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Indian Journal of Medical Science Vol. 58 No. 1, January 2004 , pp. 30-40 News The World Health Report 2003: Urgent work needed to rebuild health care systems Code Number:ms04006 Health care systems must be strengthened through focused action in countries if global health goals agreed by the international community are to be met, according to a new report published by the World Health Organization (WHO). The health care services of most developing countries require urgent investment and international support, says The World Health Report 2003 - Shaping the Future. The renewed focus on health systems and services involves all areas of WHO work: the "3 by 5" initiative to increase the availability of antiretroviral treatment for HIV/AIDS; a newly refocused drive to reduce maternal mortality; and work on chronic diseases and mental health. All of these initiatives contribute to the development of better health care in countries - and all require stronger health systems to succeed. The urgency of the challenge faced today is illustrated by the contrasting prospects of baby girls born at the same moment in Japan and Sierra Leone. While the baby born in Japan can expect to live for about 85 years, life expectancy for the child in one of Africa's poorest countries is just 36 years. The Japanese girl 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. Health for all remains the goal "These global health gaps are unacceptable," said Dr LEE Jong-wook, Director-General of WHO. "Twenty-five years ago, the Declaration of Alma-Ata on Primary Health Care challenged the world to embrace the principles of health for all as the way to overcome gross health inequalities between and within countries," said Dr Lee. "The principles defined at that time remain indispensable for a coherent vision of global health. Turning that vision into reality calls for clarity both on the possibilities and on the obstacles that have slowed and in some cases reversed progress towards meeting the health needs of all people. This means working with countries - especially those most in need -not only to confront health crises, but to construct sustainable and equitable health systems." "To lend impetus to this process WHO is now making the achievement of results in countries its main objective", Dr Lee said. Lessons learned from tackling major health challenges including SARS, HIV/AIDS, polio eradication and tobacco use demonstrate that millions of people could be saved from premature death and years of disability through a combination of financial aid and targeted improvements in health services, says The World Health Report 2003. The report confirms that HIV/AIDS has cut life expectancy by as much as 20 years for many millions of people in sub-Saharan Africa. Every day in the poorest African countries, 5,000 men and women and 1,000 children die from HIV/AIDS. Today only 5% of all those people living in the developing world who require antiretroviral treatment for HIV/AIDS actually receive it: a treatment gap which WHO declared a global health emergency in September 2003. "The WHO goal of universal access to HIV/AIDS treatment, with the concrete target of providing treatment to three million people in the poorest countries by the year 2005 is a clear demonstration of how the principle of equitable access can be put into practice," said Dr Lee. "Working with our partners, we will show that investments we make in treating people with AIDS can help to build up health systems for the benefit of all." "To meet the major health challenges facing the world, WHO is fundamentally changing the way we work. We are committed to combining new technologies with proven approaches to provide better health care for all." Global health gaps in life expectancy growing Today's global health situation raises urgent questions about justice. In some parts of the world there is a continued expectation of longer and more comfortable life, while in many others there is despair over the failure to control disease although the means to do so exist. The report points out that even without the impact of HIV/AIDS, millions of children born in African countries today are at greater risk of dying before their fifth birthday than they were a decade ago. In developing countries, communicable diseases still represent seven out of the ten major causes of child deaths. Some of the leading killers in 2002 were:
The gap between developed and developing countries is also made starkly clear in the shocking statistics on maternal mortality. The risk for women of dying in childbirth is 250 times higher in poor countries than in rich ones. More than 500,000 women die each year as a result of complications during pregnancy. Chronic diseases are the biggest killer of adults The report also highlights the spread in developing countries of epidemics of heart disease, stroke and other chronic diseases, which in addition to communicable diseases create a "double burden" of premature death and ill-health. The report proposes a "double response" to this burden by integrating prevention and control of both communicable and noncommunicable diseases within a comprehensive health care system. Of the 45 million deaths among adults worldwide in 2002, almost three-quarters were caused by noncommunicable diseases. These are the main cause of death in all regions, except Africa where HIV/AIDS has become the leading cause of mortality among adults aged 15_59 years. In this age group, the leading killers in 2002 were:
