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Rapid Responses: Rapid Responses published:
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Millenium Development Goals: not at all achievable?
- Dr. Naseem A. Qureshi MD, PhD, IMAPA, LMIPS (11 November 2005)
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Every little helps....
- Ranjit K Dhelaria (13 November 2005)
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Revising strategies to achieve Millennium Development Goals in West and Central Africa
- Niyi Awofeso (14 November 2005)
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Where do our priorities lie?
- Peter Barlis (14 November 2005)
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Vicious cycle of poverty and millennium development goals.
- Jeevan P Marasinghe (15 November 2005)
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Reassessing strategies for improving health --sans nutrition?
- Meera Shekar (16 November 2005)
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Just follow Kerala model
- Dr Jayaraman Nambiar (17 November 2005)
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Health Care Challenges in Low-income Countries
- Sanjib Kumar Sharma (18 November 2005)
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Effective Urgent Measures
- Kshitij Mankad (18 November 2005)
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Nepal Let the private colleges help the population !!
- Sumithra Joseph (20 November 2005)
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Dr. Naseem A. Qureshi MD, PhD, IMAPA, LMIPS, Specialist Senior Registrar POB.4545, Rashid Hospital, Dubai, UAE
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Sir, The slogan "health for all by the year 2000" failed the expectations of people worldwide. The renewed slogan "health for all by the end of 21 century" will also fail people. There are many reasons for such failures. One of the most enlightening reasons is ill political will of super power mainly the United States of America. The other prime reason for such failures is the misutilization of the funds from rich nations by the administrative machineries of the poor countries. Both are incorrigible. But poor nations for their own benefits-removing poverty and offering education for all children-must mend their ways and utilize the opportunities properly given by rich nations. Both-rich and poor-should work together to achieve the goals as envisaged by the Millenium Development Project, otherwise the 8 goals will never be achieved. Thought for today: If the USA and UK stop for ever raging war against other nations and use the stipulated funds (1000 or more of bllions of dollars) for such wars in removing the poverty globally, we all including poor Americans and English people will collectively live better quality life. Reference: 1. David B Evans, Taghreed Adam, Tessa Tan-Torres Edejer, Stephen S Lim, Andrew Cassels, Timothy G Evans for the the WHO Choosing Interventions that are Cost Effective (CHOICE) Millennium Development Goals Team Time to reassess strategies for improving health in developing countries BMJ 2005; 331: 1133-1136 Competing interests: None declared |
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Ranjit K Dhelaria, Senior Medical House Officer South Tyneside District Hospital, South Shields NE34 0PL
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Dear Editor, I read this article with interest and would like to put my views about this. I come from India, and know my country very well. It is very difficult to achieve the set goals because of the hindrance from the political, wars, corruptions, illiteracy, ignorance etc, but its worth a try. I believe that since the implementation of these goals and help from other nations, we have made progress in improving the quality of life. I as a medical student, as houseman participated in many national programmes, which includes AIDS, Tuberculosis awareness programme, Pulse Polio Programme etc. By setting these goals we have made efforts to make our country a healthier place to live. I believe that every little counts. Competing interests: None declared |
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Niyi Awofeso, Conjoint Associate Professor, UNSW, Sydney, Australia. Justice Health, Sydney, NSW, Australia.
