Poverty and Human Development has been the major these of over 200 scientific and medical journals this fall. As part of that theme, PLoS Medicine asked a 30 commentators worldwide, “Which single intervention would do the most to improve the health of those living on less than $1 per day?” The respondents ranged from community activists to international experts.
Food, nutrition and related issues were common with 7 mentions. People mentioned direct food support, ensuring food security, exclusive breastfeeding as well as improvements in agriculture policy and land tenure systems that could boost food production. Five people stressed the importance of basic education, especially for females. Cash transfer and credit schemes received 4 mentions, while 4 people stressed basic water and sanitation interventions. There was some overlap in ideas.
Health related interventions fell in two broad categories, health technologies and health systems improvements. Five people suggested direct help that would provide medicines, vaccines and other technologies at the community level. Jeffrey Sachs was the only one to single out malaria when he said that, “n tropical Africa, a mass distribution of free long-lasting insecticide-treated bed nets to fight malaria accompanied by free access to artemisinin-based combination anti-malaria medicines. In other parts of the world, the situation will be different. I should add that I’ve spent years objecting to posing the question this way, since at low cost we could achieve major health advances through more comprehensive approaches.”
Health systems issues, mentioned by 5, were far ranging from community intervention to change in international agencies. Trained community health workers were suggested as the best way to deliver the above mentioned health technologies. Community/consumer participation in health policy formulation was mentioned. One person even suggested that the World Health Organization be made more effective. Better focused health/development aid was another more global approach.
Now that the malaria eradication vision has been put on the table, an economic rational for pursuing that strategy will become very important. We just need to remember that there are many other deserving interventions that will compete for funds and attention. Fortunately, taking a cue from the Millennium Development Goals, we can see the interrelationship among all these health and development issues.