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'Millions Saved'
Proven Successes in Global Health
Ruth Levine
Director of Programs and Senior Fellow
Center for Global Development
The story painted in the media about health in developing countries is virtually always gloomy. The magnitude and profundity of current health challenges from AIDS to chronic malnutrition to the lurking threat of tobacco-related causes can seem bleak, even hopeless.
This daunting outlook, however, obscures a lesser-known reality: that in the past 50 years, the developing world has witnessed spectacular improvements in health. Life expectancy has risen from 40 to 65 years, and the chances that a child will survive to the age of five have doubled. Much of this success is due to major health programs in poor countries that have saved millions of lives by introducing new medicines and technologies, providing improved health services, and fostering healthier behaviors.
A new book from the Center for Global Development, Millions Saved: Proven Successes in Global Healthi, illustrates 17 of these successes. The cases were selected by a group of 15 international health experts who were drawn together to answer the question, "Does anything really work to solve profound health problems that face poor countries?" Applying a strict criteria for success large-scale, costeffective interventions with a duration of at least five years and having a major health impact the working group selected 17 interventions that have saved millions of lives, and improved millions more. From the elimination of measles in southern Africa to the reduction of diarrheal deaths in Bangladesh, Millions Saved provides clear evidence that even in the very poorest countries with limited health infrastructure, major public health efforts can and have changed the world for the better.
The results of these programs are extraordinary:
- Throughout Latin America, mothers no longer worry about their children contracting polio.
- Vast regions of Africa are now habitable because river blindness is under control.
- In Thailand, a health initiative successfully headed off what seemed destined to be a massive AIDS epidemic.
- And in Sri Lanka, women can give birth without fear of dying in sharp contrast to women in most poor countries of the world.
Millions Saved proves that donor funding can work, that it's not "money down a rat hole" the popular image of the foreign aid business. In the majority of cases, donor funding and thus taxpayer dollars proved instrumental in saving lives. The United States, for example, has helped fund at least half of the cases documented in Millions Saved. (A list of donors and their contributions in the Millions Saved cases is available at www.cgdev.org/publications/MillionsSaved/). Rarely was success achieved through the singular effort of one donor, however. Most often, success has required the collaboration of a broad partnership of donors, international agencies, national governments, nongovernmental agencies and private companies. For example, the guinea worm disease eradication program benefits from the participation of a large number of donors the Carter Center, the U.S. Centers for Disease Control and Prevention, UNICEF, the World Health Organization, the Bill & Melinda Gates Foundation, the World Bank, the UN Development Program, nongovernmental agencies, more than 14 donor countries, private companies, and the governments of 20 countries in Asia and Africa. As a result, prevalence of guinea worm disease has been reduced by 99 percent and the number of cases has fallen from 3.5 million to less than 35,000.
Public health programs turn out to be a remarkably good investment. The costs are dwarfed by the social and economic benefits of eliminating, treating, or controlling disease. For example, a tuberculosis program in China treated more than 1.5 million patients over 10 years at a total cost of US$130 million, preventing 30,000 TB-related deaths annually and averaging just US$15-20 for each healthy life-year saved. The economic returns were enormous. Each dollar invested in the program generated US$60 in the form of savings on treatment costs and the increased earning power of healthy people.
Experience also shows that national governments can get the job done a finding that contrasts with the view that governments in poor countries are inefficient at best and corrupt at worst. The public sector was integral to the successful delivery of services in most cases. In the southern cone of Latin America, for example, ministries of health collaborating across borders greatly diminished the threat of Chagas disease, an often deadly parasitic disease spread through insect bites. In Sri Lanka, a 60-year commitment to provide key public health services dramatically reduced the number of deaths during pregnancy and delivery.
Reaching success in current health battles will not be easy, but it can be achieved. Closing the gaps may require new and longer funding commitments, an effort to create a genuine consensus about what needs to be done, and even more hard work. These actions take energy, brains and money, but they are within our reach. And they are far simpler and less costly than the loss of lives and livelihoods that failure will bring.
Each year, about 3 million children in poor countries die of disease that can be prevented by immunization. Last year alone, 3 million people in sub-Saharan Africa became infected with HIV. These are millions of reasons, and millions of chances, to succeed.
Reference
i Millions Saved: Proven Successes in Global Health, by Ruth Levine and the What Works Working Group with Molly Kinder. Center for Global Development, 2004.
For more information, visit the website www.cgdev.org/publications/MillionsSaved/
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17 Successes in Global Health
- Eradicating smallpox
- Preventing HIV and sexually transmitted infections in Thailand
- Controlling tuberculosis in China
- Eliminating polio in the Americas
- Saving mothers' lives in Sri Lanka
- Controlling onchocerciasis in sub-Saharan Africa
- Preventing infant deaths from diarrheal deaths in Egypt
- Improving health in Mexico
- Controlling trachoma in Morocco
- Reducing guinea worm disease in Africa and Asia
- Controlling Chagas disease in the southern cone of South America
- Reducing fertility in Bangladesh
- Curbing tobacco use in Poland
- Eliminating measles in southern Africa
- Preventing iodine deficiency in China
- Preventing dental caries in Jamaica
- Preventing Hib disease in Chile and The Gambia
Elements of Success in Scaled up Global Health Programs
- Predictable, adequate funding from both international and local sources. Almost all of the successful programs managed to obtain long-term commitments of financial support up to 20 years of funding.
- Political leadership and champions. Nearly all of the cases illustrate the importance of visible high-level commitment to a cause.
- Technical innovation with an effective delivery system, at a sustainable price. In many cases, concerted efforts to make new technologies available at a cost that was affordable to developing countries and donor agencies often through a public-private partnership helped lead to better health.
- Technical consensus about the appropriate biomedical or public health approach. Agreement within an expert community about the right strategy is a central factor in the appropriate design of programs.
- Good management on the ground. Good health service delivery requires trained and motivated workers, supplies, equipment, transportation and supervision.
- Effective use of information. Information raises awareness about the extent of a health problem, helps shape the design of a program and increase its prospect for success, and motivates.
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