Infectious diseases can be controlled in the world’€™s poorest countries. This is the message contained in a World Health Organisation (WHO) report ‘€“ “Health A Key to Prosperity”.

The report names Uganda, Thailand and Senegal as national success stories in the fight against HIV/AIDS. Over a million lives have been spared from TB in the past decade due to the success of TB control efforts in countries such as China, India, Nepal and Peru.

Malaria has been turned back in Azerbaijan and Vietnam and reduced in some parts of Kenya and Ethiopia.

Childhood deaths and disability have been reduced in Bangladesh, Benin, Brazil, Malawi, Mexico, Pakistan, Tanzania and Thailand. And maternal deaths have been reduced in a number of countries, including Sri Lanka.

Yet many of these achievements remain invisible and unrecognised by the world at large, the report said.

As a result, many people remain skeptical about the possibility of controlling disease in poor countries.

“As this report shows, such fatalism is no longer scientifically defensible. Over the coming decade, it is possible to make huge gains against the major infectious diseases which have a disproportionate impact on the health and well-being of the poor.”

The report mentions seven tools that are highly effective when used correctly:

• TB medicines are 95% effective in curing the disease and cost as little as U$10 for a six month course of treatment;
• Oral Rehydration Therapy is high effective in treating dehydration caused by diarrhoeal diseases. The cost is U$0,33 (per course);
• Antibiotics for pneumonia are 90% effective and cost U$0,27 (per course);
• Antimalarials are 95% effective and cost as low as U$0,12;
• Bednets can reduce child deaths by 25% and cost as low as U$4 for an insecticide treated bednet. Yet, in Africa, only an estimated 1% of children sleep under a bednet;
• Vaccines are 85% effective in preventing measles and cost U$0,26 per dose (including the cost of the injection equipment);
• Latex condoms are highly effective in preventing HIV and cost U$14 for a year’€™s supply.

Many low-income countries have shown that by using the available tools both widely and wisely the disease burden of infectious diseases can be reduced dramatically, the report said.

“But it is not easy, especially in the over 20 countries worldwide that have less that U$20 a year per capita to spend on health. Many countries have succeeded in spite of poverty.”

Malawi is set to eliminate measles in a country where only 3% of the population have access to adequate sanitation and Bangladesh has reduced neonatal tetanus death rates by over 90% at a time when most mothers in this country do not have access to a “clean” delivery.

According to the report, in many cases, efforts to reduce the burden of disease have been driven by firm political commitment at the highest level. Examples include Uganda and Thailand where political leadership has been critical in the fight against HIV/AIDS and where every government sector has been involved.

Another example is Peru, where the government has established TB control as a social, political and economic priority.

Success has often involved new ways of working, the report said. This included entering into partnerships with the private sector, non-governmental organisations and United Nations agencies ‘€“ for the social marketing of condoms in Uganda and for malaria control in Azerbaijan.

In some countries, governments are providing health services and commodities outside the formal health sector in an effort to broaden access to health care.

In Senegal, mosques throughout the country are a focal point for HIV prevention efforts, counselling and support. In Tanzania a school-based programme has improved the health of children infected with intestinal worms, and in Kenya, employers are supplying bednets to their workforce through payroll purchasing schemes.

The WHO report stated further that innovation, born out of a pragmatic approach to achieving results, has made all the difference in some countries.

In Nepal, hostel accommodation is provided for TB patients from remote mountain areas to encourage compliance with treatment.

In China, cash incentives are provided to local health workers for every TB case they detect and cure. And in Thailand, the government worked with brothel owners to ensure 100% condom use ‘€“ despite the fact that prostitution remains illegal.

Meanwhile, in Senegal, religious leaders opposed to condom use have had the courage to refer people to other service providers.

Elsewhere, efforts to promote the home as first hospital ‘€“ in a bid to ensure rapid diagnosis and prompt treatment for malaria and diarrhoeal diseases, for example ‘€“ have helped reduce child deaths in Ethiopia and Mexico.

Training of health care workers and education of mothers have been key elements for success, as witnessed in Sri Lanka where high female literacy rates and midwifery training for health care workers have both been instrumental in preventing maternal deaths.

In India, a massive training programme involving 100 000 health workers has helped ensure that treatment of TB can be provided within the community.

Meanwhile, sex education for children and adolescents has been an integral part of successful HIV prevention programmes in Thailand, Senegal and Uganda.

Well stocked supplies, medicines and other low-cost tools at the community level are essential. Without the availability of these lifesaving commodities, health workers are unable to do the job for which they are trained.

In some cases, local production of drugs, vaccines and other commodities has helped keep prices down, WHO said.

Examples include community production of bednets in Kenya, manufacture of tetanus toxoid vaccines in Bangladesh, and local production of anti-malarial drugs in Vietnam.

In Mexico, supplies of oral rehydration salts were increased almost tenfold in the fight against childhood diarrhoeal deaths.

Elsewhere, social marketing of condoms in Senegal and Uganda has been a key factor in preventing HIV.

Finally, an approach focused on achieving measurable results is central to most of the success stories.

In Senegal, Thailand and Uganda, disease surveillance and monitoring systems have been essential in tracking the course of the HIV/AIDS epidemic and monitoring the effectiveness of interventions.

Meanwhile, Malawi’€™s success in controlling measles has involved efforts to improve surveillance and monitoring systems.

And Vietnam’€™s dramatic success in reducing malaria deaths has been backed up by strengthened disease reporting and epidemic forecasting systems.

“If we can take these interventions to scale, make them available worldwide, we will have in our hands a concrete, result-orientated, and measurable way of starting to reduce poverty,” said Dr Gro Harlem Brundtland, WHO Director-General.

“We are asking for a massive effort.”

(Source: Health A Key to Prosperity. Success Stories in Developing Countries)