Neglect of health systems has international consequences The continuing HIV/AIDS epidemic, deadly outbreaks of diseases such as SARS and the challenge of completing the eradication of polio are all symptoms of a failure to invest in health systems. This failure can have rapid and devastating international consequences, the report says. "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. 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 Dr Lee. The lessons learnt from such health emergencies are helping to shape strategies for an urgent health system response to the prevention and care of HIV/AIDS. This will involve complex health interventions that WHO recognizes as being not only feasible in resource-poor settings, but precisely what is needed. "The experience we will gain in responding to HIV/AIDS will eventually be applicable to the full range of chronic conditions, from diabetes to stroke," said Dr Lee. The report suggests ways in which international support can counter some of the main health care systems weaknesses, including critical shortages of health workers, inadequate health information, a lack of financial resources and the need for more government leadership aimed at improving the health of the poorest members of society. The report calls for rapid increases in training and employment of health care workforces, and stronger government-community relationships. "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. We have learned this through successes such as controlling the SARS epidemic and major advances in the polio eradication campaign, and we have learnt it through setbacks as well, such as the continuing rise of AIDS, TB and malaria. All of these lessons have prepared us for the tasks ahead," said Dr Lee. Source: http://www.who.int/mediacentre/releases/2003/pr93/en/ Information Interventions May Help Individuals Make Cancer Screening Decisions Brochures and web-based information that individuals access independently may help them make appropriate decisions about cancer screening, says a report by the Task Force on Community Preventive Services in the January 2004 issue of the American Journal of Preventive Medicine. This type of information is increasingly needed because the science related to cancer screening is difficult to communicate in an office visit, and many persons at high risk don't have regular health care and must make decisions on their own. The review showed that brochures and web information may help individuals make informed decisions about whether and when to be screened and the type of screening when multiple choices are available. "We know that making decisions about cancer screening can be difficult for individuals and their families," said Dr. Julie L. Gerberding, director of the Centers for Disease Control and Prevention (CDC). "These findings from the Task Force provide important insight about how public health can communicate effectively about the risks, benefits and other outcomes associated with screening." The task force reviewed interventions designed to help people make specific choices among options (including not being screened or deferring the decision). The review produced evidence that interventions generally led to increased knowledge about cancers and their associated screening tests. The review did not determine whether such strategies could help patients participate in decision making at the level they desire, result in decisions that are consistent with patient values and preferences, or improve screening rates. The authors note that while screening tests are available for many types of cancers, the effectiveness of screening for all types of cancer has not been proven. The findings are the result of a systematic review of the literature on informed decision- making interventions conducted by the independent Task Force on Community Preventive Services, which is supported by the CDC. Informed decision making occurs when individuals have enough information about a disease, the screening test for it, and their personal risk level to make a choice that reflects their preferences and values, and allows them to participate in decision making at the level they choose. The Task Force on Community Preventive Services, established in 1996, is the community-based counterpart to the U.S. Preventive Services Task Force, considered the gold standard for clinical preventive services. The Task Force releases its findings to a wide variety of public health decision makers as the