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The eight Millennium Development Goals (MDG) -sub-divided into 18 targets and 48 indicators - represent a ‘line of ‘best fit to facilitate global human development. The first seven goals are mutually reinforcing and directed at reducing poverty in all its forms, while the last goal provides a framework for the attainment of the first seven. Unfortunately, the countries in West and Central Africa remain the major ‘outliers’ relative to this line. All of the 16 ‘desperately deprived’ countries in the 2004-2005 Chronic Poverty Report are in sub-Saharan Africa, with 12 being in West or Central Africa.1 Even the most optimistic estimates acknowledge that that the MDG would not be achieved within the stated time frame in these African regions. For example, the 2005 “Nigerian Statistical Fact Sheet on Economic Development”2 indicated that between 67% and 72% of the estimated 70 million population of northern Nigeria live in chronic poverty, defined as persistently living on less than $US1/ day. Average maternal mortality in northern Nigeria is around 2420 per 100,000.3 The 2004 World Population report predicts that Nigeria would move from its current 9th to 5th most populous nation in the world with its population expected to grow from 137 million in 2004 to 307 million in 2050. Similar trends abound in most West and Central African countries. Given the current realities, a re-assessment of the strategies to improve the MDG in these regions should include the following: (1) setting realistic targets and indicators that can be achieved within the next decade. For instance, the goal of universal basic education in these regions is obviously unrealistic given high chronic poverty levels, high female illiteracy, and poor funding of the education sector. Setting realistic MDG for the next decade in these regions has a potential to motivate national governments and funding agencies to work towards achieving them4; (2) Work in partnership with the World Bank to implement strategies suggested in their 2005 MDG report5 (i.e. anchor reform efforts in country-led strategies, improve the environment for private-sector-led economic growth, scale up human development services, dismantle barriers to unfair trading practices, and substantially increase the level and effectiveness of development assistance); (3) incorporate family planning activities into MDG in these regions, and provide adequate funding for promoting their adoption. While I acknowledge that the third strategy is politically sensitive and vulnerable to ‘neo-Malthusian’ criticisms, it is long overdue in these regions, where women currently have the highest parity rates in the world, making it increasingly difficult to adequately deliver human development initiatives to those most in need. References 1) Institute for Development Policy and Management, University of Manchester, UK, 2004. The Chronic Poverty Report, 2004-05. URL: http://www.chronicpoverty.org/chronic_poverty_report_2004.htm 2) Federal Bureau of Statistics, Nigeria. The Nigerian Statistical Fact Sheet on Economic and Social Development. FCT, Abuja, Nigeria, 2005. 3) Adamu YM, Salihu HM, Sathiakumar N, Alexander GR. Maternal mortality in noerthern Nigeria: a population-based study. Eur. J. Obstetrics, Gynaecology and Reproductive Biology, 2003; 109: 153-9. 4) Evans DB et al. Time to reassess strategies for improving health in developing countries. British Medical Journal, 2005; 331: 1135-6. 5) World Bank. Millennium Development Goals Report, 2005. URL: http://ddp-ext.worldbank.org/ext/GMIS/home.do?siteId=2 Competing interests: The author is keen to work with governments and Non-Governmental Agencies to facilitate progress with regards to implementation of MDG in West and Central Africa. |
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Peter Barlis, Consultant Physician The Northern Hospital, Epping, Victoria, 3076, Australia
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Dear Editor Despite significant advances already made in achieving the Millennium Development Goals [1], the world on a global level continues to experience health inequities, none the more obvious in the developing world. Here, communities continue to confront malnutrition, poverty, inadequate water supply, poor sanitation and high rates of infant mortality [2]. The immediate reasons for the lagging health status of the developing world are well known and include poverty, violence, and environmental degradation. When analysing global health statistics, the true magnitude of the problem becomes frightingly confronting. For example, in 2000, nearly 11 million children died before their fifth birthday [3]. Furthermore over half a million women in developing countries died during pregnancy or childbirth as a consequence of conditions eminently preventable or treatable [3]. Such appalling health conditions despite considerable work already undertaken have and will continue remain on the global health agenda and Evans et al [1] provide a timely warning bell. Although we may have made great inroads to the health status of the developing world, the often lagging funding and infrastructure resources continue to burden this most vulnerable community. Perhaps part of the solution lies with the contracting of health services. Loevinsohn and Harding provide a contemporary review of contracted health services with non-government organisations (including for-profit groups) to provide health services to developing countries [4]. They purport such models may improve competition and drive down costs of providing health services which in turn facilitates governments to focus more on other roles that they are uniquely positioned to undertake including ‘ planning, financing and regulation’ [4]. Although the contracting process itself has a number of inherent complexities and challenges, it should continue to be discussed and debated alongside the many other approaches and strategies in place in striving to rid the developing world of sub-optimal and often inhumane living conditions. 1. Evans DB, Adam T, Tan-Torres Edejer T, Lim SS, Cassels A, Evans TG, et al. Achieving the millennium development goals for health: Time to reassess strategies for improving health in developing countries. BMJ 2005;331: 1133-6 2. Dyer, O. WHO needs more money to deliver better health care to poor people. Bmj. 2005; 331:180. 3. The World Bank & World Health Organisation. High-level forum on the health millennium development goals. Overview of progress towards meeting the health millennium development goals. 2003. The World Bank: http://www.who.int/hdp/en/IP1-overview.pdf 4. Loevinsohn B, Harding A. Buying results? Contracting for health service delivery in developing countries. Lancet. 2005; 366: 676-81. Competing interests: None declared |
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Jeevan P Marasinghe, Medical Officer 3-Special care baby unit,De Zoysa Hospital for women,Colombo,Sri Lanka.
