News Release

Thailand, Vietnam, Cuba: Examples of poorer countries that have improved primary health care

Peer-Reviewed Publication

The Lancet_DELETED

Despite problems including political instability, low income per person, and high HIV/AIDS prevalence, some countries have made substantial progress in primary health care (PHC), such as Thailand, Vietnam, Peru and Brazil. In this fourth in a Series of eight papers in the Alma-Alta Special Issue of The Lancet, Dr Joy Lawn, Saving Newborn Lives/Save the Children, Cape Town, South Africa, and colleagues, examine reasons behind the progress in the 30 best performing countries, and the issues for the worst-performing countries.

The authors use average annual reduction in child mortality (under five years) between 1990 and 2006 to gauge progress; Thailand* has the highest yearly reduction at 8.5%, and this is no coincidence — the country also has achieved universal coverage of immunization and skilled birth attendance, with low inequity – ie, the interventions reach those who need them most. In these progressing countries, nationally agreed packages of priortised PHC, attention to district management systems, and investment in primary care extension-workers linked to the health system have all played their part. Even countries such as Nepal, Laos, Bangladesh and Guatemala – some of the world's poorest – have made progress on child mortality starting with highly effective, selective strategies such as using community healthworkers to treat children at home with pneumonia, and achieving high coverage with immunization.

Of the 30 best performing countries, 14 were shown to have comprehensive PHC based on skilled birth attendance coverage of over 80%. Cuba is among these countries and has a mortality rate for children under five years lower than that in the USA despite a per capita income that is 2% of the USA. In the first year after birth, Cuban mothers and babies receive 15 home visits from their local family doctor, focused on preventive care. And progress has been made in the very place the Alma-Ata declaration was made. For a girl born in Alma-Ata, the then USSR, in 1978, her risk of dying before her fifth birthday was 7.3%. The risk for a baby born in 2008 in what is now Almaty, Kazakhstan, is than half this at 2.9%. And while global mortality for children under-five has also halved between 1978 and 2008, the reduction has been less in poorer countries (42%) and more in richer countries (77%). War (Iraq, Chad), HIV (South Africa, Zambia), poor governance (Nigeria) and specific adult mortality challenges (eg alcoholism in men in Russia) explain why some countries are well off track to meet health-related Millennium Development Goals (MDGs). In these cases, the PHC systems are overwhelmed by the demands placed upon them.

The authors conclude: "More detailed analysis and evaluation within and across countries would be invaluable in guiding investments for primary health care, and expediting progress towards the MDGs and health for all."

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Joy Lawn, Saving Newborn Lives/Save the Children-US, T) +27 (0) 21 532 3494/ +27 (0) 798839706 E) joylawn@yahoo.co.uk

Full paper: http://press.thelancet.com/AA4.pdf


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