Guide to Community Preventive Services. To date, 88 Community Guide findings have been published, providing new guidance for public health leaders making decisions about the application of limited public health resources. Source: http://www.cdc.gov/od/oc/media/pressrel/r031216b.htm Guidelines for Infection Control In Dental Care Settings The first comprehensive recommendations in 10 years for dental infection control were released today by the Centers for Disease Control and Prevention (CDC). The new document, Guidelines for Infection Control in Dental Health-Care Settings, 2003, updates previous guidelines issued in 1993 and 1986 and consolidates recommendations from other relevant CDC guidelines and standards as well as those of other major infection control organizations. The new Guidelines use the broader term "standard precautions," which are protocols to protect against exposures to blood, other body fluids including saliva, mucous membranes, and broken skin, rather than "universal precautions," which are measures intended only to prevent exposures to blood. Developed by CDC staff in collaboration with a working group of infection control experts, the two-part document contains a review of the scientific evidence regarding dental infection control issues plus consensus, evidence-based recommendations. The 2003 Guidelines cover several issues not specifically addressed in earlier CDC dental guidelines. These issues include management of occupational exposures to infectious microorganisms transmitted through contact with blood and other body fluids; dental unit water quality; selection and use of dental devices with features designed to prevent needlesticks and other injuries from sharp objects; hand hygiene products including alcohol handrubs; latex hypersensitivity; dental radiology; and program evaluation. The 2003 Guidelines also address management of personnel health and safety issues in dental practices. "Proper infection control procedures can prevent transmission of diseases to patients and dental health care personnel, said Dr. William Kohn, Associate Director for Science in CDC's Division of Oral Health. "This new document provides the latest information to assist the dental profession in maintaining its already strong record of safe dental care." The new Guidelines also consider needs for future research on infection control. Some of those identified include: determining optimal method and frequency of testing dental unit waterlines to maintain water quality standards; developing devices with passive safety features to prevent injuries; more clearly characterizing the epidemiology of blood contacts and related prevention measures; and evaluating design of strategies to communicate the risk of disease transmission in dentistry to the public. The CDC Division of Oral Health seeks to improve the oral health of communities by extending the use of proven strategies to prevent oral diseases, enhancing monitoring of oral diseases, strengthening the nation's oral health capacity, and guiding infection control in dentistry both domestically and internationally. The full report, Guidelines for Infection Control in Dental Health-Care Settings, 2003, can be found at www.cdc.gov/mmwr. For more information about infection control practices in dental care settings, please visit our Web site at www.cdc.gov/oralhealth/infectioncontrol. Source: http://www.cdc.gov/OralHealth/pressreleases/NewGuidelines.htm Rapid Increases in Newer HIV Epidemics in Asia and Eastern Europe The global AIDS epidemic shows no signs of abating. Five million people became infected with HIV worldwide and 3 million died this year alone _ the highest ever. The findings are featured in "AIDS Epidemic Update 2003," a comprehensive new report on the global HIV/AIDS epidemic issued today by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) in advance of World AIDS Day, commemorated on 1 December. One in five adults across southern Africa are now living with HIV/AIDS, the highest rate since the beginning of the epidemic. While infection rates across sub-Saharan Africa vary widely, from less than 1% in Mauritania to almost 39% in Botswana and Swaziland, the breadth of the epidemic indicates that HIV/AIDS now has a firm hold on most countries in the region. In several countries in sub-Saharan Africa, high levels of AIDS mortality now match the high rate of new infections, creating a cycle of illness and death due in great part to the almost complete absence of large-scale HIV prevention or antiretroviral treatment programmes. According to the new report, an estimated 40 (between 34 and 46)* million people are living with HIV worldwide, including 2.5 (between 2.1 and 2.9) million children under the age of 15. Globally, an estimated 5 (4.2-5.8) million people were newly infected and 3 (2.5-3.5) million people died of AIDS in 2003. Sub-Saharan Africa, the most severely affected region of the world, accounted for over 3 million of these new infections and 2.3 million AIDS deaths. Every