Conclusions

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Seven "wows" emerge from a close review of the cases presented in Millions Saved. These cases provide clear evidence that large-scale success in health is possible - countering a common view that the health problems of the developing world are intractable, and that development assistance to health yields few benefits.

1. Major health interventions have worked even in the poorest countries

Success is possible even in the world's most underdeveloped and remote regions, in the face of grinding poverty and weak health systems. The world's poorest countries, where the average citizen earns far less than US$1,000 per year, have seen major public health successes.

2. Donor funding has saved lives

Many of the cases described in Millions Saved succeeded because of help from the international community in the form of grants, development loans, and contributions of expertise and drugs.

3. Saving lives saves money

The costs of successful public health initiatives are dwarfed by the social and economic benefits of eliminating, treating, or controlling the disease.

4. Partnership is powerful

Achieving large-scale success has often required collaboration among diverse partners. National governments, donors, and private companies have combined their resources through innovative partnerships, and international agencies have broken through institutional and bureaucratic walls to work effectively toward a common purpose. While such collaboration is not always easy, the benefits are evident: Some parties bring funding, others bring technical capabilities in public health, and others generate the political will to sustain the effort in the face of competing priorities.

5. National governments can get the job done

The public sector was integral to the successful delivery of services in most cases - in contrast with the view that governments in poor countries are uniformly inept at best and corrupt at worst.

In these instances and others, such as the measles initiative in Southern Africa and the condom program in Thailand, financial support depended not on donors but primarily on local resources - another dimension of the public sector's contribution to success.

6. Health behaviors can be changed

Success often depends on specific efforts to promote appropriate behaviors, rather than just on the introduction of new drugs and technologies.

7. Successful programs take many forms

Successful "vertical" programs - centrally managed, disease-specific initiatives that are isolated from broader health services - are often best known. But many other initiatives have also worked. In several of the success stories, the boundary between a vertical approach and efforts to strengthen health systems is broken down, showing how disease-specific efforts can work with and strengthen routine health service delivery.