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Note: This document is from the archive of the Africa Policy E-Journal, published
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Africa: Health Strategy
Africa: Health Strategy
Date distributed (ymd): 010105
Document reposted by APIC
+++++++++++++++++++++Document Profile+++++++++++++++++++++
Region: Continent-Wide
Issue Areas: +economy/development+ +health+
Summary Contents:
This posting contains a mid-December press release on a report by
six international agencies, entitled 'Health: A Key to Prosperity.'
The report (from the WHO, UNICEF, UNESCO, UNAIDS, UNFPA and the
World Bank) outlines key factors for combating AIDS, tuberculosis,
malaria, childhood diseases and maternal and perinatal conditions,
even in resource-poor settings, Citing success stories indicating
the potential for significant impact, it calls for funding and
systems to implement such measures on a wider scale over the next
decade.
The report, however, carefully avoids the issue of treatment for
HIV/AIDS in developing countries, simply saying that
'antiretroviral therapy is still unaffordable for most developing
countries.' As noted in another posting today with documents from
the Global Treatment Access Campaign and Medecins sans Frontieres,
and links to the latestWashington Post series on Africa, Drugs and
AIDS, this complacent assumption is under growing challenge, with
pharmaceutical companies and international agencies under pressure
to go beyond token action to drastically reduce prices and increase
availability of antiretrovirals and treatments for AIDs-related
diseases.
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Geneva, 19 December 2000
World Health Organization (WHO) Press Release
http://www.unaids.org/whatsnew/press/eng/who1912.html
http://www.who.int/inf-new
POORER HALF OF THE WORLD CAN EXPECT BETTER HEALTH AND PROSPERITY
WITHIN THE NEXT DECADE
New Report from Six UN Agencies Shows That the Main Diseases
that Cause and Perpetuate Poverty Can be Successfully Controlled
A new report jointly issued by six United Nations agencies
claims that worsening AIDS, TB and malaria epidemics are not
inevitable, shown by the many successful strategies to turn back
these diseases, and prevent the deaths they cause, deployed by
several developing countries. The targets for reducing the toll
of these illnesses, set by the world's leaders at successive
summits over the last year, are feasible. What is needed are the
funds and systems that will enable widespread implementation of
actions that have shown to be effective, the report says.
In a joint report issued today - "Health, a key to Prosperity:
Success Stories in Developing Countries" - the World Health
Organization (WHO), the United Nations Children's Fund (UNICEF),
the United Nations Educational, Scientific and Cultural
Organization (UNESCO), the Joint United Nations Programme on
HIV/AIDS (UNAIDS), the United Nations Population Fund (UNFPA)
and the World Bank outline key factors for combating AIDS,
tuberculosis, malaria, childhood diseases and maternal and
perinatal conditions, even in resource-poor settings.
"The prospects of intervening to prevent death in developing
countries have never been better," said Dr Gro Harlem
Brundtland, Director-General of WHO. "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 significantly scale up its
global work to fight diseases in the world's poorest countries.
The Report 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.
"The success stories described in these pages demonstrate how
far many nations have come in defining viable strategies to
attack these public health threats and in scaling up for a
national impact," said Mr James Wolfensohn, President of the
World Bank. "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."
The Report identifies six important characteristics of
programmes that have succeeded to control diseases of poverty:
- political commitment at the highest level is key to achieving
results and sustaining programmes
- successful disease and mortality prevention has often involved
new ways of working, e.g., entering into partnerships with the
private sector, nongovernmental organizations, and UN agencies
- innovation, born out of a pragmatic approach to achieving
results, has made all the difference in some countries
- 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
- widespread availability of supplies, medicines and other
low-cost tools at community-level is essential
- measuring results is key to planning control measures
Yet UNICEF Executive Director Carol Bellamy said many of these
success stories remain invisible to a largely pessimistic world.
"There's widespread skepticism about controlling disease in the
developing world. In light of this report, such fatalism is
simply unacceptable," said Ms. Bellamy. "Given what we know,
over the next decade it will be possible to make huge gains
worldwide. But if we don't make a concerted effort now, we are,
in essence, condemning millions of people to death."