day in 2003 an estimated 14,000 people were newly infected with HIV. More than 95% of those live in low- and middle-income countries. "The world is now mounting a greater response to AIDS through individual initiatives like the US Government's Emergency Plan on AIDS and the Global Fund to Fight AIDS, TB and Malaria," said Dr Peter Piot, UNAIDS Executive Director. "However it is quite clear that our current global efforts remain entirely inadequate for an epidemic that is continuing to spiral out of control. AIDS is tightening its grip on southern Africa and threatening other regions of the world. Today's report warns regions experiencing newer HIV epidemics that they can either act now or pay later - as Africa is now having to pay." AIDS Maintains a Stranglehold in Africa, Hitting Women Disproportionately An estimated 26.6 (25-28.2) million people in sub-Saharan Africa were living with HIV in 2003, and an estimated 3.2 (3-3.4) million people in the region were newly infected during the past year. About 30% of people living with HIV/AIDS worldwide live in southern Africa, an area that is home to just 2% of the world's population. South Africa alone was home to an estimated 5.3 million people with HIV at the end of 2002 — more than any other country in the world. "The most devastating social and economic impacts of AIDS are still to come," said Dr Piot. "Widespread treatment access would substantially mitigate the devastating impact of HIV/AIDS, which affects everything from agriculture to national defense. Effective HIV prevention programmes must be scaled up dramatically if we want a realistic chance at reducing the number of new infections." The epidemic is particularly devastating for women in sub-Saharan Africa, where women are more likely to be infected with HIV than men. Among young people this discrepancy is particularly high, with young women aged 15-24 up to 2.5 times more likely to be infected than young men in the same age group. Rapid HIV Spread in Many Regions Driven by Injection Drug Use, Unsafe Sex A new wave of HIV epidemics is threatening China, India, Indonesia and Russia, mostly due to HIV transmission through injecting drug use and unsafe sex. The new UNAIDS/WHO report presents many clear warning signs that Eastern Europe and Central Asia could become home to serious new HIV epidemics. Prevalence rates in these regions continue to grow and show no signs of abating. Young people are among the hardest hit by HIV/AIDS in this part of the world. While young men still bear the brunt of the epidemic, 33% of those infected at the end of 2002 were women, up from 24% the year earlier. Despite the growing prevalence of HIV infection, too little prevention outreach, such as safe sex education or adoption of safer injection techniques, is being employed in these areas. The epidemic is also growing in areas where, until recently, there was little or no HIV present, including many areas in Asia and the Pacific. Recent rapid increases in HIV infections in China, Indonesia, and Viet Nam show how suddenly an epidemic can erupt wherever significant levels of drug injecting occur and, as seen in Eastern Europe, illustrate the urgent need to increase prevention efforts before the epidemic expands beyond high-risk groups. Response, While Improving, Falls Far Short of What is Needed "AIDS Epidemic Update 2003" notes that the response to HIV/AIDS as measured by spending and political action has improved dramatically in recent years, but improvements are still far too small and slow in coming to adequately respond to the growing global epidemic. The report indicates that the rapid scale-up of treatment access is urgently needed to help avoid the devastating effects of millions of anticipated illnesses and deaths. In an effort to scale up treatment, the World Health Organization, the convening agency for HIV care in UNAIDS, and partners are developing a comprehensive global strategy to bring antiretroviral treatment to 3 million people by 2005, known as the `3 by 5' initiative. "The World Health Organization will unveil detailed implementation plans for `3 x 5' next week, to coincide with the commemoration of World AIDS Day," said Dr LEE Jong-Wook, Director-General of the World Health Organization. "This represents an unprecedented drive to increase the number of people receiving treatment. For `3 x 5' to succeed, however, and for treatment access to increase further in the future, the international community must continue to increase its financial and logistical support." In addition to treatment gaps, the report finds that surprisingly little is being done to implement even the most basic cost-effective HIV-prevention efforts. Prevention resources remain scarce, especially in sub-Saharan Africa where, outside of Senegal and Uganda, few prevention success stories can be identified. In many of the hardest-hit countries, there are no national orphan programmes in place, coverage of voluntary counselling and testing is threadbare, and prevention of mother-to-child