Life-saving interventions must be delivered to those at greatest
risk through health services. Health services provide the means
for dispatching the tools and supporting the strategies needed
to combat infectious diseases. These services are required to
provide good-quality health care that is affordable, accessible,
equitable and relevant to needs. If progress is to be made, vital
components must include trained and well-motivated staff, laboratories
and microscopes, health centres and facilities for storing medicines,
and vehicles for visiting remote areas.
A shortage of health professionals
The death toll among women
Source: World Health Report, 2000
|Poor access to services
In many developing countries groups that are marginalized because of their ethnic background, geographical location or gender are at higher risk of levels of infectious disease. For example, in north-eastern and south-eastern Brazil, (poor regions with large ethnic minorities) the death rate among children under-five for the poorest 20% of the population is now three times that for the richest 20% in the rest of the country.
A long history of gender discrimination also leads to inequalities that perpetuate women's lack of access to resources and services for themselves and their children. Almost 70% of the 1.2 billion people living in extreme poverty are women who experience more illness and are less likely to receive medical treatment before the illness is well advanced. In many cultures, the lower value assigned to women translates into higher levels of suffering, with nearly 33% of all causes of death among women being due to infectious diseases.
TEN STRATEGIC FACTORS FOR DELIVERING
AND STRENGTHENING HEALTH SERVICES
Cultivating broad-based partnerships
and civil society participation
Listening to the poor
|MODELS FOR IMPROVING
HEALTH SERVICE DELIVERY
Despite many obstacles, countries have managed to mobilize funds, skills, knowledge and action to reverse the impact of infectious diseases. These achievements usually originate in identifying and responding to the most urgent health needs and are a result of strong government commitment. They are also characterized by a commitment to removing barriers to health service access and making services equitable, accountable and supportive to the poor.
|Comprehensive HIV/AIDS prevention
and treatment has reduced AIDS
deaths in Brazil, 1999
Source: Government sources Brazil, 1999
Brazil allocates US$ 450 million each year to providing free antiretroviral treatment. In Asia, Thailand's dramatic reduction in HIV infection rates is also largely due to government financing of most HIV/AIDS control programme activities. In 1997, the country's budget for these activities had reached US$ 82 million more than US$ 1 per capita. Even this underestimates the magnitude of country-mobilized funds: as early as 1991, private businesses alone contributed an estimated US$ 80 million towards fighting AIDS in Thailand.
The process of developing sectorwide approaches has gathered momentum in several African nations where they are the preferred mechanism for strengthening district and primary health care services. Resources have been invested in their development and are bearing fruit in terms of improved strategic planning and financial control, wider political support and country ownership. In Uganda, the Government has demonstrated a commitment to building health-organization and management systems and to developing a sound legal and regulatory framework in health care. Minimum health care packages have been developed and access to services improved through construction and upgrading of primary health care centres. Funds channelled to primary health target "best buys" cost-effective interventions which benefit the poor have been used to increase immunization coverage, distribute insecticide-treated nets and antimalarials, expand awareness of HIV risks and increase condom use by vulnerable groups. The Government has also established HIV/AIDS coordination mechanisms at central and district levels that are reviewed quarterly by donors and civil-society organizations.
Key in reducing Uganda's high HIV infection rates has been a remarkably high level of political commitment spearheaded by the President himself to prevention and care, involving a wide range of partners across all sectors of society. A large number of local NGOs and community groups have taken up HIV/AIDS care, support and prevention activities, with people living with HIV playing a leading role. In addition, a creative social marketing scheme boosted condom distribution to over a million and condom use from 7% nationwide to 85% in urban areas within the short space of a decade. Another innovative scheme is a self-treatment kit for sexually transmitted infections (STIs). Shopkeepers who sell the kits over the counter at low, subsidized prices are also trained in STI management strategies. Yet another Ugandan innovation was the 1997 introduction of same-day voluntary counselling and HIV testing services. The combination of education and action has helped reduce the country's HIV infection rates even while the rates of neighbouring countries are still spiralling upwards.
Uganda has also taken significant steps to address malaria. Prices for essential drugs can be lowered if governments reduce import duties, customs and taxes, and remove unduly restrictive regulations. In a recent move to ensure malaria protection for millions of children and adults, Uganda and 12 other African countries Cameroon, Côte d'Ivoire, Ghana, Kenya, Mali, Mozambique, Namibia, Nigeria, Sudan, the United Republic of Tanzania, Zambia and Zimbabwe reduced or abolished taxes on insecticide-treated nets to make them more affordable. Previously, tariffs constituted 30% - 40% of the retail prices of nets.