PAHO Efforts Among World-Class Health Successes

Two hemispheric public health efforts spearheaded by the Pan American Health Organization (PAHO) are among 17 large-scale health interventions held up as models of success in a new book from the Center for Global Development (CGD) in Washington, D.C.

The book, Millions Saved: Proven Successes in Global Health, demonstrates that "major public health efforts can and have changed the world for the better—well beyond what would have occurred through income growth alone," CGD President Nancy Birdsall notes in the preface.

"The magnitude and profundity of current health challenges facing the developing world—from AIDS to chronic malnutrition to the looming threat of tobacco-related cancers —can seem daunting," Birdsall writes. "But past challenges have been surmounted and serve as object lessons: Even in countries with few financial resources and limited health infrastructure, sensible and systematic efforts to improve health have worked."

The books cites the PAHO-led hemispheric campaign to eradicate polio and efforts to control Chagas' disease as two examples of successful, cost-effective public health interventions, along with the World Health Organization-led global campaign to eradicate smallpox.

Other efforts detailed in the book include Thailand’s "100 percent condom" program, which targets commercial sex workers and other high-risk groups to prevent HIV/AIDS, and China's use of directly observed treatment (DOTS) to reduce tuberculosis prevalence and improve the cure rate in half of China's provinces.

Polio eradication

In the late 1970s, polio caused some 15,000 cases of paralysis and 1,750 deaths each year in Latin America and the Caribbean. In 1985, PAHO launched a major campaign to eradicate the disease in the region. The effort built on PAHO's decade-old (at the time) Expanded Program on Immunization, which had succeeded in reducing the toll of childhood illness in the region.

Luis Fermín Tenorio Cortez, center, was the last recorded case of polio in the Americas. He was 2 in 1991, when his case was reported. By 1994, the disease had been officially declared eradicated from the hemisphere, making the Americas the first region to achieve such success. Photo by Armando Waak/PAHO

To increase polio immunization coverage, endemic countries in the region implemented national vaccine days twice a year, during which they vaccinated every child under 5, regardless of vaccination status. The final stages of the campaign included Operation Mop-Up, which consisted of house-to-house vaccination in communities with polio cases or low vaccine coverage. A key component of the effort was the "most comprehensive surveillance system for human health that has ever existed in the [Western] hemisphere," the book notes.

As a result of the PAHO-led campaign, the hemisphere reported its last case of polio in 1991, and the disease was formally declared eradicated from the Americas in 1994. At the global level, the number of polio cases has been reduced from 350,000 in 125 countries in 1988 to fewer than 800 cases in just six countries in 2003. Despite setbacks that have plagued the final stages of the global campaign, the world is today on the verge of eliminating polio forever.

Millions Saved notes that the polio eradication effort in the Americas received some $120 million in support from national and international donors during its first five years. PAHO's partners included the United Nations Children's Fund (UNICEF), the U.S. Agency for International Development (USAID), Rotary International, the Inter-American Development Bank and the Canadian Public Health Association.

Fighting Chagas

Chagas' disease is a parasitic illness that can cause fatal organ damage and is only endemic in South America. In the early 1980s, there were some 700,000 new cases each year. In 1991, PAHO launched the Southern Cone Initiative to Control/Eliminate Chagas in seven South American countries. The program sent teams of fumigators to treat more than 2.5 million homes across the region with longlasting pyrethroid insecticides. It also funded improvements in rural housing to eliminate the insect vector's hiding places and carried out blood screening to prevent transmission through transfusions.

By 2000, the program had helped reduce the incidence of Chagas by an average 94 percent in participating countries, and annual deaths from the disease dropped from 45,000 to 22,000. By 2001, transmission had been halted in Uruguay, Chile, and large parts of Brazil and Paraguay.

Participating countries provided more than $400 million to fund the program, which Millions Saved terms one of the most cost-effective interventions in public health.

In the Americas region, the book also cites Mexico's Oportunidades ("Opportunities") program, which provides education, health and nutrition to rural families through a conditional cash grants program. The program has reduced rates of illness and malnutrition and increased school enrollment.

Also cited is Jamaica's policy of fluoridating table salt to prevent dental caries. The program helped reduce severe caries in 6-to 12-year-olds by more than 80 percent in less than a decade. At only 6 cents per person per year, salt fluoridation has proved highly cost effective, saving $250 in dental treatment for each $1 spent.