The Report is broken down into five sections: tuberculosis,
malaria, AIDS, childhood diseases, and maternal and perinatal
conditions. Among its highlights are:
Tuberculosis (TB)
Almost 2 million people die from TB every year - 98% of them in
developing countries. And yet anti-TB medicines are 95%
effective in curing TB and cost as little as US$10 for a
six-month course of treatment.
In Peru, for example, 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 10 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 using WHO's DOTS
(Directly Observed Treatment Short-course) strategy 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
6-8 months of regularly-supervised treatment
- reporting systems to monitor treatment progress and programme
performance
Malaria
Malaria kills over 1 million people per year, mostly in Africa,
and most of them children. And 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% of African children today sleep under a bednet.
The main prongs of the Roll Back Malaria partnership's strategy
to reduce the ill-health and poverty, which malaria induces,
include:
- access to rapid diagnosis and treatment at village/community
level
- preventive treatment for pregnant women
- multiple measures to prevent mosquito bites
- a focus on mothers and children - the highest risk groups
- better use of existing malaria control tools
- research to develop new medicines, vaccines and other tools
- improved surveillance to improve epidemic forecasting and
response
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% 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 mobilization of volunteer health workers. And
in Kenya, an innovative scheme involving a community
bednet-sewing industry, workplace promotion of bednets, and
employer-sponsored payroll purchasing schemes has helped reduce
malaria cases, slash overall healthcare costs, reduce
absenteeism and increase productivity among the workers
involved.
AIDS
While newly-released figures show that AIDS killed an estimated
3 million people in 2000, the United Nations 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
- access to safe drug injecting equipment
The example of Thailand, for example, shows how government
determination to promote 100% 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: by 1997, for
example, HIV infection rates among 21 year-old military
conscripts had fallen to 1.5%, from a peak of 4% in 1993.
The Report also notes that a year's supply of condoms costs only
US$14.
"Twenty years of experience of the epidemic have demonstrated
some key components of an effective response: strong leadership,
partnerships, overcoming stigma, addressing social
vulnerability, linking prevention to care, focusing on young
people, and encouraging community involvement in the response,"
explained Dr Peter Piot, Executive Director of UNAIDS.
The UN Agencies emphasize that in the new report that even the
Thai approach may not be sustainable if the programme focuses
just on heterosexuals, and if there is not continuous adequate
funding.
"Girls and women are most vulnerable to HIV infection given the
social and economic disadvantages they face in their day-to-day
lives," added Dr Nafis Sadik, Executive Director of UNFPA. "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. The success stories included in this
report serve as an important reminder of the power of committed
and focused multilateral partnerships."
"The AIDS epidemic is eroding the educational systems of many
countries, especially in Sub-Saharan Africa, added Mr Ko‹chiro
Matsuura, Director-General of the United Nations Educational
Scientific and Cultural Organization. "An alarming percentage of
teachers are affected by HIV and millions of children and
adolescents are no longer able to go to school. There is no
infrastructure to deal with the crisis which is undermining
these countries' economic, social and human development. It is
imperative that the international community rally to the rescue
of these teachers and students. Equally indispensable is the
need for extensive AIDS-prevention educational programmes which,
to be effective, must be respectful of the cultural context of
the populations they target."
Childhood Diseases
In developing countries, 70% 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 healthcare 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 immunize children against measles, and to
improve access to safe water and sanitation have succeeded in
reducing childhood deaths from diarrhoeal diseases by 60% 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.
Maternal and Perinatal Conditions
Every year, more than half a million worldwide die from
complications of pregnancy and childbirth - mainly severe
bleeding, infections, unsafe abortions, hypertension and
obstructed labour. Almost 90% 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
- management of STIs
Sri Lanka, for example, is a major success story. In that
country, where a third of the population is estimated to live
below the poverty line, 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.
This material is being reposted for wider distribution by the
Africa Policy Information Center (APIC). APIC provides
accessible information and analysis in order to promote U.S.
and international policies toward Africa that advance economic,
political and social justice and the full spectrum of human rights.
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