Universal Health Coverage IV

Ten Recommended Steps to Health for All in the Poorest Countries

The period of the millennium develop goals since the year 2000 has been an exciting one for public health. Because public health is really proved its worth showing how a science based approach starting with epidemiology. Building health systems supported by international help in the form of Official Development Assistance.

Malaria is a not only a lethal disease but it’s a disease that spreads very widely. And in many parts of Africa is what’s called holoendemic. Endemic meaning that people are infected. Holoendemic meaning that the whole community, everybody is infected and basically the whole year round. So to control malaria is really it’s a great feat. And malaria is being controlled right now in Sub-Saharan Africa. Thanks to the focused efforts of the Global Fund to Fight AIDS to be malaria or the U.S. initiative of PMI and others alongside it. And because of the great advances in public health and in technologies that make it possible. Long lasting insecticide treated bednets.

Community health workers who go into the communities, rather than waiting for sick people to carry their young. Often dying children many, many kilometers in their arms, hoping to arrive at a distant clinic in time. With the community health workers out in the communities, cases can be picked up much faster. Lives can be saved. A prick of the finger allows a community health worker to know within a few minutes whether that child is infected with malaria. And new medicines that replaced those fading, failing medicines like Chloroquine now based on Artemisinin. Very interesting story because Artemisinin is a molecule, extraordinarily effective in fighting malaria that was identified by Chinese scientists. How did they come to that? Because there was an ancient Chinese herbal treatment for malaria and for other fevers that came from a, a plant that the Chinese called (XXX) And that we know as Wormwood, or in its Latin, as Artemisia annua. And that was an ancient herbal remedy. But when the Chinese scientists went after it, the found out what is the active molecule and that we now call Artemisinin. When Artemisinin is put into medicinal form now, it’s enormously effective to control Malaria. And that’s one of the breakthroughs of recent years as well. If deaths of children under five have declined from 12 million back in 1990 to under 8 million in 2010, that’s a huge progress. But obviously, far from where we should be because most of those 8 million deaths are also preventable. We’ve gotten half way to building the primary health systems and we should take inspiration from that. And understand what it would mean finally to fulfill the commitments that was made already back at the founding of the United Nations and the World Health Organization. The commitment that was enunciated once again in Alma-Ata 1978. The commitments that was the motive spirit of the Millennium Development Goals of ensuring health for all and universal health coverage. Let me give ten basic recommendations of how we can move from the improved situation today. To the full breakthrough of universal health coverage and health for all within a short period of time, even within a decade. The first is a financial point. If we look at what the poor counties simply can’t afford on their own and need to be filled by official donor assistance. We can calculate how much aid should be directed at the health sector. Now mind you, I’m not talking about aid, year in, year out forever. I’m talking about an amount of aid that will shrink, as the poor countries develop, and reach a threshold, of income, where on their own, they can fund their own health systems. That threshold is reached probably somewhere around $1,200 per person per year, measured in current prices and market exchange rates. If you calculate the gap that the poor countries simply can’t manage out of their own budget, it’s around $40 billion a year Roughly $40 per person for a billion people that need that extra help. 40 billion how should we think about that is that a big number or a small number for the rich world. Well one way to think about it is that as we know there about a billion people in the rich world so it’s on the order of about $40 from each of us in the rich world, to save millions and millions of people in the poor countries. But $40 per person in the rich world is the bargain of the planet in terms of the lives that could be saved. Let me put in terms of the proportion of the rich world income. We know, that the average income of the rich countries is on the order of $40,000 per person per year. For the billion people in the rich world, it comes to about $40 trillion of income of the countries that give Official Development  assistance. 40 billion out of 40 trillion is one out of a thousand, it’s one tenth of 1% of our income. Or to put it another way it would be like saying for every $100 in the rich world take a dime put it aside, next $100, take a dime put it aside. One tenth of 1% of the income, would accumulate into a total fund of $40 billion per year.  So the starting point, number one, in the recommendation is a, annual flow of funds from the rich countries to the poorest. 40 billion a year right now. A number that would shrink over time. One tenth of 1% of high income world output each year. That would close the financing gap and enable millions of lives to be saved. Second recommendation. Put that money into highly effective organizations. My own recommendation would be to build the Global Fund to Fight AIDS, TB, and Malaria. Which has done such an outstanding job, into a Global Health Fund more generally and channel through it about $20 billion per year. So that the Global Health Fund could effectively support the basic health systems in the poorest countries. Letting those countries know that as they develop and lower disease will help them to develop. They will get less and less over time, because they will eventually graduate from the aide itself. Now third is that the low income country’s have to do their bit. They can’t fund their health systems just on their own. But they can make the valiant effort needed, they should contribute as much as feasible. And as I’ve mentioned, most fiscal experts that have looked at this regard 15% of the total budget as a stretch. But realistic and reasonable target for funding help. So the third recommendation is that the poor countries would be called upon to meet what became known as the Abuja Targets. Because of a meeting that took place in Abuja, Nigeria. The Abuja Target calls for the poor countries to devote 15% of their budget revenues to the health sector. The fourth recommendation is to finish up this job of comprehensive malaria control. Malaria is getting under control. You’d think I’m a little bit obsessed with it. And the fact in the matter is you’re right. Malaria is such a pernicious disease. Such a killer. Such a burden on development.  