Health for All in Low-Income Settings
ECOSOC
March 31, 2009
Severe malaria
The 1948 Constitution of the World Health Organization declares the highest
attainable standard of health to be a fundamental human right, “without
distinction
of race, religion, political belief, economic or social condition.”
The Universal Declaration of Human Rights of the same year declares the
right to security in the event of sickness.
The Alma Ata Declaration of 1978 called for “Health for All by 2000” through
access to primary health facilities.
The Millennium Development Goals adopted in 2000 call for a reduction
of child mortality by two-thirds, maternal mortality by three-fourths, and
the control of AIDS, malaria, and other diseases, by 2015 compared
with a 1990 baseline.
Decade of Scaling Up, 2000-2010:
Backdrop (failure of Health for All, pandemics, structural adjustment,
aid stagnation)
• Commission on Macroeconomics and Health (2000)
• Global Alliance for Vaccines and Immunizations (2000)
• Millennium Development Goals (2000)
• Gates Public-Private Partnerships (2000)
• AIDS, TB, Malaria (commitments, initiatives) (2000, 2001)
• Global Fund to Fight AIDS, TB, and Malaria (2001)
• Measles, Polio, NTDs (25+ years)
• Non-Communicable Diseases (2000)
• Disease Control Priorities in Development Countries (DCPP)
• Human Resource for Health (2004)
• UN Millennium Project Report (2005)
• Millennium Villages (2005)
• Community Health Workers (NRHM, Ethiopia, others)
• mHealth, RDTs, and other technological advances
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Aid for Health and Population
10
9
8
7
6
5
ODA (2006 USD billions)
4
3
2
1
0
The Continuing Health Financing Gap for the
Poorest 1 billion:
Roughly $50 billion per year needed ($50 per capita), of which:
• $12 billion from low-income countries
• $10 billion in existing aid (roughly 0.03 percent of GDP)
Financing Gap:
• $28 billion per year from donors (0.07 percent of GDP)
Fundamental Public Health Approach
Epidemiology
Interventions (within and beyond health system)
Systems Design
Management Planning and Implementation
• Investment
• Training
• Community empowerment
• Oversight
• Monitoring, evaluation, feedback
Financing
Feedback
Epidemiology:
Category I: Infection, Nutrition, Safe Childbirth
Category II: Non-Communicable Disease
Category III: Violence and Accidents
DALYs by Region
Global distribution of under-five deaths by cause
% distribution of deaths among children under age five, by cause, 2000-03
AIDS Measles Injuries
3%
3%
4%
Malaria
8%
Neonatal
causes
37%
Other
10%
Diarrhoeal
diseases
17%
Pneumonia
19%
Underlying causes related to:
• Tropical Ecology
• Unsafe Water
• Indoor Air Pollution
• Nutritional Deficiencies
• Lack of Preventative Health Services
• Lack of Clinical Health Services
• Lack of Family Planning and Contraception
• Lack of Safe Delivery and Neonatal Care
POVERTY IS THE MAIN UNDERLYING CAUSE
Intervention Strategies:
• Deploying Scalable, Replicable Proven Interventions
• Combining Health Sector and Non-Health Sector Interventions
• Combining Prevention and Treatment
• Empowering Households
• Mass application where feasible (bed nets, vaccines, nutrition)
• Application of mHealth strategies for scale up
Success Stories in the Control of Neglected Tropical Disease
Some Recent Expenditure Date (2003):
Public Sector Outlays for Health, per capita
Kenya
Malawi
Mali
$8
$5
$9
Brazil
Mexico
Thailand
$96
$172
$47
Canada
United States
$1,866
$2,548
Holistic Approaches to Community-led development
through
Millennium Villages
Millennium Villages
Core Interventions:
• Agriculture (inputs, diversification, business development)
• Health (clinical care, CHWs, nutrition, emergency services)
• Education (school facilities, teachers, school meals, ICTs)
• Infrastructure (roads, power, connectivity, water and sanitation)
• Business development (microfinance, farmer cooperatives,
agricultural financing)
Core Health Interventions in the MVs
• Clinical Health Services
• Community Health Workers
• Routine Prevention (vaccines, de-worming,
• Mobile Health and ICT services
• Emergency Care
• Safe Delivery
• Family Planning
• Additional Services: dental, eye, CVD
malaria control)
Ten Steps to Health for All in the Poorest Countries
1. Rich countries should devote 0.1 percent of GNP $35 billion per year
as of 2006) to health assistance for poor countries in order to close
the financing gap of the primary health system
2. Half of that could effectively be channeled through the Global
Fund to Fight AIDS, TB, and Malaria
3. Low-income countries would fulfill the Abuja Commitment of
allocating at least 15 percent of domestic revenues to the health
sector. Total spending (domestic and external funding) should be
greater than $50 per person per year in order to ensure basic health
services.
4. The world would adopt a plan for comprehensive malaria
control by 2010, with an end of malaria mortality by 2012
(estimated cost $3 billion per year)
5. The G-8 would fulfill the commitment to universal
access to ARVs by 2010
6. The world would fulfill the Global Plan to Stop TB, including
closing the financing gap of $3 billion per year.
7. The world would fulfill the funding for access to Sexual and
Reproductive Health Services, including emergency
obstetrical care and contraception, by the year 2015
8. The Global Fund would establish a window for 7 neglected tropical
diseases which can be controlled by mass chemotherapy:
hookworm, ascariasis, trichuriasis, onchocerciasis,
schistosomiasis, lymphatic filariasis, and trachoma
9. The Global Fund would establish a window for health systems,
including mass training of community health workers
10. The world would introduce primary health care (mass
prevention and treatment) of non-communicable diseases,
including: oral health, eye care, mental health,
cardiovascular disease, and metabolic disorders,
including measures on lifestyle (smoking, trans-fats,
urban design for a healthy environment), surveillance,
and clinical care.