1 / 18

First International Conference on Community Health:

Investing in Community Health to Break the cycle of poverty and disease Paul Farmer MichaEl rich Didi bertrand farmer. Harvard Medical School Partners In Health Brigham and Women’s Hospital. First International Conference on Community Health:

nemo
Download Presentation

First International Conference on Community Health:

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Investing in Community Health to Break the cycle of poverty and disease Paul FarmerMichaEl richDidibertrand farmer Harvard Medical SchoolPartners In Health Brigham and Women’s Hospital First International Conference on Community Health: The Role of Community Health in Strengthening Health Systems Kigali, Rwanda January 25, 2011

  2. Does access to care improve health? What kind of care? Where? Source: R Yates. The Removal of Health User Fees in Africa – Key Lessons from Sierra Leone. One World Link. 2011.

  3. Epidemiological Transitions: Claims of Causality I Before effective chemotherapy, sanitation and nutrition likely contributed to decreasing TB mortality. Source: T McKeown et al. An Interpretation of the Decline of Mortality in England and Wales during the Twentieth Century. Population Studies: 29, 3 (1975).

  4. Epidemiological Transitions: Claims of Causality II Spikes in mortality rates were caused by epidemics of infectious disease. Then effective medical and public-health interventions came along.

  5. Epidemiological Transitions: Claims of Causality III (Sometimes chemotherapy can have dramatic impact) Source: CDC. HIV Mortality (through 2006). Available: http://www.cdc.gov/hiv/topics/surveillance/resources/slides/mortality/index.htm

  6. Confident and contradictory claims from officialdom I “User charges increase resources for the system as a whole and allow government resources to shift to more cost-effective (generally preventative) programs.” World Bank, 1987 “Concerning the path to universal coverage, the report identifies continued reliance on direct payments, including user fees, as by far the greatest obstacle to progress.” WHO, 2010

  7. Médecins Sans Frontières. No Cash, No Care: How ‘user fees’ endanger health. MSF briefing paper. 2008. p 6, 23. Available: http://www.msf.org/msf/fms/article-images/2008-00/NocashNocareMSFapril2008.pdf

  8. Confident and contradictory claims from officialdom II “In developing countries, people with multidrug-resistant tuberculosis usually die, because effective treatment is often impossible in poor countries.”WHO, 1996 “MDR-TB is too expensive to treat in poor countries; it detracts attention and resources from treating drug-susceptible disease.”WHO, 1997

  9. Outcome of MDR-TB Treatment in Rwanda (N=224 confirmed MDR-TB patients enrolled from July 05 – Sept 08) SUCCESS RATE: 87%

  10. Confident and contradictory claims from officialdom III 1998: “If we used antiviral drugs in treatment regimens similar to those used in the U.S., it would cost approximately $35 billion per year to treat those infected in the developing world. We are talking about medical regimens that cost $5,000 to $10,000 a year and require sophisticated health provider and laboratory infrastructure…How can we get involved in care in the face of such staggering statistics?” Chief of HIV/AIDS Division, USAID 2001: “We cannot get it done because of conflicts, because of lack of infrastructure, lack of doctors, lack of hospitals, lack of clinics, lack of electricity.” USAID Administrator

  11. Community-based care for chronic disease IRural Haiti June 1999 One year later Ten years later: still responding to first-line ART

  12. Number of people receiving ART in low- and middle-income countries, 2002—2007 Source: WHO, UNAIDS, UNICEF; 2008

  13. Community-based care for chronic disease IIRural Rwanda

  14. Community-based care for chronic disease IIIUrban United States

  15. Community-based care for chronic disease IV 160 120 Viral Load (thousands/ml) 80 40 MONTHS

  16. Five pitfalls in community-health debatesLessons from first decade of the 21st century 1) Prevention versus care (But mutually reinforcing?) 2) “Absence of specialists” to stop conversation(But what about “task shifting”?) 3) “Weak infrastructure” to stop conversation(But vertical programs can strengthen health systems) 4) “Fixed high costs” to stop conversation(But drug and vaccine prices often vary over 90%) 5) Untallied cost of inaction(Social costs of orphaning, lost income, out-of-pocket health expenditures, etc. significant and incompletely captured in most studies)

  17. A strengthened Rwandan health system avoids many false debates Community-based Hospital-linked Health-center enriched

  18. Murakoze cyane!

More Related