January 2, 2001
A new report jointly issued today by five United Nations agencies and the World Bank claims that
worsening AIDS, TB and malaria epidemics are not inevitable and shows numerous strategies
deployed by several developing countries to successfully fight these diseases, and prevent the
deaths they cause.
The targets for reducing the toll of these illnesses, set by the world's leaders at successive
summits over the last year, remain feasible. What is needed are the funds and systems that will
enable widespread implementation of actions that have shown to be effective, the report says.
The report contains success stories from 20 different countries, encompassing the widest variety
of economic, social and geographic conditions. It shows, for example, how countries like Senegal,
Uganda and Thailand have developed strategies that successfully can reduce HIV infection rates,
how Azerbaijan and Vietnam have cut in half the number of deaths from malaria, how China, India and Peru have cut TB deaths by half, and how Sri Lanka
has drastically reduced maternal mortality.
The report Health, a key to Prosperity: Success Stories in Developing Countries the World Health
Organization (WHO), the United Nations Children's Fund (UNICEF), the United Nations
Educational, Scientific and Cultural Organization (UNESCO), the Joint United Nations Program on
HIV/AIDS (UNAIDS), the United Nations Population Fund (UNFPA) and the World Bank outline key
factors for combating AIDS, tuberculosis, malaria, childhood diseases and maternal and prenatal
conditions, even in resource-poor settings.
"The prospects of intervening to prevent death in developing countries have never been better,"
said Dr Gro Harlem Brundtland, Director-General of WHO. "The evidence refutes those who doubt
that the world's poorest communities can be protected from AIDS, tuberculosis (TB), malaria,
childhood diseases and maternal mortality. With a concerted effort from the international
community we can turn the promise of these success stories into a reality In the coming years."
The publication of the report comes shortly after a meeting in Okinawa, Japan, on 7-8 December,
where representatives from the G8 countries agreed to significantly scale up its global work to
fight diseases in the world's poorest countries.
"The success stories described in these pages demonstrate how far many nations have come in
defining viable strategies to attack these public health threats and in scaling up for a national
impact," said World Bank President James D. Wolfensohn. "The stories illustrate many lessons.
They demonstrate that success is possible even when resources are scarce. They show that
inputs such as drugs or vaccines, as important as they are to improving health, are not enough.
Political commitment, capacity-building, human resources, education and communication, local
adaptation and community involvement are critical. They also signal that strengthening and
increased financing of underlying health systems and social services is key to ensuring a
large-scale and more sustainable response."
The Report identifies six important characteristics of programs that have succeeded to control
diseases of poverty:
- political commitment at the highest level is key to achieving results and
- successful disease and mortality prevention has often involved new ways
of working, e.g., entering into partnerships with the private sector,
non-governmental organizations, and UN agencies;
- innovation, born out of a pragmatic approach to achieving results, has made all the difference in some countries;
- promoting the home as the first hospital helps reduce child deaths. In particular, the training and education of
mothers has been a key to success;
- widespread availability of supplies, medicines and other
low-cost tools at community-level is essential; and
- measuring results is key to planning control measures
Yet UNICEF Executive Director Carol Bellamy said many of these success stories remain invisible to
a largely pessimistic world. "There's widespread skepticism about controlling disease in the
developing world. In light of this report, such fatalism is simply unacceptable," said Bellamy.
"Given what we know, over the next decade it will be possible to make huge gains worldwide. But
if we don't make a concerted effort now, we are, in essence, condemning millions of people to
death, especially young children."
The report is broken down into five sections: tuberculosis, malaria, AIDS, childhood diseases, and
maternal and prenatal conditions. Please see the annex for highlights.
Almost 2 million people die from TB every year - 98% of them in developing countries. And yet
anti-TB medicines are 95% effective in curing TB and cost as little as US$10 for a six-month
course of treatment.
In Peru, for example, high-level political commitment has produced one of the most successful TB
control programs in the world. On current trends, the number of new TB cases could be halved
every 10 years. Diagnosis and treatment are provided free of charge and low-income families
receive food packages to encourage compliance with treatment.
In general, elements of successful TB control using WHO's DOTS (Directly Observed Treatment
Short-course) strategy include:
- government commitment to sustained TB control;
- detection of TB cases through sputum smear microscopy among symptomatic people;
- regular and uninterrupted supply of high-quality anti-TB drugs;
- 6-8 months of regularly-supervised treatment; and
- reporting systems to monitor treatment progress and program performance.
Malaria kills over 1 million people per year, mostly in Africa, and most of them children. And
women are especially vulnerable to malaria during pregnancy, when the disease can lead to
life-threatening anemia, miscarriages and the birth of premature, low birth-weight babies.
More rapid and effective treatment of malaria with anti-malarial drugs could prevent malaria
deaths. Anti-malarial drugs cost as little as US$0.12 per treatment. Meanwhile many child deaths
from malaria can be prevented through the widespread use of low-cost, insecticide- treated
bednets. But, so far, only an estimated 1% of African children today sleep under a bednet.
The main prongs of the Roll Back Malaria partnership's strategy to reduce the ill-health and
poverty, which malaria induces, include:
- access to rapid diagnosis and treatment at village/community level;
- preventive treatment for pregnant women;
- multiple measures to prevent mosquito bites;
- a focus on mothers and children - the highest risk groups;
- better use of existing malaria control tools;
- research to develop new medicines, vaccines and other tools; and
- improved surveillance to improve epidemic forecasting and response.
