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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 September 22; 335(7620): 580.
PMCID: PMC1989031

Weak healthcare systems and lack of money hamper efforts to reduce mortality worldwide

Plenty of cheap, simple ways exist to tackle global poverty, but the world lacks the commitment to implement them, health experts and economists said at an international conference in London last week.

Convened to celebrate the centenary of the Royal Society of Tropical Medicine, the conference aimed to assess progress, at the halfway point, towards meeting the eight millennium development goals set by the United Nations for 2015.

One goal is to cut by two thirds the 10 million deaths each year of children aged under 5 years old, but only seven of the 60 countries with the highest child mortalities are on track to meet it, said Cesar Victora, professor of epidemiology at the Federal University of Pelotas, in Brazil.

“Children are dying of old diseases [diarrhoea, pneumonia, and malaria] for which we have simple, effective treatments,” he said. Breast feeding, oral rehydration, antibiotics, immunisation, and mosquito nets treated with insecticide could save six million of these lives every year, he added. But coverage was at “amazingly low levels,” he said, because of weak healthcare systems that can't cope with large scale programmes and a dearth of adequately trained workers.

“We have the magic bullets, just not the guns to fire them,” he said, adding that greater efforts should be devoted to finding out how best to deliver solutions. “More of the same is not enough.”

The economist Jeffrey Sachs, director of the US Earth Institute at Columbia University, New York, argued that one tenth of 1% of the rich world's income, or $35bn, was all that was needed. “That's less than a month of Pentagon [US defence] spending or a quarter of the cost of the Iraq war each day,” he said. “The poor die not because of a lack of solutions or resources but because of a lack of the most minimal focus and will needed to accomplish them.”

Poor countries have committed themselves to spend 15% of their gross domestic product on developing health care, he said, but in a country such as Malawi that amounted to just $4.50 per person. “The poorest of the poor can't do this on their own,” he added.

Zulfiqar Ahmed Bhutta, professor of paediatrics at the Aga Khan University, Karachi, Pakistan, said existing resources needed to be targeted more carefully. “We don't just need more research but the right kind of research that will impact on health systems . . . for real people in real situations,” he said.

Staffan Bergstrom, of Stockholm's Karolinska Institute, said that each year half a million women die after childbirth in poor countries. “The most critical factor is the human resources crisis, aggravated by the vacuum cleaning [of health professionals by] rich countries,” he said.

In some African countries non-medical surgical officers had replaced doctors in rural areas, he said, performing 90% of obstetric procedures. Unlike doctors, they stayed put and were considerably cheaper, and research in Mozambique, Malawi, and Tanzania had shown that their outcomes were similar to those of obstetricians.

“It's controversial. But we need to utilise these people,” he said. “They are highly valued by the local population.”

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