Coping With Health Care in Developing Countries

By Abraham M. George

Dec. 09, 2005 (Bloomberg News) -- With all the attention focused on deadly infectious diseases, a far bigger challenge in developing nations is posed by a lack of basic health care.

The World Health Organization (WHO) lists the top 10 preventable health risks as childhood and maternal underweight; unsafe sex; high blood pressure; tobacco; alcohol; unsafe water; sanitation and hygiene; high cholesterol; indoor smoke from solid fuels; iron deficiency and obesity.

These risks account for about 40 percent of the 56 million preventable deaths that occur worldwide annually, accordingly to WHO. In most developing countries, the number of new cases related to many of these health risks has increased over time, partly due to rising populations.

Beyond infectious diseases, the main cause of ill-health is malnutrition. Poverty, hunger and malnutrition are interrelated silent realities for a majority of people in developing countries.

In India alone, more than half the children under the age of four suffer from malnutrition, 30 percent of the newborns are significantly underweight, and 60 percent of women are anemic. A recent World Bank report shows that malnutrition costs India at least $10 billion annually in terms of lost productivity, illness and death and is seriously retarding improvements in human development. Similar situations prevail in many other Asian countries and most of Africa .

Reasons for Apathy

In the face of these appalling statistics, why hasn't there been a major outcry among health authorities and the public in general? Part of the answer probably lies in the fact that primary health care, and in particular public health, is viewed as a complicated and ``non-glamorous'' area that requires sustaining efforts but does not offer sufficient visibility. Further, most of the common ailments are perceived to be local and not likely to cross borders.

The task of dealing with common illnesses and ill-health, especially among the poor in rural areas where a majority of people live, is left entirely to governments. Unfortunately, successive governments in most developing countries have failed to do an effective job.

Huge Bureaucracy

For example, during the past half a century India has built up a vast infrastructure of public health services, managed by a huge bureaucracy with little oversight. But the government spends hardly 2 percent of gross domestic product on health services, and its Primary Health Centers (PHCs) are expected to serve the 700 million or so people living in rural areas.

Inadequate infrastructure, too few physicians, absence of drugs, and lack of accountability have turned PHCs into ineffective institutions. International organizations that provide much of the external funding believe that a targeted approach to addressing some of the top health concerns can be successful without worrying much about the institutions that actually deliver primary health care.


What can be done to significantly improve the health conditions of a majority of people in the world who cannot afford quality private health care? The simple answer is to improve the primary health care system in poor countries.

Primary health-care institutions are the backbone of the health system in the villages and where patients initially come for their health needs. It is the first, and sometimes only, line of intervention against frequent health problems such as viral infections, gastrointestinal disorders, and contagious diseases. It is also where early detection of almost all infectious diseases is possible.

But most government-run primary health institutions are poorly managed in practically every developing country, and they usually do not maintain proper records of patients' health history. Patient records are all the more important when dealing with an uneducated rural population that does not have a good understanding of health risks.

Recognizing this need, our foundation runs a rural hospital in south India that keeps up-to-date computerized health records of practically the entire population of 17 villages served by its outreach programs. Armed with proper information, our health workers are able to intervene effectively without wasting unnecessary time and effort.

We have found that quality health-care delivery is possible at reasonable costs with good information and effective management. Governments also need to recognize that major improvements in rural health delivery are possible without substantial increases in public fund allocations, but only if they would embrace major changes.

Public-Private Partnership

While the private sector is relied upon for economic development, the delivery of basic services, such as education and health care for the poor, still remains a monopoly of the government. This has been the case because rural populations in developing countries are unable to pay for the services. Until rural incomes rise, a significant portion of health-care costs must be borne by the state from public funds.

But lack of affordability alone should not prohibit the involvement of the private sector. Opportunities exist for public-private sector partnership in a competitive environment. Private institutions may deliver their services at a profit but at reduced prices, subsidized or even fully paid for by the government. Similarly, the government may make available products, such as drugs, for free or at significantly low costs to private providers who serve the poor.

There is no shortage of ideas to improve the quality of health care delivery, while ensuring access for everyone regardless of income.  But only with a global commitment to improving primary health care can the present health crisis faced by developing countries be effectively addressed.

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