Sixty years ago at the launch of the World Health Organization, the world’s governments declared health to be a fundamental human right “without distinction of race, religion, political belief, economic or social condition.” Thirty years ago in Alma Ata, the world’s governments called for health for all by the year 2000, mainly through the expansion of access to primary health facilities and services. While the world missed that target by a long shot, we can still achieve it, at remarkably low cost. Ten key steps can bring us to health for all in the next few years.

First, affluent countries should devote 0.1 percent of their gross domestic product to health care for low-income countries. With a rich world GDP of $35 trillion, that would create a fund of roughly $35 billion a year—enough for $35 per capita in added health services for the roughly one billion people who need them.

Second, half the increase should be channeled through the Global Fund to Fight AIDS, Tuberculosis and Malaria. The Global Fund has proved to be a highly effective institution, with minimal bureaucracy and maximum impact. It has supported the distribution of approximately 30 million antimalaria bed nets, helped to get nearly one million Africans on antiretroviral treatment and helped to cure more than two million people of TB.

Third, low-income countries should devote 15 percent of their own national budgets to health. Consider a poor country where the average income is $300 a year. The total national budget might be around 15 percent of GDP, or roughly $45 per capita. Fifteen percent of that figure devoted to health would come to just $6.75 per person per year: not enough to provide adequate basic health care on its own, but combined with $35 per capita from donor aid, it would do the job.

Fourth, the world should adopt a plan for comprehensive malaria control, aiming to bring malaria mortality nearly to zero by 2012 through comprehensive access to antimalaria bed nets, indoor spraying where appropriate, and effective medicines when malarial illness arises.

Fifth, the rich countries should follow through on their long-standing and achievable commitment to ensure access to antiretrovirals for all HIV-infected individuals by 2010.

Sixth, the world should fill the financing gap of roughly $3 billion a year for comprehensive TB control—another area where known and long-proved interventions are highly effective but chronically underfunded.

Seventh, the world should honor, for just a few billion dollars a year, the access of the poorest of the poor to sexual and reproductive health services, including family planning, contraception and emergency obstetrical care.

Eighth, the Global Fund should offer roughly $400 million a year for comprehensive control of several tropical diseases (mainly worm infections), which occur in virtually the same regions where malaria is rampant.

Ninth, the Global Fund should open a new financing mechanism to bolster primary health care, including—most important—the construction of clinics and the hiring and training of nurses and community health workers.

Tenth, using recent breakthroughs in medicine and public health, the expanded health systems in the poorest countries should be equipped to handle noncommunicable diseases that have long been neglected but are treatable at low cost: hypertension, cataracts and depression.

These simple steps could save the lives of nearly 10 million adults and children a year, at a cost that would be nearly unnoticeable to the world’s wealthiest nations. These measures would also slow, rather than accelerate, population growth in impoverished regions, thereby easing the economic and environmental strains that bulging populations are imposing on them. Health for all is not only the moral imperative it was at the launch of the World Health Organization 60 years ago, it is also the best practical bargain on the planet.

This article was originally published with the title Primary Health for All.

7 Comments

1. 1. cheben 06:42 PM 1/3/08

   Of course, these simple steps could help provide health for all if the wealthiest nations stop squandering their riches so far accumulated to the detriment of exploited poorest nations in the past. For six decades they have been living in a fiction of prosperity without responsibility.If natural resources had not been abusively exploited and been instead equally shared among the world nations, there would have been enough for all to eat with fair social and economic condition worldwide. A plausible fact on which to ponder.
   
   Dan Chellumben

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2. 2. chuckwoolery 02:29 AM 1/18/08

   A micro tax on currency trading (Tobin tax) could pay for these 10 steps without incurring any new tax on 99.99% of humanity. Essentially, currency traders would pay for it all. But, nearly half the goal of "health for all" could be achieved with one simple, affordable measure that Sachs doesn't mention. Clean water and safe sanitation for all. Cost = approximately $30 billion a year. With currency traders sending over $1.8 trillion dollars a DAY across international borders...a micro tax of .02% could yield $100 to $200 billion a year...enough to use for some health and education efforts here at home.

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3. 3. Peter Burgess 05:21 PM 1/21/08

   Dr. Sachs makes good points, but he never asks the hard question as to WHY 60 years of international relief and development assistance has essentially failed and HOW so much money has done so little. The systemic waste and corruption in the international system of relief and development, and high finance and corporate investment is a continuing disaster and needs to be fixed before anything else.

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4. 4. Fatimata Ba 04:11 PM 1/23/08

   Very funny indeed. Has Dr Sachs any interest in the Global Fund? How can it operate without a real reinforcement of health systems in developing countries, including a consistent pay and human resource management policy?

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5. 5. Ghanim Alsheikh 09:33 AM 8/25/08

   Its not a matter of funds only. In the past, many countries specially in Africa were unable to spend all available foreign aid on health. Funds are crucial provided that national health systems are capable of sustaining what is implemented. Among all important building blocks of any effective and efficient national health system, the process of developing and retaining national health workforce stands at top. The ineffective policies and interventions between 1978 and 2000 to orient and prepare appropriate health workers was one of the most direct causes of failing to achieve the HFA by the year 2000. During that period, almost all countries around the world made drastic organizational change and infrastructure. However, health professionals at large were and still far away from being oriented to the PHC; disease-oriented attitude is still prevalent among majority of health workers. One of the most important bottle-neck pathways that all health professionals should be targeted is the pre-service training. A trans-sectional look at medical and other related schools curricula around the world will show how health professionals-in-the-making are oriented to disease-based practice. Not funds, not governments but only, us, the health professionals are to blame for the Rise and Fall of HFAll by 2000.

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6. 6. sweetmilky 11:33 PM 6/12/11

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7. 7. sweetmilky 11:34 PM 6/12/11

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