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Lecture

ch 13


Department
International Development Studies
Course Code
IDSB04H3
Professor
Anne- Emanuelle Birn

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Introduction
x What Nyerere proposed in 1968 was to achieve healthy societies by building peaceful
communities: providing social and economic security in ways that protect the vulnerable;
allowing freedom of expression and opportunities for full participation in civic life; and
providing universal and equitable distributed services, including water, sanitation,
education, shelter and health care
x Focusing on societal change through the lens of political economy, these approaches
provide a counterbalance to mainstream efforts in global health
The “Disease Controlconception of international health: its successes and limitations
x International campaigns could aid or impede the making of healthy societies
x The problem of anemia-inducing hookworm was addressed in some areas through latrine-
building, promotion of shoe-wearing; yellow fever through extensive antilarval efforts,
and then later a vaccine. The global eradication of small pox in the 1980s was the most
notable, based on aggressive immunization campaign, has been one of the single greatest
feats of international public policy
x However, the eradication of malaria was more problematic. The Global Malaria
Campaign in 1955 which exclusively involved the use of DDT to eradicate malaria meant
that 1 billion people were no longer threatened by malaria within a few years only.
However, in the late 1960s, when the technology (DDT) faltered due to mosquito
resistance and political opposition, together with concerns over DDTs environmental
effects, the campaign was abandoned.
Smallpox Eradication
x It was easier to eradicate than malaria
x Smallpox inoculation was practiced in India and China
x The lack of animal hosts, availability of effective vaccines, rapid jet vaccinators were all
important factors in its control
x The WHOs global malaria campaign in 1967 was divided into several different phases:
o Attack phase-mass vaccination program was documented was instituted, aiming
for 100% coverage. Documented coverage reached 80% and helped the incidence
of smallpox to fall below 5 cases per 100,000 inhabitants.
o Consolidation phase- mass vaccination was terminated, and it was necessary to
only vaccinate new arrivals and newborns
o Maintenance phase- surveillance and reporting was shifted to the national and
regional health service
x Accumulating funds for these campaigns however did pose hardships for the affected
countries
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The Child Survival Campaigns
x This was launched by UNICEF to eradicate common infections of early childhood using
simple medical technologies
x It used the GOBI technique- growth monitoring (G), oral rehydration therapy (O), breast
feeding (B), and immunization (I) against childhood killers such as TB, whooping cough,
tetanus, polio, diphtheria & measles. Family planning, female education and food
supplementation were also later added to the list thus changing it to GOBI-FFF
x Poverty, poor nutrition and lack of access to basic services continue to be a major
underlying cause of death among children, even as immunization increased to 79%.
UNICEFs belated call for a more integrated approach to improving child survival
programs remains overly centered on the delivery of health services and management of
global health programs, rather than on addressing social conditions broadly.
Six key ingredients for success
1. Predictable and adequate funding from both local and international sources
2. Political leadership and champions
3. Affordable technology innovation within an effective delivery system
4. Technical consensus about the appropriate biomedical or public health approach
5. Effective management of health delivery systems
6. Effective use of information
NOTE: It is important to consider the context that policies work under. For eg. Reducing
maternal mortality by 90% since the 1950s in Sri Lanka can be attributed to free health care
system with extensive rural coverage, trained midwives, good data for decision making and
target efforts to marginalized groups. While all these policies are important, what is missing is
the context of these policies. These policies did not just include midwife training, free universal
health care services but also universal education, land reform, economic security measures,
gender equality, etc.
Limitations of single disease campaigns
x There are a number of limitations that have been recognized for the selective disease
approach and related vertical programs
x Vertical programs are programs that are carried out or supervised, wholly by a
specialized service with its own personnel
x The disease-specific approach to international health does little to address overall health
or well-being. As soon as one disease is addressed, other problems emerge to replace it.
Attacking diseases one by one rather than improving the underlying determinants of most
ailments- thus becomes an end it itself
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