Jew World Order

Co-authored with Sonia Sachs and Prabhjot Singh

In Africa’s Millennium Villages (MVs), local communities are taking many actions in health care, agriculture, education, and other challenges to achieve the Millennium Development Goals. Their hard work is paying off. In just three years, the mortality rate among children under five dropped by 22 percent. This pace is three times faster than national trends in the rural areas, and is fast enough to achieve the Millennium Development Goal for child mortality (MDG 4). These results, detailed in a Lancet study published today, reinforce the global effort to build effective, low-cost, community-led health care systems that can end millions of deaths of young children and pregnant women each year.

The Millennium Villages are representative of the most impoverished settings across sub-Saharan Africa, where the rate of child mortality is fifteen times higher than in developed economies. High child mortality is caused mainly by diarrhea, pneumonia, malaria and HIV infection, all made more severe by under-nutrition, and from unsafe childbirths taking place at home without skilled personnel. These conditions go unsolved because of weak and under-financed health systems. The Millennium Villages strategy is to build a highly effective, low-cost health system to address the range of infectious diseases, nutritional deficiencies, and risks related to childbirth.

The new Millennium Village health system is starting to show notable results. Together with advances in food production and other related areas in the villages, the MV health system shares credit for the rapid gains reported today in the Lancet. Across the 9 countries included in the Millennium Villages Lancet study (Ghana, Kenya, Malawi, Mali, Nigeria, Rwanda, Senegal, Nigeria, Tanzania, and Uganda), five elements of the new health systems are re-defining what is possible in rural poor settings in sub-Saran Africa:

1. Community Health Workers. The Community Health Workers (CHWs) are the cornerstone of the community-based delivery system in the MVs. Community Health Workers are villagers who are rapidly trained, paid, supervised to serve as a lifeline between clinics and the community. They make systematic house-to-house visits in their zone, and are frontline responders for emergencies. Armed with mobile phones and rapid diagnostic tests, CHWs use well-defined procedures that are proving highly beneficial for mothers and children. The Earth Institute has led a technical taskforce on scaling up 1 million CHWs for sub-Saharan Africa that shows just how low-cost and effective they are, at around5.50 per person served per year.
2. Procedures and Decision Support: The simple idea of a checklist has been pioneered in operating rooms and hospitals throughout the world. It is equally critical for community health delivery, and can make life-and-death events like childbirths much less vulnerable to human error. In the rural clinics across the Millennium Villages, a simple protocol called “Helping Babies Breathe” – supported by the American Academy of Pediatrics – is a simple way of saving the lives of newborns that would otherwise die in the first “golden minute” of their lives when they need help to take the first breath. The United Nations Innovations Taskforce is identifying some of the most high value protocols and decision support tools for use throughout low-resource health systems.
3. Mobile phones for health management: Mobile phones are revolutionizing how poor, rural communities can escape from poverty. In the Millennium Villages, CHWs use their mobile phones to connect with clinics and with computerized “expert systems” by text messaging. These systems support the CHWs in treatment procedures (such as for malaria) and for the identification and follow up of malnourished children.
4. Low-cost devices for disease detection and management: When a young child becomes seriously ill, every second counts and often the family can’t get the child to a clinic on time. A CHW coming to the household can use a specially designed measuring tape to detect easily a severely malnourished child who needs a skilled health specialist. A malaria rapid diagnostic test can lead from detection to diagnosis to treatment in 20 minutes, and can do so at the family’s home. A specially designed low-cost timer can help a less expert eye detect if a child with a fever is breathing too fast, indicating a likely pneumonia. Many conditions are life threatening but preventable and treatable. The Millennium Villages has applied the pioneering work of innovators to rethink in fundamental ways the design of low-cost health systems.
5. Verbal Autopsies and Management Responses: There are many possible reasons why mothers and children die unnecessarily in rural areas. Perhaps their illness was not diagnosed. Perhaps they could not get to a clinic. Perhaps they didn’t receive adequate care at the facility. By carefully tracking the likely cause of deaths on every occasion, health systems can learn about their own weaknesses, and take corrective actions. The Millennium Villages have therefore implemented a “verbal autopsy” system to try to account for each death of mothers and children, and to use this information to strengthen the health system.

These five elements represent systematic investments in primary health delivery that feature prominently in the Millennium Villages. Of course these systems also depend on remarkable and committed people in each community. Yet the systems approach empowers these people, and improves their productivity and ability to save lives. Without such a systematic approach, even the most dedicated workers are likely to fall short, grow frustrated, and perhaps leave the effort.

Today, approximately one out of every eight children in sub-Saharan Africa dies before his or her fifth birthday from preventable and treatable causes. These deaths are preventable through the deployment of effective, low-cost health systems of the kind being pioneered in the Millennium Villages. The communities are making rapid progress, and are inspiring their neighbors and national governments to learn from these successes. We continue to see rapid progress as new technologies, smart phones, wireless broadband, and improved medicines and diagnostic tests come to the aid of poor communities. With teamwork and global partnerships, these successes can be extended throughout the world’s poorest villages. Health for all, long a dream of humanity, can become a reality in the coming years.

Dr. Sonia Sachs is Director of Health, Millennium Villages Project.
Dr. Prabhjot Singh is Assistant Professor of International and Public Affairs and leads the System Design Group of the Millennium Villages Project.

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