Combining health and social protection measures to reach the ultra ...

Innovationwhen much progress and achievement had been madetowards global malaria control. The global community hadseized the opportunity to use concurrently two very effectivevector control tools: the newly discovered DDT and drainageof swamps, in conjunction with mass prophylaxis and promptcase identification, and treatment using chloroquine. It wasthe first time malaria was being attacked globally withmultiple tools and the operations were military-like. Within ashort period, malaria had been eradicated in Europe andAmerica and transmission had been reduced significantly inmany parts of Africa and India, with some countries comingclose to eradication. However, following the diseaseeradication in Europe, and considering the costs ofmaintaining the operations in the remaining parts of theworld, quick, nonevidence-based decisions were taken andthe eradication campaigns were abandoned followed byabrupt withdrawal of the funding support to countries. It wasbelieved that malaria eradication in the developing world, andin particular Africa and India, was not achievable given thevastness of the terrain and there was a global atmosphere ofdespair and loss of direction. This is an example of poormonitoring of activities. It was as if the world had given up onmalaria, leaving the plight of the poor to themselves now thatthe rich countries had rid themselves of the disease. Theensuing results were catastrophic, and malaria came back inthe form of epidemics in countries which had achieved goodtransmission reduction and were near to eradication. Welearnt later that this was a result of loss of natural immunityfollowing the transmission reduction and that, in such cases,withdrawal of vector control activities should not have beeneffected so abruptly.Lessons learntThe above examples have taught us that global problemsrequire globally concerted efforts. When such efforts aredirected at evidence-based interventions, and are givensufficient resources to reach and maintain high levels ofcoverage, success is assured. The decisions to continue orstop an intervention should be guided by evidence. The costof making the wrong decisions in public health are very high.It is important to integrate programmes within existing healthsystems to ensure governments’ commitments and long-termsustainability.Had research been applied to evaluate the achievementsmade in large parts of India, Madagascar and Africa, and inparticular the cases of projects like the Pare-Taveta Scheme 8 ,malaria eradication efforts would probably have not beenabandoned. The research would have revealed that it wouldhave been totally unethical to do so, and would likely haveled to further research on how to maintain the operations atlower costs.Current challengesThe new millennium has brought with it new determinationand commitment by the global community, in face of the stillintolerably high disease burden and preventable deaths,despite huge technological advancements. The ambitiousMillennium Development Goals 2 (MDGs) indicate the sense ofurgency and anxiety that the global community isexperiencing over the continuous suffering of the majority ofthe global population. Regions have risen to the occasion andmade serious commitments to work together, while countrieshave set their own targets and committed themselves toallocating sufficient resources to achieve the targets.Africa has also responded by forming its own mechanismto enhance research and technological developments asmeans for achieving the MDGs. New Partnerships for Africa’sDevelopment (NEPAD) is a promising innovative mechanism,capable of accelerating African achievements.The challenges facing all these efforts include ensuring:✜ availability of effective and affordable tools which areaccessible to those who are at greatest risk (those whoneed them most);✜ accessibility and utilization of such tools by populationsof endemic countries;✜ research on the effective application of multiple tools;✜ integrating strategies within the health systems;✜ strengthening health systems to allow rapid scaling-up ofinterventions;✜ research capacity-strengthening in endemic countries toenhance discoveries, knowledge utilization andownership of new and improved tools.ConclusionsWhile the above challenges are formidable, there arepromising opportunities for making the world a healthierplace to live in. In the first place, effective interventions andtools are available for the conditions causing the greatestdisease burden. Effective vaccines for childhood diseases areavailable. Water sanitation technology has been there eversince the cause of cholera was discovered. Safe deliverymethods are available to prevent maternal mortality.Secondly, there are signs of increased awareness of inequitiesin health. The risk of spreading infections to the rest of theworld is real and imminent, given current climatic changes,freedom of movement and the persistence of highly endemicinfectious diseases in low-income countries. As a result of thisfear and good will from the global community, more funds arebeing provided to help improve the health of the poor. Indeedcurrent key concepts, such as “funding poverty-relateddiseases”, “providing support towards neglected diseases”and “global health approach” are fast gaining momentum.Debt relief has been widely accepted as a strategy to allowbetter funding of health and education, and enhancingaccountability and good governance by countries.These are therefore promising moments and goodopportunities for making populations healthier; however, asprevious experiences have shown, the availability of a tool perse may not be sufficient to make a difference. The key is toensure that endemic countries do own the means to solvetheir own problems and have the capacity to participateactively in global efforts targeting those who need them most.If the current funds do not flow to the targeted endemiccountries to support capacity strengthening, there is greatdanger that health care systems will remain weak andendemic countries will continue to have weak research102 ✜ Global Forum Update on Research for Health Volume 4