Azerbaijan, Ethiopia, Kenya and Vietnam have all shown success in rolling back malaria. In
Vietnam, for example, government commitment, largely in the form of the supplying of free
insecticide-treated bednets and the use of locally-produced, high quality anti-malarial drugs,
reduced the malaria death toll by 97% in a five-year timespan. The concerted drive against the
disease involved a major investment in training and disease reporting systems, the use of mobile
teams to supervise health workers, and the mobilization of volunteer health workers. And in
Kenya, an innovative scheme involving a community bednet-sewing industry, workplace promotion
of bednets, and employer- sponsored payroll purchasing schemes has helped reduce malaria
cases, slash overall healthcare costs, reduce absenteeism and increase productivity among the workers involved.
While newly-released figures show that AIDS killed an estimated 3 million people in 2000, the
United Nations argues against accepting a worsening AIDS pandemic as inevitable. Although there
is no AIDS vaccine and antiretroviral therapy is still unaffordable for most developing countries,
experience in countries such as Senegal, Thailand and Uganda has shown that reduction in
infection rates is possible. Effective prevention measures include:
- access to condoms;
- prophylaxis and treatment of opportunistic infections including STIs and TB;
- sex education at school and beyond;
- access to voluntary counselling and testing;
- counselling and support for pregnant women and efforts to prevent mother-to-child transmission of HIV;
- promotion of safe injection practices and blood safety; and
- access to safe drug injecting equipment.
The example of Thailand, for example, shows how government determination to promote 100%
condom use in brothels and to ensure wide access to HIV prevention campaigns through schools,
the mass media and the workplace have been key factors in lowering HIV infection rates, the
Report notes: by 1997, for example, HIV infection rates among 21 year-old military conscripts
had fallen to 1.5%, from a peak of 4% in 1993. The Report also notes that a year's supply of
condoms costs only US$14.
"Twenty years of experience of the epidemic have demonstrated some key components of an
effective response: strong leadership, partnerships, overcoming stigma, addressing social
vulnerability, linking prevention to care, focusing on young people, and encouraging community
involvement in the response," explained Dr. Peter Piot, Executive Director of UNAIDS.
The UN Agencies emphasize in the new report that even the Thai approach may not be
sustainable if the program focuses just on heterosexuals, and if there is not continuous and
"Girls and women are most vulnerable to HIV infection given the social and economic
disadvantages they face in their day-to-day lives," added Dr. Nafis Sadik, Executive Director of
UNFPA. "The burden of caring for entire families falls increasingly on the shoulders of women as AIDS continues to devastate families and
communities. Further efforts must be made to empower women and girls and create a space for
female decision-making in private as well as public life. The success stories included in this report
serve as an important reminder of the power of committed and focused multilateral partnerships."
"The AIDS epidemic is eroding the educational systems of many countries, especially in
Sub-Saharan Africa," added Koichiro Matsuura, Director-General of the United Nations Educational
Scientific and Cultural Organization. "An alarming percentage of teachers are affected by HIV and
millions of children and adolescents are no longer able to go to school. There is no infrastructure to deal with the crisis which is undermining these countries' economic,
social and human development. It is imperative that the international community rally to the
rescue of these teachers and students. Equally indispensable is the need for extensive AIDS-prevention educational programs which, to
be effective, must be respectful of the cultural context of the populations they target."
In developing countries, 70% of childhood deaths - over 8 million - are caused by no more than
five conditions - pneumonia, diarrhoea, malaria, measles and malnutrition. Three out of every four
children who seek healthcare are suffering from one or more of these conditions. Yet low-cost
interventions are available to prevent or treat them.
In Mexico, for example, determined efforts by the government to promote the use of oral
re-hydration therapy - which costs as little as US$0.33 - to immunize children against measles,
and to improve access to safe water and sanitation have succeeded in reducing childhood deaths
from diarrhoeal diseases by 60% in less than a decade. Other key factors in this success have
included an increase in education levels among women, investment of adequate resources and the
widespread use of case management guidelines.
Maternal and Prenatal Conditions
Every year, more than half a million world-wide die from complications of pregnancy and childbirth
- mainly severe bleeding, infections, unsafe abortions, hypertension and obstructed labor. Almost
90% of these deaths occur in Asia and sub-Saharan Africa. And most of them could be prevented
at low cost. WHO's Mother-Baby package, for example, costs no more than US$3 in low-income
countries. The strategy involves ensuring access to:
- antenatal care;
- normal delivery care assisted by a skilled birth attendant;
- treatment for complications of pregnancy;
- neonatal care;
- family planning advice; and
- management of STIs.
Sri Lanka, for example, is a major success story. In that country, where a third of the population
is estimated to live below the poverty line, maternal mortality rates are among the lowest in the
developing world. Most deliveries take place in a health facility, with the support of a skilled birth
attendant. This achievement is the result of government commitment to improving education and
health in Sri Lanka, the relatively high status of women, and high female literacy rates.
1 WHO, UNICEF, UNAIDS, UNESCO, UNFPA