G8: More than money required to advance health of poor nations

With the next G8 summit, our leaders rich and poor are at a defining moment. As the bold global health commitments of previous summits come back into focus, these leaders can no longer ignore a problem haunting every effort to save lives in the poorest regions: the health systems in many African and Asian countries are in no shape to deliver life-saving vaccines and medicines where they are most needed. This message is at the heart of a German government proposal to the current G8 which calls for a coordinated drive to reinforce health services worldwide.

There are some bright spots to report, from southern Ethiopia for example. Adjabush Wakalto, an 18 year old rural health worker, is on the frontline of a movement revolutionising health care delivery in this nation of 80 million people. Once a week, she walks two hours to a local health centre to fetch vaccines for the children of her village. Returning with her precious supplies, she visits with mothers and immunises their babies against deadly preventable diseases such as diphtheria, whooping cough and measles. Adjabush is a key actor in an ambitious scheme by the Ethiopian Government ? the Health Extension Programme – to create a comprehensive health care system of 30,000 trained workers capable of providing services to communities scattered across the nation.

It?s a positive start. But there is a long way to go in Ethiopia and other poor countries.

As the world approaches the midpoint of its painfully slow journey to end global poverty, we are far behind in meeting agreed health targets such as reducing child mortality. Almost 100 countries are not on track to cut child deaths by two-thirds by 2015. The scale of the effort needed can be measured by comparing the deaths of children under age five in our two nations: a child in Ethiopia is 30 times more likely to die than a child in Germany.

The G8 heads of state of the United Kingdom, France, Germany, Italy, Canada, the USA, Russia and the European Union are currently meeting in Heiligendamm on the Baltic Sea. (In recent years, the G8 have made politically powerful commitments to scaled up action against infectious diseases, AIDS and malaria). If G8 leaders use the full weight of their influence in 2007 to promote coordinated action for health services, they will make a crucial difference in moving this agenda forward. Without G8 support, millions of the world?s poorest people will continue to endure without access to services. And Africa?s deep aspiration for development and prosperity will remain a distant dream.

Beyond political commitment and leadership, the challenge is to find an effective model and bring it up to scale. The GAVI Alliance, through long-term targeted support, is credited with dramatically boosting immunisation rates in the poorest countries, and is now applying its unique public/private business model to the finance strengthening of health services. GAVI?s experience suggests that strong programmes must be led by the nations themselves, based on national plans of action and mutual accountability. Successful programmes also require flexible, long term and predictable funding, and they reward good performance.

Whether the goal is to immunise more children, reduce deaths from AIDS and malaria or prevent women?s deaths in childbirth, individual health interventions in the poorest nations will only be effective if service delivery is robust and comprehensive.

A mother bringing her child for vaccination, for example, must feel confident she will be able to receive a range of other basic services on her next visit to the health centre.

If it can provide the courageous leadership that is currently needed, the current G8 German Presidency, and in particular Chancellor Merkel, will be remembered in 2015 as key actors catalysing global action for health systems at a critical moment. Moreover, a G8 impetus could trigger further momentum by G20 leaders and other leading development actors. The global community could go forward together as partners, guided by the needs of local communities themselves.

Adjabush Wakalto, and frontline health workers everywhere, continue to perform daily miracles to deliver services where none were previously available. They are counting on this leadership and they deserve our support.

The authors
Tedros Adhanom Ghebreyesus, PhD, is Minister of Health of the Government of Ethiopia, and a member of the GAVI Alliance Board of Directors. Frau Professor Dr. Rita Süssmuth, former President of the German Bundestag, serves as Commissioner of the Global Commission on International Migration and as a member of the Board of Directors of the GAVI Fund.

See also

• www.gavialliance.org