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Poverty is the biggest obstacle for the developing countries to achieve a sound health care system. But the problem is further aggravated by mishandling of resources, careless diversion of money to make the investment an utter failure. There are ample numbers of examples in developing countries like Sri Lanka. The major blame should go to lack of communication and very poor decision making. I personally do not agree with fact that millennium development goals are too ambitious and unrealistic. All the eight goals are achievable if the existing local government and the authorities are incorporated into it in a meaningful way. jeevanmarasinghe@yahoo.com Competing interests: None declared |
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Meera Shekar, Senior Nutrition Specialist Human Development Network, World Bank, 1818 H Street, Washington DC-20433
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The article by Evans et al is timely and appropriate. It is indeed necessary to reassess current strategies and their cost-effectiveness in improving health outcomes. However, what comes as a surprise is that the call for such a reassesment is limited to a disease-model as linked to Millennium Development Goals (MDG) 4, 5 and 6 only. This, despite the fact that, WHO in a recent World Health Report (2002) listed child underweight as the leading risk factor contributing to the global burden of disease; and the classic paper by Pelletier and Habicht (1993) has clearly shown that malnutrition underlies over 55% of all under-five mortality in developing countries. These results, which indicate that mild to moderate malnutrition is associated with elevated mortality and that there is an epidemiologic synergism between malnutrition and morbidity, have been substantiated by several other studies. As long as the global community continues to aim to address health as a disease model divorced from nutrition, as this paper proposes, it will continue to fail in achieving the MDGs. Malnutrition represents the non- income aspects of poverty and a malnourished population can not aspire to achieve the health MDGs without also addressing nutrition. Furthermore, many nutrition interventions that can be mainstreamed through the health sector are among the most cost effective best-buys in development as assessed by the Copenhagen Consensus and others (Bhagwati et al, 2004; World Bank, 2005). Any future efforts at achieving the MDGs must incorporate these nutrition interventions. References: 1. World Health Organization. World Health Report 2002: Reducing Risks, Promoting Healthy Life. Geneva: WHO. 2002. 2. DL Pelletier, EA Frongillo Jr and JP Habicht. Epidemiologic evidence for a potentiating effect of malnutrition on child mortality. American Journal of Public Health, Vol 83, Issue 8 1130-1133, 1993. 3. World Bank. Repositioning Nutrition as Central to Development: A Strategy for Large Scale Action. Washington DC World Bank Directions in Development Series. 2005. 4. Bhagwati, Jagdish, Robert Fogel, Bruno Frey, Justin Yifu Lin, Douglass North, Thomas Schelling, et al. 2004. “Ranking the Opportunities.” In Bjorn Lomborg, ed., Global Crises, Global Solutions. Cambridge, U.K: Cambridge University Press. Competing interests: None declared |
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Dr Jayaraman Nambiar, Associate profesor MAHE,Manipal
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Dear Sir, I wish you should seriously visit a state in India called Kerala where the health statistics as good as any other western countries.The goverment sector is very good and health care system is excellnet.I wish you should work on this kind of a system and try to implement the same in other Countries too. Competing interests: None declared |
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Sanjib Kumar Sharma, Associate Professor Department of Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
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Nepal remains one of the poorest countries in the world at 136th position of the Human Development Index(1) along with shortage of health work force. The number of physicians and nurses were 1,259 and 6,216 respectively in 2001-2002. Thus the number of physicians per 10,000 population was 0.54(2). Although the government is still fighting to restore the basic human needs, poverty elimination, reduce maternal and infant mortality, and control infectious diseases, non communicable diseases (NCDs) is rising simultaneously because of rapid urbanization, and life style changes. In view of the already limited resources, a system must needs to be developed so that a viable option and sustainable method toward reaching the Millennium Development Goal (MDG) as well as to curtail the growing burden of NCDs in low income countries like Nepal is possible. Health care in Nepal is delivered through hospitals in the urban areas, and through health centres and health posts in the rural areas. In 1991, a National Health Policy was made with the objective of bringing up-graded health services to the majority of the population of Nepal through the extension of basic primary health services. However, due to centralization of health care giver to capital and major cities this task seems more and more challenging. Many district Hospitals and District Health offices are without medical doctors and the people of the country has to depend upon paramedics for the day to day health care service in those areas. However, if properly trained and supervised from time to time these health work force is proven to be effective in general and certain emergency health care management. A good example could be management of snakebite in Snake bite treatment centre at sub center of Damak Red Cross Society run by paramedical staff. They received training, exclusively on snakebite management before the establishment of the centre3. The reinforcement of training is done yearly. Case fatality rate in this centre was low(2.82%) in comparison to others health centres(6.06 to 58.8%)(3). There is