Seeing the Big Picture in Global Health….for Children’s Sake

There is perhaps no measure of a country’s health situation as telling as the health of its children. Children are often the most vulnerable members of society, especially when they are living in areas affected by conflict and/or have been displaced. According to the World Health Organization (WHO) 2005 edition of the World Health Report, the following diseases were the top causes of death for children under five throughout the world.

Neonatal Conditions*, 37%
Lower respiratory infections, 19%
Diarrhea, 18%
Malaria, 8%
Measles, 4%
HIV/AIDS, 3%

*This includes pre-term birth, birth asphyxia, and infections

We’ve seen some successes in the past year. In 1988, there were 350,000 cases of polio worldwide. Now there are approximately 1185. Between 1999 and 2003, deaths from measles have decreased by 39%, but are still much too high in many parts of Africa.

HIV/AIDS is an exceptional global health issue that merits attention. We’ve seen more funding and attention in 2005 than ever before. From a maternal/child health perspective though, one sees that the major causes of mortality are often overlooked. Based on media coverage alone, who would guess that respiratory infections kill more children in Cambodia than HIV/AIDS? Or that diarrhea kills more children more malaria, measles, and HIV/AIDS combined?

Alarmingly, the report estimates that poor or delayed care seeking may result for as much as 70 percent of deaths in children under five. This report shows us how important community-based health programs are in countries such as Haiti. In the few years that I have left Haiti, the cost of gasoline, and by extension, transportation has gone up. The ride from my village to the nearest city which once cost 25 gourdes has more than doubled. As the country grows poorer, people’s mobility is increasingly limited. When I arrived in Haiti, I would often see a group of people taking a sick friend or family member to the hospital by carrying him or her on a bed hoisted onto their shoulders. After Project Medishare established a clinic in Thomonde, that was no longer necessary.

The solution is community based health programs that are comprehensive, culturally competent, and focused on the needs of the people being served. Partners in Health has worked with partners such as Project Medishare to build capacity and attain resources needed to establish effective satellite clinics in numerous villages on the Central Plateau such as Thomonde and Las Cohobas.

These satellite clinics are the focal points for training community health workers and health agents who can carry out directly observed therapy programs for HIV/AIDS and TB. Mothers can take their children to one of these clinics without fear of being turned away if they do not have money. The dehydrated children will receive cheap and remarkably effective oral rehydration therapy. The child with malaria will receive treatment in 24 hours, one of the most effective indicators for survival. Children with a respiratory infection will receive the antibiotics they need, and parents will be educated on how to help prevent another infection from occurring in the future.

As we speak, Project Medishare is expanding services into the neighboring province of Marmont and Partners in Health staff are in Rwanda replicating their model. Even in these unstable times, there are successes. Let’s keep working together for a healthier 2006….we can do this by ensuring that we keep a sense of perspective as to what is really killing children.

Bryan Schaaf
Haiti Innovation