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| >> Foreign Aid in the National Interest >> Chapter 3 >> Health Indicators: Advances and Obstacles |
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Jump to Chapter 3 Sections:
For the most part few comprehensive data are available on health care services over time and
across developing countries. An exception involves data on services for children and mothers, which can be used to show general trends. Among the most important of these trends are changes in financing, with a clear shift toward private resources to provide and pay for services.
Maternal and child health servicesImmunization rates show the progress made as part of long-standing global concerns for childhood health services. Twenty year ago less than one child in five was vaccinated against measles in developing countries. By 2000 nearly four out of five children received this immunization. As a result the number of measles cases has plummeted. Similar progress has been made in immunization coverage for diphtheria, pertussis, and tetanus. But there is still a need for better coverage particularly in Africa, which continues to lag behind other developing regions (box 3.2). Bringing new knowledge to technology: the example of vaccines (Box 3.2)The new H influenza type B vaccine (Hib) was first licensed in the United States in 1989 and recommended by the WHO for routine childhood immunization in 1998. It is now among the safest of all vaccines. Hepatitis is also falling to the scientific sword. Hepatitis A (HAV) is highly endemic throughout the developing world. Until recently, prevention options were limited. A vaccine has been available since 1995 for long-term prevention of HAV in persons two years of age and older. It has not been widely used and is nor recommended for use since Hepatitis A is not usually a fatal disease. In 2001, The U.S. Food and Drug Administration approved a new combined Hepatitis A and B vaccine. The remaining challenge is Hepatitis C, a viral infection of the liver whose causative agent was not identified until 1989, and whose genome is so highly mutable that vaccine development has been stymied. For some diseases endemic in the developing world, particularly parasitic diseases, scientific knowledge remains inadequate to generate technological solutions in the near term. The examples of significant progress in filariasis and onchocerciasis hold out hope for broader parasitic solutions in the future. For others, such as pneumococcus vaccines for children under two years of age, solutions have proved inadequate in children in the developing world due to differing serotypes. For others, such as the development of a vaccine for diarrheas caused by rotavirus, the cause of between 25 percent and 60 percent of all pediatric hospitalizations and 5 percent of child deaths, analysis is still under way. Still, the next 15 years will see significant progress, standing on the shoulders of the genomic revolution and scientific advance. The Global Alliance for Vaccines and Immunization (GAVI) is focusing on three new vaccines within the next five to seven years, pneumococcal conjugate vaccines, rotavirus oral vaccines, and meningococcal A (or A/C) vaccines. The GAVI partnership, involving public, academic and industrial players, works at overcoming the financial problems of applying vaccine research and development to vaccines for highrisk populations in developing world markets. Private industry is pursing independent research on vaccine delivery technologies based on protein carriers that will likely open new vistas for the specific problems of developing nations. Source: Raymond 2002 The challenge is to make developing countries self-reliant in their immunization efforts. After nearly half a century of effort, most decisionmakers (for health and nonhealth) understand the benefits of immunization. Systems for delivering and managing immunizations are also well understood. And in many countries resources are available for immunization programs, either domestically or from donors. What country programs often lack is political leadership and public commitment. These shortcomings have also impeded progress on other health issues as when some developing countries have ignored serious health problems or refused to use donor resources and foreign private philanthropy to treat serious infectious diseases. Recent decades have seen a rise in public-private partnerships between multinational corporations, nongovernmental organizations, and international donors. Partnerships include efforts to develop new tuberculosis drugs, HIV/AIDS treatment and prevention programs, and malaria treatment and control efforts. Such collaboration has also occurred at the local level. For example, commercial soap manufacturers have served as financing and media partners in publicly sponsored hand-washing campaigns. The campaigns increased hand-washing and reduced diarrhea. Such experiences offer a platform for innovative, collaborative efforts to control diseases and provide health services. page 2 |
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