Anne Mills

Disease control priorities in developing countries

This first edition provides information on disease control interventions for the most common diseases and injuries in developing countries to help them define essential health service packages. Life expectancy in developing countries increased from forty to sixty-three years between 1950 and 1990 with a concommitant rise in the incidence of noncommunicable diseases of adults and the elderly. It is still necessary to deal with under nutrition and communicable childhood diseases. Also, new epidemic diseases like AIDS are emerging, and the health of the poor during economic crisis is a growing concern. These health developments intensify the need for better information on the effectiveness and cost of health interventions. The information is intended for health practitioners at every level. Individual chapters offer preventive and case management guidelines critical to improving the quality of care. The need for health sector reform is global. Both developed and developing countries, and centrally planned and market oriented health systems share basic dissatisfaction with the present organization and financing of health care delivery and a conviction that there are better ways to obtain results with the available resources. This book attempts to assist health sector reformers to review existing services and adapt them to provide the most cost effective interventions available.

Overcoming health-systems constraints to achieve the Millennium Development Goals

Effective interventions exist for many priority health problems in low income countries; prices are falling, and funds are increasing. However, progress towards agreed health goals remains slow. There is increasing consensus that stronger health systems are key to achieving improved health outcomes. There is much less agreement on quite how to strengthen them. Part of the challenge is to get existing and emerging knowledge about more (and less) effective strategies into practice. The evidence base also remains remarkably weak, partly because health-systems research has an image problem. The forthcoming Ministerial Summit on Health Research seeks to help define a learning agenda for health systems, so that by 2015, substantial progress will have been made to reducing the system constraints to achieving the MDGs.

Disease control priorities in developing countries, second edition

This is the second edition of the original 1993 publication on public health. The purpose of this book is to provide information about what works, specifically, the cost-effectiveness of health interventions in a variety of settings. Such information should influence the redesign of programs and the reallocation of resources, thereby helping to achieve the ultimate goal of reducing morbidity and mortality. As was the case with the first edition, this second edition of will serve an array of audiences. This second edition of Disease Control Priorities in Developing Countries (DCP2) seeks to update and improve guidance on the what-to-do questions in DCP1 and to address the institutional, organizational, financial, and research capacities essential for health systems to deliver the right interventions. DCP2 is the principal product of the Disease Control Priorities Project, an alliance of organizations designed to review, generate, and disseminate information on how to improve population health in developing countries. In addition to DCP2, the project produced numerous background papers, an extensive range of interactive consultations held around the world, and several additional major publications.

MATERNAL HEALTH IN POOR COUNTRIES: THE BROADER CONTEXT AND A CALL FOR ACTION

In this paper, we take a broad perspective on maternal health and place it in its wider context. We draw attention to the economic and social vulnerability of pregnant women, and stress the importance of concomitant broader strategies, including poverty reduction and womens empowerment. We also consider outcomes beyond mortality, in particular, near-misses and long-term sequelae, and the implications of the close association between the mother, the fetus, and the child. We make links to a range of global survival initiatives, particularly neonatal health, HIV, and malaria, and to reproductive health. Finally, after examining the political and financial context, we call for action. The need for strategic vision, financial resources, human resources, and information are discussed.

Advancement of global health: key messages from the Disease Control Priorities Project

The Disease Control Priorities Project (DCPP), a joint project of the Fogarty International Center of the US National Institutes of Health, the WHO, and The World Bank, was launched in 2001 to identify policy changes and intervention strategies for the health problems of low-income and middle-income countries. Nearly 500 experts worldwide compiled and reviewed the scientific research on a broad range of diseases and conditions, the results of which are published this week. A major product of DCPP, Disease Control Priorities in Developing Countries, 2nd edition (DCP2), focuses on the assessment of the cost-effectiveness of health-improving strategies (or interventions) for the conditions responsible for the greatest burden of disease. DCP2 also examines crosscutting issues crucial to the delivery of quality health services, including the organisation, financial support, and capacity of health systems. Here, we summarise the key messages of the project.In June 2004 six fighters from the Congolese Rally for Democracy-Goma gang-raped a woman in the presence of her husband and children while another soldier raped her three-year-old daughter according to Human Rights Watch. In June 2005 a 17-year-old boy was arrested by a Mai-Mai officer after he refused to draw water for the military stationed there and was severely tortured while he was held in detention in the camp. A local non-governmental organization (NGO) reported that the boy was released only after a large fine was paid. In November 2005 three soldiers from the United Congolese forces tied an 11-year-old girl with an electric cable and repeatedly raped her in a military camp according to the United Nations Organization Mission in the Democratic Republic of the Congo (MONUC). These cases are examples of the brutal violations against Congolese children as documented by the Watchlist on Children and Armed Conflict in its April 2006 report Struggling to Survive: Children in Armed Conflict in the Democratic Republic of the Congo. The country continues to endure the worlds deadliest humanitarian crisis and according to the International Rescue Committee more than 38000 people die every month as a direct and indirect consequence of the armed conflict in the Democratic Republic of the Congo (DRC). As many as 45 per cent of these deaths occurred among children who fell victim to intolerable human rights violations committed in an atmosphere of almost complete impunity. (excerpt)

What can be done about the private health sector in low-income countries?

A very large private health sector exists in low-income countries. It consists of a great variety of providers and is used by a wide cross-section of the population. There are substantial concerns about the quality of care given, especially at the more informal end of the range of providers. This is particularly true for diseases of public health importance such as tuberculosis, malaria, and sexually transmitted infections. How can the activities of the private sector in these countries be influenced so that they help to meet national health objectives? Although the evidence base is not good, there is a fair amount of information on the types of intervention that are most successful in directly influencing the behaviour of providers and on what might be the necessary conditions for success. There is much less evidence, however, of effective approaches to interventions on the demand side and policies that involve strengthening the purchasing and regulatory roles of governments.

Cost-effectiveness of malaria control in sub-Saharan Africa

BACKGROUND Information on the cost-effectiveness of malaria control is needed for the WHO Roll Back Malaria campaign, but is sparse. We used mathematical models to calculate cost-effectiveness ratios for the main prevention and treatment interventions in sub-Saharan Africa. METHODS We analysed interventions to prevent malaria in childhood (insecticide-treated nets, residual spraying of houses, and chemoprophylaxis) and pregnancy (chloroquine chemoprophylaxis and sulfadoxine-pyrimethamine intermittent treatment), and to improve malaria treatment (improved compliance, improved availability of second-line and third-line drugs, and changes in first-line drug). We developed models that included probabilistic sensitivity analysis to calculate ranges for the cost per disability-adjusted life year (DALY) averted for each intervention in three economic strata. Data were obtained from published and unpublished sources, and consultations with researchers and programme managers. FINDINGS In a very-low-income country, for insecticide treatment of existing nets, the cost-effectiveness range was US

The Millennium Development Goals: a cross-sectoral analysis and principles for goal setting after 2015

4-10 per DALY averted; for provision of nets and insecticide treatment

Mobilising financial resources for maternal health

19-85; for residual spraying (two rounds per year)

Health financing to promote access in low income settings—how much do we know?

32-58; for chemoprophylaxis for children