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Education And Debate

Lessons from developing nations on improving health care

BMJ 2004; 328 doi: (Published 06 May 2004) Cite this as: BMJ 2004;328:1124

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Re: One Additional Lesson...

Dear Editor,

In relation to the topic of lessons from developing nations on
improving health care, I agree with Dr. Sapag who responded to Dr. Berwick
(1) that improvement in developing countries will not be "even more
feasible than it is in wealthy ones" unless resource and structural
constraints are addressed. It is not by chance that at the beginning of
the third millennium, still some 10.8 million children die in a year in
developing countries before they reach their fifth birthday. And it is
well known why those children die. Most of these deaths are due to acute
respiratory infections, diarrhea, measles, malaria or malnutrition or a
combination of these conditions (1). With the use of the existing
technology, the world would be able to decrease those deaths by at least
60%. WHO and UNICEF developed the Integrated Management of Childhood
Illness (IMCI) strategy, which aims to reduce death, the frequency and
severity of illness and disability, and to contribute to improved growth
and development. It combines improved management of childhood illness with
aspect of nutrition, immunization, and other important interventions that
influence child health, including maternal health (2).

Based on the
evidence it is clear that the time is not for contemplation or
expectation, but for action. Authorities from developed and developing
nations should learn that those problems affecting children in developing
countries are not acceptable in a rational world. More resources should be
allocated for implementation and for research that will support the
implementation of those interventions. As expressed by Dr.Sapag,
"understanding is important for collaboration among nations, but most
important is the ability and the will of leaders, advisors and donors to
listen and become involved in improving healthcare worldwide." We from
developing countries do hope that all authorities, from developing and
mainly from developed nations, can learn that every child deserves a
chance to succeed, to grow healthy, to be happy and to be able to
contribute to a construction of a new and more equitable world.

1. Donald M Berwick. Lessons from developing nations on improving
health care. BMJ 2004 328: 1124-1129.

2. Black RE, Morris SS, Bryce J. Where and why are 10 million
children dying every year? The Lancet 2003; 361: 2226-34.

3. Gove S. Integrated management of childhood illness by outpatient
health workers: technical basis and overview. The WHO Working Group on
Guidelines for Integrated Management of the Sick Child. Bull World Health
Organ 1997; 75 Suppl 1: 7-24.

Competing interests:
None declared

Competing interests: No competing interests

03 March 2005
Antonio J Cunha, MD, PhD
Professor of Pediatrics & Director, Institute of Pediatrics, IPPMG
Federal University of Rio de Janeiro, Brazil