Global Health - Health Interventions

Health Interventions

Many low-cost, evidence-based health care interventions for improved health and survival are known. Priority global targets for improving maternal health include increasing coverage of deliveries with a skilled birth attendant. Interventions for improved child health and survival include: promotion of breastfeeding, zinc supplementation, vitamin A fortification and supplementation, salt iodization, handwashing and hygiene interventions, vaccination, treatment of severe acute malnutrition. In malaria endemic regions, use of insecticide treated bednets and intermittent pharmacological treatment reduce mortality. Based on such studies, the Global Health Council suggests a list of 32 treatment and intervention measures that could potentially save several million lives each year.

Progress in coverage of health interventions, especially relating to child and maternal health (Millennium Development Goals 4 and 5), is tracked in 68 low-income countries by a WHO- and UNICEF-led collaboration called Countdown to 2015. These countries are estimated to account for 97% of maternal and child deaths worldwide.

To be most effective, interventions need to be appropriate in the local context, be timely and equitable, and achieve maximum coverage of the target population. Interventions with only partial coverage may not be cost-effective. For example, immunization programs with partial coverage often fail to reach the ones at greatest risk of disease. Furthermore, coverage estimates may be misleading if not distribution is taken into account. Thus, mean national coverage may appear fairly adequate, but may nevertheless be insufficient when analyzed in detail. This has been termed 'the fallacy of coverage'.

Although health intervention programs are in place, there are paradoxes affecting their capability to make a difference. As Farmer states in his article, many populations are facing the ‘outcome gap’ meaning that some populations have access to medical treatment while others due not. The reason for this is that the countries supporting these populations do not have sustainable infrastructure. The unfortunate problem with this is that a more effective treatment will leave many untreated solely for the reasons that their country does not have sustainable infrastructure to support it. Human rights is central with this problem because sustaining health in a population should be universal and accessible to all. It is also noted in the article that lack of infrastructure is commonly referenced to for a lack of healthcare in a country, demonstrating its prevalence in global health. In making progress with health interventions, taking into account the 'outcome gap' is vital to a programs success and whether or not treatments will be able to reach those who need it. It is important to note that although we do have these interventions in place, many external factors influence how effective (if at all) a program can be.

Journalist Laurie Garrett argues that the field of global health is not plagued by a lack of funds. There are many funds available to the global health field at the present time through many different agencies. But more funds does not always translate into any positive outcomes. The problem lies in the way these funds are allocated to different issues; they are very narrow in their approach where the focus is on one single disease. This stove-piping approach disregards other dire health issues in global health, particular disease can more funds due to interest of the donors and not to what is actually needed. Efforts need to be coordinated rather than focusing on single disease. Most money that is given comes with strings attached clauses where the money is spent at the wishes of the donor. More money is needed where there are no conditions attached. Donors must figure out how to build not only effective local health infrastructures but also local industries, franchises, and other profit centers that can sustain and thrive from increased health-related spending.

While investments by countries, development agencies and private foundations has increased substantially in recent years with aim for improving health intervention coverage and equitable distribution, including for measuring progress towards the achievement of the Millennium Development Goals, attention is also being increasingly directed to addressing and monitoring the health systems and health workforce barriers to greater progress. For example, in its World Health Report 2006, the WHO estimated a shortage of almost 4.3 million doctors, midwives, nurses and support workers worldwide, especially in sub-Saharan Africa, in order to meet target coverage levels to achieve the Millennium Development Goals 4 and 5.