The Human Journey

Creating a Sustainable Future

Aid – Investments in Health

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Most poor countries lack skilled workers so innovative solutions must be found to improve their lives. The World Health Organization advises that new training models must be created for skilled health professionals if there is any chance of meeting the Sustainable Development Goal of universal health coverage by 2030. It proposes utilizing technology to train the millions of unemployed youth around the globe to become health care workers. Even though doubts about such programs have been expressed, accelerated training programs for young people are already being implemented in Afghanistan and Ethiopia. For more on the possibilities, challenges and potential see: Could unemployed youth solve the health care worker crisis?

In Peru, Voxiva has developed a medical diagnostic system that enables low-skilled health workers in remote areas to identify illnesses using numbered picture cards. Health workers just telephone their findings to officials in Lima using a card with simple instructions and numbers corresponding to the diseases they must report.

The Mobile Technology for Community Health MOTECH is an open source software project delivered by Grameen Foundation. It is adapted to facilitate communication between patients, caregivers, and/or health administrators, providing health solution via mobile phone. It communicates to patients or caregivers via voice or SMS supporting the sick as well as pregnant and young mothers, reminding them of appointments, lab visits, to take medication, to report symptoms prior to treatment, and so on. Through it caregivers can be given a basic training in diet, nutrition and basic health requirements, immunization, etc. so that they can visit people in their communities and share this information.

Iodine Deficiency Disorders
Iodine Deficiency Disorders: Areas Affected and Control Programmes, 1991
(Source: WHO (1990), reproduced in: ACC/SCN (1992). Figure 3.6, p.49)

Iodine in salt is lost during storage, transportation, and cooking, and millions of children in India suffer from iodine deficiency disorder. Unilever developed a process to prevent iodine loss and now markets their iodized salt in Ghana, Ivory Coast, and Kenya where the disorder is also a problem.

Making use of technology

The poor make use of new products and services in unexpected ways. Farmers in India use the internet to chat with their friends, watch movies, and listen to music. They print out their children’s school grades, track global price futures, and use email to get answers on agricultural problems. Women from different villages meet in virtual chat rooms to discuss political and social issues.

As we have seen with Ushahidi and Unilever, solutions to problems and innovations developed in one local market can often be applied to similar markets globally. The Food and Drug Administration and the Center for Disease Control in the US are now using the system that Voxiva developed for monitoring infectious diseases in rural Peru.

Providing clean water and sanitation are elementary effective investments in health; diarrhea can be reduced by up to 95 percent by providing households with clean drinking water. Yet, even today, about one-fourth of the world's population does not have access to clean drinking water, 42 percent do not have a toilet where they live and over a million poor children in South Asia and sub-Saharan Africa die each year from diarrhea. Most of these deaths can be prevented by inexpensive, simple solutions, like adding chlorine to drinking water. In India's villages, the cost of providing tap water and a toilet is about $4 per household: this small investment could reduce severe diarrhea by half and malaria by one-third. A bottle of chlorine costs about 18 cents and lasts for about a month, but only 10 percent of the population in Zambia use it to treat their water. If villagers cannot afford to pay, governments and aid organizations need to step in to subsidize the cost. At the same time, education is necessary so that people clearly understand both the value and application of such interventions: in India, many children die from dehydration because mothers don’t believe that a packet of oral rehydration solution will do any good.

Most successful health initiatives are programs run by aid agencies with the cooperation of local authorities and local health workers. Vaccination programs and programs to eliminate pests are prime examples. But health-care systems are difficult to setup and maintain. They are generally inefficient and merely expanding them would, according to Deaton and others “simply mean more clinics that are open irregularly, more officials diverting funds, and more health-care workers being paid not to do their jobs.” Plus money spent on health care in poor countries is too often used to treat the urban elite while “children die from diseases that could have been treated for a few cents or avoided altogether with basic hygiene practices.”

The Global Alliance for Vaccines and Immunization will buy drugs that are needed in developing countries to give drug companies the needed push. As a result, again according to Deaton, “Children are now being immunized in ten countries against pneumococcal disease, which currently kills half a million children each year.” The importance of immunization is hard for people to understand, because it is difficult to make the link between treatment and absence of disease. Providing incentives can make a difference. When villagers in India were given two pounds of dried beans for each immunization and a set of stainless steel food plates for completing the course, immunization rates increased from 6 percent to 38 percent. People should have easy access to the medicines they need and restricted access to the medicines they don’t need, so that drug resistance is prevented.

Esther Duflo and her colleagues at the Poverty Lab looked at ways to increase
child-immunization rates in India. This study was in New Dehli in 2003.

Many parents in poor countries rely on their children to take care of them in their old age, and having a large number of children increases the likelihood that at least one of them will do so. More than half of the elderly in China live with their children. Most parents invest less in daughters because sons are more likely to care for them in their old age. The result is that in some regions of China, there are 124 boys to 100 girls.

Growing populations put additional stress on the environment and further diminish scarce resources, such as clean water. Women tend to adopt contraceptive practices that conform to the social and religious norms of their community, which means that even when women have a choice, relatives and social norms pressure them to have more children that they would like. In areas that have family planning clinics, fertility rates are lower because even discussing the issue with female health workers lowers the number of children women wish to have. When women have access to contraceptives without their husband’s knowledge, fertility rates drop and the number of unwanted births decreases. Educated women and women who own property are in a better negotiating position with their spouse and family, because they are better able to find a job should the marriage end in divorce. Fertility rates dropped in Peru when women’s names were added to property titles. Changing cultural attitudes via the media has shown some success: after soap operas became popular in Brazil, birth rates dropped to levels more in line with the female characters in the show.

A simple step like making school uniforms free to teenage girls has been shown to decrease teenage pregnancies and encourage girls to stay in school. Of course access to contraceptives makes a bigger difference: pregnancy rates are very high in developing countries where contraceptives are not available. Adolescents can make smart choices if they are fully informed and able to avoid sexually transmitted diseases and pregnancy. Unfortunately, in too many schools, children are told about abstinence, but pregnancy prevention methods, such as condoms, are not discussed.

Although it’s possible that programs which provide for the elderly would make it unnecessary for parents to have so many children, family decision-making is a complicated process that does not always result in what is best for the family. Studies of family farms show that programs that remunerate women benefit the family more than those which pay men. Nevertheless, more resources are allocated to men in spite of the fact that they spend more money on alcohol and tobacco when their crops do better, and women spend more money on food when theirs do better.