Health for all

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Science  26 Apr 2019:
Vol. 364, Issue 6438, pp. 309
DOI: 10.1126/science.aax7591

Imagine a world where affordable, quality health care is available to every person, and where infectious disease and infant and maternal mortality are as rare in the poorest parts as they are in wealthier countries. The world has already come a long way toward meeting this goal. But to finish the job, we need to change our thinking.

To be sure, the incidence of child mortality and cases of deadly infectious diseases have dropped dramatically around the world. For example, polio, which once paralyzed a thousand children every day, has been eliminated from all but three countries, with just 33 cases last year. Measles cases, despite a recent, alarming global surge, are now a fraction of what they were four decades ago. All this was made possible because global health organizations and the governments of lower-income countries have worked together to provide the most vulnerable communities access to essential health care interventions, such as clean water, sanitation, and vaccinations.

A medical attendant in Tanzania enters information to improve health workers' data literacy.


And yet, 1 in 10 children are still missing out. Most are the hardest to reach, whether they live in remote rural villages, conflict zones, among the swelling numbers of displaced people, or in rapidly growing urban slums where they might be undetected by formal health systems. Meeting their needs will require focusing more on health interventions that have both the greatest reach and are conduits to other health services for vulnerable communities. Childhood vaccination does precisely this. Vaccination reaches more children—more than 85%, who are inoculated against a range of infectious diseases—than any other health intervention globally.

When a child gets access to vaccines, it benefits that child's community. With vaccines come supply chains, logistics, cold storage, trained health care staff, data monitoring, disease surveillance, and health care records. Parents and siblings often come along with the child who is being vaccinated, giving them potential access to a host of other health interventions—from neonatal and maternal health care to malaria prevention measures, and sexual and reproductive health and education.

Achieving health for all will also require a change in mindset. We must examine the barriers that deny health care to so many others. Such barriers can take different practical, cultural, or social forms, but identifying them can inform the development of new tailored solutions. If parents have too far to travel, for example, then build more health facilities closer to those who need them. Similarly, the lack of after-hours vaccination clinics or the use of male vaccinators in some settings can prevent or deter attendance. Also, traditional paper medical records may make it difficult for health care workers to know who is missing out because parents may rarely attend the same clinic twice.

This new mindset will require a shift in business models. Instead of seeking solutions that have the greatest utilitarian value, it could be better to look for innovative solutions that have an intended disproportionate impact, largely benefiting the few rather than the many. For example, in Tanzania, the Electronic Immunization Register, a tablet-based system, is giving vaccinators access to records across entire regions regardless of which clinic they are in. This is enabling them to proactively track which children are missing out.

As the 2030 deadline looms for the United Nations Sustainable Development Goals (SDGs), targets driving a broad range of development efforts today, providing health for all is likely to become increasingly more difficult. The good news is that nations have already taken the first major step with the SDG Global Action Plan, a commitment made last year by global health agencies to unite around efforts to accelerate progress. The hope is to start implementing a plan in September 2019. Health for all is achievable, but this vision requires new thinking by everyone.

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