HIV transmission is virtually non-existent. "With increased focus on the urgent issue of access to treatment, there is also a danger that the equally important issue of prevention will continue to be overlooked," said Dr Piot. "There has been an upsurge in the past few years in political support, policy formulation, and funding on HIV/AIDS. This momentum must be maintained and expanded — for both treatment and prevention — if the epidemic is to be reversed." "AIDS Epidemic Update 2003" also notes that close to 40% of countries that have reported on progress made in implementing the Declaration of Commitment on HIV/AIDS (adopted at the UN General Assembly Special Session on HIV/AIDS in 2001) have not yet adopted legislation to prevent discrimination against people living with HIV/AIDS. Such legislation is vital to prevention efforts, as it can help individuals get tested for HIV without fear of persecution and discrimination. Combating HIV-related stigma and discrimination is the theme of the UNAIDS World AIDS Campaign this year. Improved Epidemiological Surveillance While last year's "AIDS Epidemic Update" estimated the total number of people living with HIV to be 42 million, improved epidemiological monitoring shows that the population living with HIV, while continuing to grow, is slightly smaller than previously believed. The report emphasizes that this apparent reduction reflects an improvement in HIV surveillance only, and does not represent a decrease in either infections or illnesses - both of which continue to rise. To emphasize the need for better HIV surveillance in many countries, the report this year also includes ranges for the HIV/AIDS estimates provided. Improved data and understandings of the epidemic are vital for effective planning and programming at country and regional levels. Source: http://www.who.int/mediacentre/releases/2003/prunaids/en/ The Health Academy: The first step towards a virtual school to promote public health world-wide The World Health Organization (WHO) announced on 11 December 2003 the launch of the Health Academy, in collaboration with Cisco Systems, Inc. The Health Academy is a novel approach to improve health through information technology. It will provide the general public with health information and knowledge required for preventing diseases and following healthier lifestyles. The mission of the Health Academy is to demystify medical and public health practices and to make the knowledge of health specialists available to all citizens of the world through Internet-based technology. It will promote good health by explaining essential public health functions in a language that all people can understand, taking into consideration their individual cultural sensitivities. Two pilot studies spanning the 2003-2004 academic year have just begun, one in Egypt and the other in Jordan. The studies are directed at 12 to 18 year old students in 20 schools in Egypt and 21 schools in Jordan. Based on this experience, the Health Academy may be expanded in the two pioneer countries as well as in other countries and regions of the world. "The Health Academy provides unprecedented opportunities for effective health promotion through people-centred partnerships" said Dr LEE Jong-wook, Director-General of WHO. "It is more than just education; it is a means to influence attitudes and behaviour towards a healthier lifestyle, which in turn may help reduce gaps between prosperity and poverty and health and sickness", Dr LEE added. The e-learning technology used by the Health Academy is more than just distance learning. It allows the learner to construct from first principles the very essence of what is being taught and to build on this knowledge. This approach helps to develop critical thinking and enhances concentration capacities. The curriculum is exciting to both educators and students, as it is a truly interactive mix of different media technologies. WHO's rich information resources and expertise in health issues, as well as its worldwide access to health information in all countries, is the main source of validated health content for the Health Academy. Cisco Systems is responsible for the provision and deployment of information technology, and the development of the e-learning methodology. "Cisco is proud to collaborate with the World Health Organization in this pioneering effort to extend health education to the world, in building stronger, healthier and more productive global communities", said Mr John Morgridge, Chairman of the Board, Cisco Systems. "Using Internet technology to advance learning has global reach and is a timely and stimulating way to deliver important curriculum to developed and developing countries around the globe." The launch of the Health Academy was made at the Geneva Press Club, in the presence of Dr Sherif HASHEM, First Secretary to the Minister of Telecommunications of Egypt, and H.E. Dr Fawaz Zu'bi, Minister of Telecommunications and Information Technology of Jordan, The project was also