World
Poorest countries well behind global health goals
By British Medical Journal
Nov 12, 2005, 19:08

Despite a world strategy for health agreed five years ago, most of the poorest countries on earth are lagging far behind achieving it, say a series of papers published on BMJ.com today (11/11/05).

If these countries are to make meaningful progress on the strategy aims - the Millennium Development Goals - most will have to raise funds or be forced to reallocate monies from other programmes, argue the authors, all experts from the World Health Organisation.

The Millennium Development Goals were agreed between 189 of the world's major western nations and much of the developing world. Those specifically on health were designed to take action on five key fronts: reducing mother and infant deaths, tackling child poverty, preventing the spread of HIV/AIDS, and controlling malaria and tuberculosis.

Current approaches must change if the goals are to be achieved more quickly. In curbing the spread of HIV/AIDS, treatment with first-line antiretrovirals has now become at least as cost effective as some of the well known preventive interventions, such as voluntary counselling and testing, say the authors. Educating sex workers, mass media messages, and treating people for other sexually transmitted infections, should also be the focus of new campaigns.

Mothers and newborns must have both basic and emergency medical services as a priority, and all children should get measles immunisation and micronutrients as a matter of course, say the authors.

The fight against malaria demands a much larger injection of resources than currently available, and substantial investment is also needed to meet targets on reducing tuberculosis, they argue.

The papers, which examine the cost-effectiveness of health policies in Africa and South-East Asia, preview a two-day Paris summit next week (14-15 November 2005) to look at why the Millennium Development Goals have not been met.

Both Africa and South-East Asia have such a huge degree of need, and so many underused interventions, that it is difficult to redeploy resources currently being spent on achieving the goals. But policy should shift to escalating the most cost-effective activities, say the authors.

"These results represent the best evidence currently available. We hope that this series contributes to not only improving population health with the available resources, but to raising more funds for health as well," they conclude.

An accompanying editorial says that, in addition to better implementation of cost-effective health interventions, three key challenges must be addressed if the Millennium Development Goals are to be met.

Finance issues must be resolved, say the authors. Many developing countries are way behind target on allocating 15% of public funds to healthcare. And only the Scandanavian countries have met the donor nations' goal to give 0.7% of gross national product to official development assistance.

If improvements are to be sustainable they must be backed by local stability and growth, as well as adequate local resources, say the authors. Thailand for instance has redeployed 30% of its national budget since 1985 to social (including health) development - and away from national security and public debt.

Fairer international trade policies are also important. High farming subsidies in developed nations have meant much lower economic growth in less developed countries, particularly among poor farmers.

The second challenge is rethinking how financial aid is allocated. Too much global aid is earmarked for certain programmes, which can distort an individual country's healthcare priorities. As a result health workers are shifted from badly funded but important programmes to support better paid global initiatives.

International migration of health workers exacerbates matters, say the authors. Nine of the 20 countries with the highest emigration rates are in sub-Saharan Africa - where the Millennium Development Goals are least likely to be reached.

The third challenge is to get accurate information on what is being achieved, so that policy makers can monitor progress towards the goals.

If the Millennium Development Goals are not to end up just another unfinished programme, these three areas, together with cost-effective measures, must be addressed.

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