a possibility that these health work-force can also be trained and utilized in rural set up for reaching toward MDG and prevention of NCDs in Nepal. Lack of resources and sustainability of the program ,once the external funding is terminated, remains an issue in donor-driven program in low income countries. In this context, creating public awareness of the risk factors and the diseases (e.g. using mosquito net in malaria prone area and healthy life style for prevention of NCDs) through various local information medias and direct interaction with public needs to be emphasised, along with local capacity building. The local educational Institution should take a leading role in this areas. B P Koirala Institute of Health Sciences, a teaching University hospital with community oriented medical education, in Eastern Nepal has lunched the concept of teaching district by means of providing health work force in various district hospitals along with coordinating the clinical training of medical students, interns and residents posted in district hospitals. The team also address the health related issue in the community of given area. Similarly, a community program for detection and prevention of NCD with the help of local organisations and medical students has been initiated. The coordinated multi-sectoral approach involving both governmental and non-governmental organisations is essential in reaching MDG and preventing NCDs in low income countries like Nepal. 1. United Nations Development Programme Report 2005. Human Development Indicator. http://hdr.undp.org/reports/global/2005/pdf/HDR05_HDI.pdf (accessed 16th November 2005) 2. WHO. Country health profile: Nepal. w3.whosea.org/EN/Section313/Section1523.htm (accessed 16th November 2005) 3. Sharma SK, Khanal B, Pokhrel P, Khan A, Koirala S. Snakebite- reappraisal of situation in Eastern Nepal, Toxicon 2003;41(3):285-289. Competing interests: None declared |
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Kshitij Mankad, SpR (Clinical Radiology) Leeds Teaching Hospitals NHS Trust LS1 3EX
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Indeed, it is time to reassess strategies for improving health in developing nations of the world. The answer is not going to be provided by pumping money and technology around, but by changing the very way people think. Technology like a disco dream strains the ability of traditional moralities and ethics to provide authoritative guides to behaviour and health consumerism. We are living in a make belief world. The WHOs cry for ''health for all by the year 2000'' remained an elusive dream in the backdrop of the thorough lack of ethics and poor health entrepreneurship. The provision of basic health infrastructure needs should be a universal responsibility. While idealistic goals like the ''millennium goals'' may well provide a few directive principles, the need really is to have health planners world wide who can think at the grass root levels and come up with workable and sustainable solutions to resurrect the rotting health eros in so many countries of the world. Understandably, population, illiteracy and poverty form a vicious cycle of events . We as health advocates need to promote a sense of good public health in the global community. Basic hygiene, cleanliness and a general sense of awareness would probably go a long way in solving major public health issues- and that is definitely possible in spite of horrific population densities existing in many parts of the world. That should be the first step. Technology should be used to reach this message out to people in a more effective and anabolic way, rather than just be used to cater to a select strata of the society that looks at distance communication means only to get more ‘superfluous’, ‘modernised’, or ‘trendy’. The media must assist health professionals in this respect. Many diseases, including population explosion can be rid of merely by telling people in their own words what they are supposed to do and not. The next step for any responsible government of the third world should be to ensure safe drinking water, good drainage and provision of practicable housing and sanitation measures. Clean and monitored community toilets is an example. These processes will trigger a positive feedback reaction in communities world wide and people will start taking responsibilities locally. That would change the mindset of an individual anonymous denizen eventually- as he forms the structural and functional unit of the global village. On the other hand are capitalistic disparities in health care affordability. Not much can be done about that in the present way of things; however, in some ways the rich man should be made to pay for the poor man’s health. Is that too much to ask for? There has to be a basic standardisation of health practice between economic sections of a society. A strong political will, an honest polity, and leaders with a vision and determination to bring about a health renaissance will prove to be catalysts in the transformation. It is one thing to have a ‘national plan’, its another to ensure its effective implementation. That is where a more unified approach worldwide will count. We are already fighting the third world war. It’s worse than a nuclear war. Our enemies are capitalism, lack of ethics, population explosion and diseases. It is time to change our minds and join hands with each other to secure a safer and healthier place for posterity. . Competing interests: None declared |
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Sumithra Joseph, Doctor PHC KUNDUVELLALA Kuttikole
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Recently in the last 5 to 10 years many private individuals and organisations have started many colleges in Nepal taking advantage of the law there. But sadly none of them contributes anything significantly to the public health care system of Nepal. I personally feel you should make it compulsory to start new public health projects there by this colleges. sumithra Competing interests: None declared |
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