Neglecting health systems costs too many lives, states The world health report 2003



Urgent investment and international support is needed to rebuild health care systems in developing countries if global health goals are to be met says The world health report 2003 — Shaping the future, launched in Geneva on 18 December.

The need for a country-level focus on health systems and services has been prompted by the continuing HIV/AIDS pandemic, deadly outbreaks of diseases such as SARS and the challenge of completing polio eradication — all of which are symptoms of the failure to invest in health systems.

"Even before I took office I travelled to China to view the impact of SARS and appreciated the importance of stronger health systems to deal with this latest epidemic," said Dr LEE Jong-wook, Director-General of WHO. "And there will be more to come, hence the urgency of strengthening our ability to respond to and prevent epidemics, whether they be local or global," said LEE.

The need to urgently refocus on health systems is also illustrated by the huge variations in life-expectancy between developing and developed countries. A baby girl born in Japan, for example, can expect to live for about 85 years. A baby girl born at the same moment in Sierra Leone, on the other hand, can expect to live for only 36 years. The girl in Japan will receive some of the world's best health care whenever she needs it but the girl in Sierra Leone may never see a doctor, nurse or health worker.

"These global health gaps are unacceptable," said LEE who highlighted failing health systems as obstacles to progress in achieving the health-for-all goal enshrined in the Alma-Ata Declaration on Primary Health Care 25 years ago. Overcoming the gross health inequalities experienced between and within countries means "working with countries — especially those most in need — not only to confront health crises, but to construct sustainable and equitable health systems," he said. The principle of equitable access to health is central to WHO's current main objective: increasing access to HIV/AIDS treatment in developing countries.

The report says that whilst HIV/AIDS has cut life expectancy by as much as 20 years for many millions of people in sub-Saharan Africa, even without the impact of this disease, millions of children born in African countries today are at greater risk of dying before their fifth birthday. The risk for women dying in childbirth, says the report, is 250 times higher in poor countries than in rich ones. Some of the 500 000 deaths which occur each year as a result of complications during pregnancy could be avoided by improvements in health care systems.

Comprehensive health care systems must include prevention and control of noncommunicable diseases, the report says, highlighting the spread in developing countries of epidemics of heart disease, stroke and other chronic diseases which in addition to communicable diseases create what it refers to as a "double burden."

The report appeals for international support in countering some of the main weaknesses in health care systems including critical shortages of health care workers, inadequate health information, a lack of financial resources and the need for more government leadership aimed at improving the health of the poor.

"Effective action to improve population health is possible in every country but it takes local knowledge and strength and sustained international support to turn that possibility into reality," said LEE.

World Health Organization Genebra - Genebra - Switzerland
E-mail: bulletin@who.int