ut so much within reach of control that we do need to put the focus on it. And we’re close to getting the job done, but still underfunded roughly by half. So my third recommendation, fourth recommendation is that the world should adopt a plan for comprehensive malaria control. That would cost roughly, $3 billion a year. Which enable the poor countries to finish up the supply chains, the funding of community health workers, the rapid diagnostic tests, the medicines and so forth to really get the job done. Fifth recommendation. The leading donor countries should fulfill their longstanding commitment to providing universal access to antiretroviral medicines for individuals infected with HIV. And having the clinical indications for antiretroviral treatment. These medicines work. The treatment to poor people saves their lives. It’s been shown to be highly effective. More treatment would mean lower transmission of the disease because when an individual is treated with antiretroviral medicines. The viral load, that is the concentration of the virus in the body diminishes sharply. Making it much less likely for the virus to be transmitted from one individual to another. Sixth recommendation. That the leading donor countries should also fulfill their commitment to partnership with the poor countries. In funding following the global plan to stop TB, to stop tuberculosis. This too has a financing gap on the order of $3 billion a year, roughly $3 per person per year in the high income world. Roughly, cup of coffee at your favorite coffee shop in a high income country would be what is needed incrementally in order to build the requisite fund. Recommendation seven. That the world, especially the donor countries and their financing and the poor countries and their implementation, should guarantee access to sexual and reproductive health services. This would include emergency obstetrical care for safe childbirth, antenatal care for safe pregnancy, and contraception. Because many, many women around the world want to have fewer children. They want to use modern contraceptives. But they lack access or they lack the funds to, be able to afford it on a market basis. And so we need full funding of family planning services, contraception and emergency obstetrical care. Pregnancy safe management. And, again, at a very low budget. These services could be made universal. Eighth, the Global Health Fund would take up what have sometimes been called neglected tropical diseases. The neglected tropical diseases are diseases less in the headlines than malaria. Less in the headline than AIDS. The experts in those disease communities feel a little bit neglected because they are saying wait a minute, we also have powerful tools to fight deeply debilitating diseases. And yet, we are sometimes overlooked because our diseases that we’re studying and trying to control are not in the  headlines. And when I tell you the names you’ll say, you’re right, not in the headlines, never heard of them at least for some of them. But among these neglected tropical diseases are hookworm, that I presume most have heard. Ascaris which is a kind of worm infection. Trichuris another worm infection. Onchocerciasis, yet, another infection in the tropical areas that is absolutely a killer, but can be prevented and can be treated. Schistosomiasis, a disease in which a snail plays an important role in the life cycle of this disease. Filariasis, lymphatic filariasis, another vector borne tropical disease with, terrible consequences. Also controllable through bed nets. and, with, ample effort and organization, a disease whose burden could be reduced very, very sharply. And various forms and causes of blindness including trachoma, that is an infection of the eye that can cause blindness. And that can be prevented,ah, that is wide spread, a major cause of blindness. Also, we know, one could add though it’s not in the usual list of the neglected tropical diseases, is cataracts. Where advances in surgery allow for remarkably low cost replacements of the lens when individuals are blinded by  cataracts. And this is another case where communities especially elder, older people can be brought back to sight. With the tremendous benefits of course for themselves in the community at very, very low cost. So category eight, expand the Global Fund’s reach to these neglected diseases. Category nine, the Global Fund should establish special financing to complete the health systems. Not only the targeted diseases, but the training and deployment for example, of community health workers. This would be a crucial part of the, transformation from a disease targeted fund to a general global fund that’s providing a broad base of services. We have called at the United Nations for the deployment of a 1 million community health workers in Africa by the year 2015 as a major boost for achieving the Millennium Development Goals. Malaria control, it’s essential to get the community health workers out into the communities with their rapid diagnostic test with their Artemisinin in their backpacks. With their mobile phones for, getting advice from the clinics or being able to call an ambulance. When the community health workers are out there, the malaria burden, plummets. And finally, recommendation ten, is that there are now, a number of noncommunicable diseases. Typically that have been overlooked in many of these urgent MDG related efforts that also can be part of the primary health system. Dental care for example, treating cavities, something very basic, but often not present in poor countries. Eye care, mental health counseling and mental health interventions for the massive burden of depression for example which is pervasive around the world. Many cardiovascular diseases where people have undiagnosed high blood pressure, hypertension that can cause loss of life for adults. But if treated, brought under control can absolutely have the consequences meliorated or the adverse consequences controlled all together. A number of cancers can be addressed at very low costs. And of course, campaigns against tobacco use are part of any good public health system because tobacco remains a massive killer. That’s a behavioral challenge but it’s a behavioral challenge that we need to meet because it’s one of the most effective ways to save lives. Moral of the story, we’re close. It’s not so hard, the Millennium Development Goals have given a big spur to effort, we can now see a pathway to help for all. In the next phase of the Global Development Objectives, the Sustainable Development Goals. I would expect that universal health coverage will feature prominently in the next phase of goals. And we will have the opportunity indeed to complete what we have started. To finally achieve to realize health as a basic human right.

Pedro Pereira Leite

Researcher and professor. He had his PhD. on museology in 2011, with the title “Muss-amb-ike Homeland: The commitment on musicological process”, that was published in 2011. In 2012 he finishes a Post-PhD Research on "Biographical Glances: The intersubjectivity poetry on museology, at Lusófona University (Lisbon). Presently he is working in his Post PhD. Research about: “Global Heritages" with the aims to build a network on local cognizance and memory manager has a tool to build the will of action in 3 different communities, linked by past communed heritages.” He works at CES. He participates on different Research network, presented papers in national and international conferences, and had published books on research subjects.

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OpenEdition sugere que esta publicação seja citada da seguinte forma:
Pedro Pereira Leite (23 de Abril de 2015). Universal Health Coverage IV. Global Heritages. Recuperado em 13 de Julho de 2024 de https://doi.org/10.58079/p2ng


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