Common Dreams / Published on Tuesday, December 7, 2004 by OneWorld.net
Amid the gloomy news about the continuing spread of HIV/AIDS and other deadly infectious diseases, a major Washington-based development group is touting a new study that highlights what might be considered in less fraught times to be monumental advances in fighting threats to human health in poor countries.
Success is possible in the battle against devastating diseases in developing countries, according to Millions Saved: Proven Success in Global Health, a report documenting 17 case studies of public-health campaigns over the past 30 years that produced important results.
Among the most successful were immunization of millions of children that eliminated polio in Latin America and the Caribbean; the dramatic reduction in the incidence of onchocerciasis or river blindness in rural West Africa and of chagas disease in the southern cone of South America; and the reduction of smoking in Poland and South Africa.
The common elements of success in all 17 cases according to the report, included predictable and adequate funding from both international donors and local sources; political leadership and high-profile champions who promoted the campaigns; technological innovation that ensured delivery of the required treatments at an affordable price; consensus about the right approach; good management on the ground; and effective use of information.
The world has witnessed remarkable success in global health, said the study's main author, Ruth Levine. Even in the poorest countries, millions of lives have been saved through public health programs (that) have successfully distributed new medicines and changed peoples behavior to cut deaths and disability.
The study found several surprises or what Levine calls wows in analyzing the cases.
The most important, perhaps, was that success has been achieved even in the poorest of countries that are characterized by grinding poverty and weak or virtually non-existent health systems.
The key to success in these countries often stressed the mobilization through public information of the target community, as in the many vaccination campaigns that have taken place over the past 30 years and the fight against river blindness, which required spraying along fast-running rivers followed by the distribution of medication which has to be taken only once a year.
As a result, transmission of the disease has been virtually halted in West Africa, an estimated 600,000 cases have been prevented, and 18 million children born in the affected areas are now free of the threat of river blindness.
A second lesson is that governments in poor countries can do the job; indeed in some cases, they also have been the chief funders.
This contrasts with the view that governments in poor countries are uniformly inefficient at best and corrupt at worst, according to the study. In each of the 17 cases, in fact, the government was integral to the successful delivery of services in most instances, sometimes in collaboration with non-governmental organizations (NGOs) or the business.
Thus, it was the ministries of health of the four countries of South Americas southern cone that worked together in fighting chagas disease, while in southern Africa, vaccinations campaigns in seven countries helped reduce the number of childhood measles cases, which were often fatal, from 60,000 in 1996 to just 117 by the year 2000.
In Sri Lanka, maternal mortality has been halved at least every 12 years since 1935, in large measure because of the services that are designed, delivered, and monitored within the public-health system, according to the report.
Another major finding is that, although technological innovations, such as new medications, have played an important role in successful campaigns, very basic behavior change was also a prominent feature in a number of surprising cases.
Thus, in the campaign against guinea worm in Africa and Asia, where the number of cases has fallen from 3.5 million in 1986 when the effort began to less than 35,000 in 2003, families learned to filter their water conscientiously, while, in the fight against deaths from dehydrating diarrheal disease in Bangladesh, mothers learned and now teach their grown daughters how to mix a salt-and-sugar solution for oral rehydration therapy (ORT) for sick children.
In Poland and South Africa, anti-tobacco campaigns were aimed explicitly at altering behavior and used a combination of legal measures, taxation and communication efforts to achieve that goal.
This is good news in light of the health challenges that now confront us, very few of which can be tackled through improved technology alone, according to the report.
Another lesson taught by the study is that international coalitions have worked. It noted in particular the campaign to eradicate guinea worm, a parasite that, once ingested from contaminated water, normally grows to two to three feet in length inside its victim before breaking out of the skin back into water to lay its eggs. The campaign involved the participation of the Carter Center, the US Centers for Disease Control and Prevention, the UN Children's Fund (UNICEF), the World Health Organization (WHO), the Bill & Melinda Gates Foundation, the World Bank, the UN Development Program (UNDP), many NGOs, more than 14 donor countries, and private companies, such as Du Pont and Precision Fabric Groups, which donated cloth for water filtration, as well as 20 governments and public-health systems in Asia and Africa.
The campaign against river blindness similarly required cooperation from the World Bank, WHO, UNDP, the Food and Agriculture Organization, the governments of 19 African countries, 27 donor countries, more than 30 NGOs, the pharmaceutical company that provided the medication, Merck, and more than 80,000 rural communities in West Africa alone.
Among other successful campaigns covered in the study were the WHO-led immunization against small pox that eradicated one of the worlds most feared scourges; the halving of the incidence of tuberculosis in China between 1990 and 2000 through the application of the directly observed treatment, short course (DOTS) therapy; the reduction by some 82 percent in diarrheal deaths through ORT in Egypt between 1982 and 1987; and the implementation of a sustained family-planning and contraceptive program in Bangladesh that has halved female fertility in just two decades;
Also noted are the reduction in the incidence of iron deficiency, or goiter, in China from 20 percent to nine percent from 1995 to 2003 through the introduction and distribution of iodized salt; Jamaica's National Salt Fluoridation Program that resulted in a decrease of up to 87 percent in dental caries in schoolchildren between 1987 and 1995, and the reduction by more than 90 percent in the incidence of trachoma, the leading preventable cause of blindness, among children under 10 in Morocco through a coordinated strategy of surgery, antibiotics, and face washing.
Finally, the report lauded Thailand's 100 percent condom program that targets commercial sex workers and other high-risk groups to prevent the spread of HIV/AIDS and other sexually transmitted diseases. As a result, Thailand had 80 percent fewer new HIV cases in 2001 than in 1991, according to the report.
By learning from the past we can increase the chances of success against the diseases that are causing massive suffering in developing countries today, said Levine.