welcomed by Mr Hamadoun Touré, Director of Telecommunications development at the International Telecommunication Union, Mr Erkki Liikanen, European Commissioner and Baronness Nicholson of Winterbourne, Member of the European Parliament. The educational process will not stop at the participating users enrolled in the courses. Once the Health Academy is established, the equipment and courses provided can be used in the evenings by parents and the general public under the guidance of the mentors. This could have important benefits in improving the teacher-parent relationships as well as educating people of all age groups in the use of the computer, accessing Internet and in the subjects selected. In addition, the Health Academy may be extended to community Internet centres and other points of access. As such, it is one way that health development will become entrenched in societies with access to information technology. Free life-saving medicines for half a million patients suffering from tuberculosis Half a million of the world's poorest tuberculosis patients are to benefit from free life-saving drugs under an agreement signed today by the World Health Organization (WHO) and the pharmaceutical company, Novartis. Novartis will donate the drugs to the Global Drug Facility, which is hosted by WHO and operated by the Stop TB Partnership. The facility has supplied procurement support and medicines to 2.8 million TB patients in 65 countries since its launch. The drugs will be provided over a five-year- period to countries scaling up TB control with support from the Global Fund to fight AIDS, Tuberculosis and Malaria. WHO Director-General Lee Jong-wook welcomed the agreement as a major contribution to TB control. "Novartis has taken a strong lead in fighting tuberculosis and we encourage other drug manufacturers to follow their example. Massive investment in patient care from the pharmaceutical industry will have an enormous impact on reducing the TB death toll," he said. TB kills almost two million people every year. In Africa , lack of access to quality drugs is a key constraint to fighting tuberculosis and the TB/HIV co-epidemic. The Chairman of the Stop TB Coordinating Board, Ernest Loevinsohn, welcomed the donation as an important contribution to the goals of the Global Drug Facility. "In less than three years, the Global Drug Facility has played a vital role in strengthening TB control programmes and ensuring access to life-saving drugs for patients in the poorest countries. The donation from Novartis recognizes this role and will enhance the Global Drug Facility's capacity to fulfil its commitments in the coming years." Under the agreement, Novartis will manufacture special patient kits containing fixed-dose combination tablets* in blister packs. The design improves patient compliance and greatly reduces the risk of developing drug-resistant TB, which is far more costly and difficult to treat. The drugs will be supplied free of charge to programmes using DOTS, the internationally recommended strategy for TB control. More than 10 million people have been successfully treated under DOTS since 1993, when WHO declared TB to be a Global Emergency. * The fixed-dose combination tablets used in the initial intensive two month phase contain 150 mg Rifampicin, 75 mg Isoniazid, 400 mg Pyrazinamide, 275 mg Ethambutol. The fixed-dose combination tablets for the four month continuation phase contain 150 mg Rifampicin, 75 mg Isoniazid. Source: http://www.who.int/mediacentre/releases/2003/pr94/en/ CDC Launches "Preventing Chronic Disease" to Connect Public Health Research and Practice The Centers for Disease Control and Prevention today announced the launch of a peer-reviewed electronic journal, Preventing Chronic Disease: Public Health Research, Practice, and Policy (PCD). The journal will focus on prevention, screening, surveillance, and population-based programs that address the leading causes of the death and disability in the United States. "Many chronic diseases are largely preventable, and we have the science needed to help Americans lead healthier, longer lives. This free online journal will make the latest prevention research accessible to doctors, public health professionals and others who can put it to work and improve Americans' health," said HHS Secretary Tommy G. Thompson. The first issue of PCD (available online at www.cdc.gov/pcd) includes a video about tobacco control programs and articles about nutrition, dementia surveillance, osteoporosis, population-based interventions for communities of color, diabetes prevention, law, school health, and community-based research and partnerships. Contributors include David L. Katz of Yale, who writes a regular health column for 0 Magazine, and S. Leonard Syme, emeritus professor of epidemiology at the University of California at Berkeley. Chronic diseases are responsible for seven of 10 deaths in the United States or more than 1.7 million deaths each year. The treatment of chronic diseases accounts for 75 percent of