive generations. Conception to 24 months of age is a crucial time to prevent or reduce under-nutrition. Proven nutritional measures already exist, which if scaled-up could reduce all child deaths by about a quarter in the short term. A country’s sustained economic growth rate is significantly influenced by the health of its people. It is little wonder, therefore, that illness is a cause of poverty as families tap into savings or sell what they own to cover the costs of medical care. If we are serious about fighting poverty, improving the perilous health of millions of the world’s poorest people must be a top priority of the global development community. What can we do? We need to strengthen health systems across the board; we need to focus on verifiable results; and we all need to work together better. Stronger, integrated, health systems are an essential platform for effective universal prevention, treatment, care, and mitigation of diseases such as HIV/AIDS, TB, and malaria. They enable community engagement to reach every mother and child and all vulnerable groups; they can safeguard people’s ability to thrive, acquire valuable skills and life experience which in turn boost economic growth, and reduce the poverty caused by catastrophic illness, and provide the structural ‘glue’ that combines multiple health-related programs within public and private sector, and civil society health programs. In practical terms, strengthening health systems means putting together the right chain of events that, for example, gets life-saving drugs and health workers to mothers and their newborns where they’re needed most, whether it be in remote mountain villages or in the crush of poor urban neighborhoods. It means making sure that poor people get the good quality health services they need. Many existing aid programs for health stall or actively fail because there is no functioning health system with the capacity to deliver services and drugs to the people who need them. Focus on results—without results, health system strengthening has no meaning. Without health system strengthening, there will be no results. One promising approach to strengthening health systems is ‘results-based financing.’ In fact, using this approach, the World Bank is working with Mozambique, Rwanda, and other African countries, to help them lower their numbers of child deaths and improve their maternal health respectively. This innovative approach links aid directly to verifiable results. We know for example that mothers are more likely to have successful births for their babies if they take place in health facilities where help, advice and equipment is on-hand, rather than at home. In India, for example, a government scheme convinced the majority of poor mothers in key states to have their babies in health facilities; a success made possible by subsidizing the cost of the mother’s transport to and from the clinic, as well as providing incentives for the health workers to deliver better services. Health systems, however, don't function in isolation, they need to show their worth and their value to people at the household level, at the community and local government levels, as well as the national levels. It is important to have systems that not only show results but respond to demand. We need to work together better— with the health and development arena increasingly crowded by bilateral and multilateral partners, as well as new foundations and charities, it is clear that donors too have a bargain to keep. In fact, there is widespread recognition that the maternal and child survival MDG goals will not be achieved without significantly improved performance and coordination by all stakeholders within countries and internationally. And we all have to learn from each other’s successes and failures. This is key to moving forward faster. With this task in mind, it is fitting indeed to invoke the memory and achievements of Prince Mahidol, the Father of Modern Medicine in Thailand, and a man who saw many years ago that a well-functioning public healthcare system was a cornerstone of a vibrant, modern society. Let us use the Prince’s health summit in Thailand this week to step-up our efforts to help middle-income and developing countries to strengthen their health systems to achieve long-term, sustained good health, stronger growth, and more promising national prospects in the global economy.