Are these all the global health successes in the past 50 years? No. This book is a sample of successful health interventions, and is by no means a comprehensive or exhaustive list.
Are these all vertical programs? Millions Saved documents many different types of programs, including several that focus on a specific disease or intervention through a stand-alone separate from the routine health system; these are often called "vertical" programs. Other types of programs have also succeeded, however, including overall health system strengthening, legal and regulatory improvements and "classic" public health approaches such as food fortification. Several of these are included in Millions Saved.
Are these programs sustainable? We did not include as a criterion financial sustainability, or the program's ability to continue once donor funding ended. Each of the 17 cases lasted at least five years, some as many as 30, and most continue today.
Are you saying these programs are the best ones -- the ones we should be putting our money into? No, we are not suggesting that this is the list of interventions that should be funded in the future. Instead of recommending specific types of interventions (such as ORT or DOTS), we are offering guidance about the core ingredients that should be present to increase the likelihood that global health programs of all types will succeed. These include predictable, adequate funding, political leadership, technical consensus, good management, the effective use of information, and affordable technical innovations within an effective delivery system.
How do you know these programs worked? In each of the cases, solid evidence - summarized in the respective case studies - confirms that the impact on health is attributable to the specific health efforts rather than to broad economic and social improvements. The case write-ups were based on documentary evidence from scientific articles published in peer-reviewed journals and/or rigorous impact evaluations of the programs, as well as interviews with key informants. Each case write-up was reviewed by technical experts knowledgeable about the case. For more information, see how do we know?.
Are all these countries politically stable, with good governments? Were the starting conditions always favorable? Many of the programs identified in Millions Saved benefited from stable political environments, but progress has been made even where the public sector was very weak. The guinea worm eradication programs, the river blindness programs, and smallpox eradication campaign have all succeeded in reducing or even eliminating entirely disease in some of Africa's least stable countries.
The problems facing the world (e.g., AIDS) now are really different than the problems in the past. Does any of this really apply to today's challenges? In almost all the cases that we now call successes, the challenges seemed extremely daunting - similar to the challenge of the HIV/AIDS crisis around the world. There were moments in each case when the disease seemed insurmountable, the technology was still on the drawing board (or too expensive or unusable in developing country conditions), the funding was nowhere in sight, international agencies were squabbling, and no one appeared ready to take up the challenge. The lessons gleaned from the success in each case - stemming from a combination of science, luck, money, vision, and management talent - provide both inspiration and essential lessons for how major success can again be achieved.
Were these programs all run by donors, with expatriate technical staff? Slightly more than half of the cases in the book relied on donor funding to achieve their objectives. Even in these cases, however, the involvement of the governments and local communities in the affected countries was essential. And in many cases, such as the river blindness programs in Africa, the management and staff were largely African.