the $1.3 trillion spent each year on health care in the United States. "Public health is at a crucial turning point _ we have never had more challenges, but we have also never had more opportunities to make such a difference in the health and well-being of every American. This e-journal provides a unique opportunity to share results and ideas with public health professionals and promote the idea of preventing, rather than simply treating, chronic disease," said Lynne Wilcox, editor-in-chief of Preventing Chronic Disease: Public Health Research, Practice, and Policy. The journal is currently accepting manuscripts from scientists and public health practitioners in academia, industry, government service, and the community. The journal will be published quarterly. To submit a manuscript or to sign up for a free subscription, visit www.cdc.gov/pcd. Subscribers to PCD will benefit from the e-journal's multimedia capabilities, including audio and streaming video presentations. Additionally, all articles and transcripts will be available for download. Source: http://www.cdc.gov/od/oc/media/pressrel/r031215.htm
The alarming spread of polio in West Africa is now the biggest threat to global eradication of the disease, UNICEF Executive Director Carol Bellamy told leaders of the Economic Community of West African States (ECOWAS) on 19 December 2003. Two West African countries - Nigeria and Niger - now account for almost half the world's total polio caseload, according to the Global Polio Eradication Initiative (GPEI), a partnership including UNICEF, WHO, Rotary International and the U.S. Centres for Disease Control and Prevention (CDC). "This year, West Africans have put down their arms in Liberia and in Cote d'Ivoire, liberating millions of children from conflict," said Bellamy, speaking at the ECOWAS Heads of State Summit in Accra. "Now children urgently need the same vision and decisiveness from their leaders to stop polio, before the disease spreads out of control in the region." Nigeria is at the root of the recent surge of polio across West Africa. With more cases of the disease than any other nation, Nigeria has been identified as the source of recent polio importations into Ghana (8), Burkina Faso (7), Chad (3), Togo (1). Responding to these importations cost the world over $20 million in 2003. Much of this cost could have been avoided by improving countries' routine immunization services, to protect children against polio and a whole host of other childhood disease, said Bellamy said. "Too many children in West Africa are absolutely defenceless against preventable childhood disease, creating the perfect conditions for epidemics," she said. "With polio in Nigeria on the rise and spreading, West African nations have to make routine immunization the backbone of their national polio defence. It's a case of balancing an investment in child health against the cost of responding to polio importations." Bellamy presented a "four-point plan" to stop transmission of polio in West Africa by end-2004: eliminate the virus in the remaining reservoirs in Nigeria and Niger, immunize every child in West Africa with the polio vaccine during 2004 polio immunization campaigns, strengthen national routine immunization, and develop rapid-response plans to manage imported viruses. To tackle polio and other major regional problems, Bellamy welcomed with "great optimism" the formal adoption of the ECOWAS Peer Review on the Situation of Children - a landmark initiative which provides a forum for West African leaders to evaluate how well each nation is meeting the needs of its young people. This forum is so important, she stressed, because only through regional accountability for child welfare will West Africa make real progress on problems like polio eradication, child trafficking and HIV/AIDs, issues that transcend national borders. She encouraged Heads of State to use the Peer Review mechanism as a unique opportunity to broaden children's participation in issues concerning their welfare. "Children will tell us whether we are living up to our promises and making real improvements in their situation," she said. "When their voices are heard, they can be true agents of change." For many children in West Africa, says Bellamy, the situation remains "desperate". In 2003, approximately 46% of girls in West Africa were out of school, tens of thousands were trafficked across borders for labour and sexual exploitation and over 2.2 million were orphaned by the HIV/AIDS pandemic. "When crises are on this scale, countries cannot tackle them alone; regions must face them together," she said. UNICEF is funded entirely by the voluntary contributions of individuals, foundations, businesses, and governments. Contributions to UNICEF's ongoing support for the Global Polio Eradication Initiative can be made at http://www.supportunicef.org/ Source: http://www.unicef.org/media/media_18257.html Copyright by The Indian Journal of Medical Sciences |
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