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.
[Dr Gro Harlem Brundtland, Director-General of WHO]"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 scepticism 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, especially young children."
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
Koichiro 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.
For further information, journalists can contact Mr
Gregory Hartl, WHO Spokesperson, WHO, Geneva. Telephone (+41 22) 791
4458. Fax (+41 22) 791 4858. Email :
inf@who.int
In Washington, DC, journalists can contact Mr Jim Palmer, Cell phone +1
202 262 9823. All WHO Press Releases, Fact Sheets and Features as well
as other information on this subject can be obtained on Internet on the
WHO home page www.who.int
