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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.
Tens of thousands of poor communities throughout central and east Africa have reduced the prevalence of river blindness through their management of local delivery of the antibiotic ivermectin.
In Bangladesh, health workers used house-to-house visits to bring needed health commodities and information to low-income women who, for cultural reasons, could not venture far from home.
Throughout sub-Saharan Africa, a campaign to eradicate guinea worm disease overcame the challenge of reaching thousands of remote villages that were outside the national public health infrastructure - and in some instances were not even known to the government - and reduced the disease's prevalence by 99%.
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.
In Egypt, for example, it was a program funded by the USAID and supported by technical expertise from the WHO that contributed to the prevention of 300,000 child deaths from dehydrating diarrheal disease between 1982 and 1989.
In China, it was a project financed by a World Bank loan and buttressed by WHO guidance that prevented 30,000 cases of TB each year.
In Morocco, the donation of antibiotics by Pfizer has helped reduce the prevalence of blinding trachoma by 75%.
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.
For example, a tuberculosis program in China treated more than 1.5 million patients over 10 years at a total cost of $130 million, preventing 30,000 TB-related deaths annually and averaging just $15-20 for each healthy life-year saved. The economic returns were enormous: Each dollar invested in the program generated $60 in the form of savings on treatment costs and the increased earning power of healthy people.
Similarly, efforts to control river blindness in sub-Saharan Africa between 1974 and 2002 cost less than $1 per protected person and prevented 60,000 cases of blindness. As a result of the program's positive impact on health, an estimated $3.7 billion will accrue from improved worker and agricultural productivity.
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.
The guinea worm disease eradication campaign benefits from the participation of a large number of partners - the Carter Center, the US Centers for Disease Control and Prevention, UNICEF, WHO, the Bill & Melinda Gates Foundation, the World Bank, the UN Development Program, nongovernmental organizations, more than 14 donor countries, private companies (including Dupont and Precision Fabrics Group, which have donated more than US$14 million worth of cloth for water filters), and the governments of 20 countries in Asia and Africa.
The international effort to control onchocerciasis has relied on the long-term participation of the World Bank, WHO, UNDP, the Food and Agriculture Organization, the governments of 19 African countries, 27 donor countries, more than 30 nongovernmental development organizations, Merck, and more than 80,000 rural communities.
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 the southern cone of Latin America, ministries of health collaborated across borders to greatly diminish the threat of Chagas disease.
In Sri Lanka, the reduction in maternal mortality was due to a 60-year commitment to the provision of public services.
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.
In some of Africa's most remote and disadvantaged villages, for example, families changed traditional water-handling practices and learned to filter their water to prevent guinea worm disease.
In Bangladesh, mothers learned - and now teach their grown daughters - how to mix clean water with a simple salt-and-sugar solution to prevent childhood deaths from dehydrating diarrheal disease.
And in Poland, which had the highest cigarette consumption in the world before 1990, smoking rates have plummeted as a result of a combination of taxation, health education, and legal restrictions on tobacco consumption, sales and advertising.
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.
For example, the polio eradication campaign in Latin America has strengthened the health infrastructure and surveillance systems and improved the region's ability to detect and control other health threats, such as measles, cholera, and tetanus. In addition, the health planning models developed by the national governments during the polio campaign have strengthened the governments' management capabilities and have expanded to cover broader mother and child issues.
In the effort to control river blindness in central and east Africa, the community-directed model of antibiotic delivery has demonstrated a valuable entry point for expanding primary health care in communities that have little or no access to health care.