Investment in maternal health plan involves more than just cash

By Keith Martin MD, Edmonton Journal - June 26, 2010

During the world's largest meeting of pediatric academic scientists in Vancouver last month, a persistent refrain was heard: We know how to save lives in developing countries, so why aren't we doing it?

Many of these pediatricians live in two worlds.

They work in some of the most sophisticated labs in the West, and also labour in the slums and rural areas of some of the most impoverished countries in the world.

They witness first-hand the tragic gap between the knowledge we have and the failure to implement this knowledge on the ground, where it is needed the most.

For physicians it is particularly soul-destroying to see your patient die for want of something that is cheap and easily available in the West.

Simple solutions can save millions of lives. For example, zinc supplements could reduce childhood mortality for pneumonia and gastroenteritis (combined they kill 4.4 million children per year) by nearly fifty per cent!

Connecting the knowledge we have with those who could benefit from it is one of the greatest challenges of our time. The bridge to do this is through strengthening developing countries' primary health care systems. The G8 and G20 summits provide an extraordinary opportunity to do just this. Such a plan could save the lives of the nine million women and children who die every year from easily preventable or treatable causes. So how can we achieve this?

Invest in access to primary health care, such as: trained health-care workers, basic medications (120 of the World Health Organization's list of 130 essential medicines are already off patent, which means that generic companies can freely make them today), diagnostics, adequate nutrition (including micronutrients), clean water and sanitation, a reliable power source, and access to family planning and safe abortion services.

Primary health care is the single, unifying mechanism through which we can roll out treatment and prevention programs for everything from HIV/AIDS to malaria and maternal care.

The G8 should create a new Global Fund for Maternal and Child Health, which would ultimately disburse $12 billion a year.

This would double the world's current expenditures in this area that historically has been the most underfunded and neglected of all the Millennium Development Goals.

The rollout of these assets to support primary care could be done by partnering with organizations that already have sites and reliable logistical systems in place. The World Food Program, UNICEF, UNDP, the International Red Cross, and others distribute food and medical care to vulnerable populations.

They have the mechanisms to get life-saving products to people in need. Dispensing basic health care through established systems would obviate the need to create new distribution mechanisms, which would save millions of dollars in administration costs that can be used instead for patient care.

Each G8 nation could take the leadership role in one of the inputs required to deliver primary health care. For example: the U.S. could take the lead in training health care workers; Canada could champion access to sanitation, potable water, and adequate nutrition (we could use the Micronutrient Initiative and Engineers Without Borders as partners); the French could lead in providing access to family planning and safe abortions where it is legal, etc.

Investing in reducing maternal and childhood mortality and morbidity also has a broader, more powerful effect on the entire population that is not well known.

With the assets available to treat the most common complications of pregnancy, you can also treat 80 per cent of the medical problems encountered in the emergency room, including the world's major killers: gastroenteritis, pneumonia, malnutrition, tuberculosis, malaria, sepsis and complications arising from HIV/ AIDS.

If the world's richest nations and other donors are unwilling to act on purely humanitarian grounds, there is a very strong economic argument to support investing in this plan.

Every dollar spent in primary care ultimately reduces health-care costs by $4 and social costs by a staggering $20. Thus, investing in primary care also makes excellent economic sense: healthy people are productive people who can then lift their families, communities and countries out of poverty.

G8 nations have a remarkable opportunity to make the most profound change in the health of the world's poorest people that we have ever seen. Canada has a chance to make this happen with strong, clear leadership that will support a plan driven by science, not ideology.