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See Inside January 2008

Primary Health for All

Ten resolutions could globally ensure a basic human right at almost unnoticeable cost



MATT COLLINS

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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.

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