[Comment] Thailand in forefront of race for better health

from The Bangkok Post

By JOY PHUMAPHI

For millions of the world's poorest people, ill-health and disease too often go hand in hand with grinding poverty and blunted national aspirations. In looking for solutions to this troubling state of global health, we can learn a great deal from Thailand. Given that most of the world's development thinking cascades from wealthy OECD countries in the North to countries in the South we need to hear more from Thailand and other countries like Cambodia, Ethiopia, Rwanda, and Vietnam, which have achieved breakthroughs in primary healthcare, to export their development experience in a South-South dialogue to show their neighbours in South Asia, Africa and other regions what works, what doesn't, and why. This experience should not stay confined to national borders.

At the Prince Mahidol Awards Conference in Bangkok this week, we have heard yet again that weak health systems are a significant roadblock to improving the health of people in developing countries. Thailand, by contrast, has focused on strengthening its health system and this has allowed the nation to cope with and contain other epidemics of global significance such as avian influenza and Sars.

This a clear case of how a stronger national healthcare system can not only protect the people of Thailand, but the greater worldwide community as well.

Thailand has also shown the world that HIV/Aids could be confronted with well-financed prevention, care and treatment programmes. These programmes, initiated in the 1990s, may have prevented as many as 7 million new cases of HIV infection by 2006.

Thailand is in select company here. Only a handful of other countries have been able to reverse an HIV epidemic in this way.

Sadly, for millions of other people in South Asia and Africa, this level of healthcare is a distant mirage. Despite some notable examples of success, we continue to see unacceptable levels of sickness and death that abandon people to poverty and desperation.

Almost 11 million children die every year, mainly from preventable causes like pneumonia, diarrhoea and malaria. More than 500,000 women die during pregnancy and childbirth every year. In 2006, almost 3 million people died from HIV/Aids. Tuberculosis is curable, yet 1.7 million people die from it every year.

Nearly one-third of children under five in the developing world remain underweight or stunted, leading to irreversible brain and physical damage. Prevention is therefore a long-term investment which greatly benefits both present and successive generations.

A country's sustained economic growth rate is significantly influenced by the health of its people. It is little wonder, therefore, that illness is a cause of poverty as families tap into savings or sell what they own to cover the costs of medical care. If we are serious about fighting poverty, improving the perilous health of millions of the world's poorest people must be a top priority of the global development community.

What can we do? We need to strengthen health systems across the board; we need to focus on verifiable results; and we all need to work together better. Stronger, integrated health systems are an essential platform for effective universal prevention, treatment, care and mitigation of diseases.

In practical terms, strengthening health systems means putting together the right chain of events that, for example, gets life-saving drugs and health workers to mothers and their newborns where they are needed most. It means making sure that poor people get the good quality health services they need. Many existing aid programmes for health stall or actively fail because there is no functioning health system with the capacity to deliver services and drugs to the people who need them. Focus on results _ without results, health system strengthening has no meaning. Without health system strengthening, there will be no results.

One promising approach to strengthening health systems is ''results-based financing.'' In fact, using this approach, the World Bank is working with Mozambique, Rwanda and other African countries to help them lower their numbers of child deaths and improve their maternal health. This innovative approach links aid directly to verifiable results.

Health systems, however, don't function in isolation; they need to show their worth and their value to people at the household level, at the local community and national levels. It is important to have systems that not only show results but respond to demand.

We need to work together better. With the health and development arena increasingly crowded by bilateral and multilateral partners, as well as new foundations and charities, it is clear that donors, too, have a bargain to keep. In fact, there is widespread recognition that the Millennium Development Goals of maternal and child survival will not be achieved without significantly improved performance and coordination by all stakeholders within countries and internationally.

And we all have to learn from each other's successes and failures. This is key to moving forward faster.

With this task in mind, it is fitting indeed to invoke the memory and achievements of Prince Mahidol, the Father of Modern Medicine in Thailand, and a man who saw many years ago that a well-functioning public healthcare system was a cornerstone of a vibrant, modern society.

Let us use the Prince's health summit in Thailand this week to step up our efforts to help middle-income and developing countries to strengthen their health systems to achieve long-term, sustained good health, stronger growth, and more promising national prospects in the global economy.

Joy Phumaphi is vice-president of the World Bank's Human Development Network; a former WHO assistant director-general for family and community health; and a former minister of health in Botswana.