Better health for poor women and children will strengthen global security

The U.S. Agency for International Development (USAID) recently released its third annual Acting on the Call report. It details the progress that is being made to improve maternal and child health in 24 priority countries. For the first time, this year’s report focuses on the poorest 40 percent of the world’s population. USAID asserts that investment in better care for people with the least can save the lives of 8 million women and children by 2020.
The USAID vision is critical because attention to the needs of the poorest of the poor, and especially women and children, is humane and moral, and it is key to global stability.
{mosads}The World Economic Forum (WEF) has identified access to health care and improved health outcomes as essential prerequisites to growth and development globally. The WEF specifically identifies infectious disease, which remains ubiquitous in poor, underserved regions of the world, as one of the greatest global economic risks. 
Implementing a strategy targeting the poorest of the poor for investments in global health care is an argument that Partners In Health co-founders Dr. Paul Farmer and Dr. Jim Yong Kim, now head of the World Bank, and Harvard Business School Professor Michael Porter made three years ago in a seminal paper in the British medical journal, The Lancet. They highlighted the urgency of improvements in health care for the destitute poor, especially for women and children. These must be complemented by ensuring access to stable sources of nutrition, clean water, sanitation and stable housing. Their premise is clear: when people are healthier starting at birth, individuals and nations thrive.
Science enabled 20th century medicine to deliver enormous improvements in reducing infant and maternal mortality and in controlling many infectious diseases. These advances catalyzed rapid economic and social advancement in the industrialized world. 
Yet today, in the 21st century, millions of people around the world continue to die from 18th and 19th century illnesses. The world’s poorest people deserve access to the modern health care that people in wealthier countries take for granted. Moreover, death and disability from preventable illnesses reinforce the dire conditions of poverty, stunt development and foster social disintegration. 
At Partners In Health, we applaud USAID’s focus on the very poorest populations and on women and children. As we know too well, social injustice and care disparities cause the greatest suffering and misery; the opportunity for breathtaking improvements is at our fingertips. Every day for more than 30 years, we have seen the importance and the benefit of that focus. We see people dying unnecessarily from preventable conditions – and poor women and children are the most vulnerable. Nearly 800 women die every day in childbirth, and 99 percent of those deaths occur in developing countries. In 2014, during the height of the Ebola epidemic, Partners In Health began providing health services in Sierra Leone. According to the World Health Organization, in that West African country, a woman dies in about one in every 90 births. That’s more than 50 times higher than in the United States. This is tragic and unthinkable, and it can be prevented. 
For decades, Sierra Leone’s health care system was tattered by years of civil war and by abject poverty. What remained was decimated by the Ebola epidemic. During our first year in the country, Partners In Health focused on responding to the Ebola outbreak and on dealing with its immediate aftermath. But, in keeping with our mission to build sustainable health care systems in the most underserved regions of the world, we opened clinics and strengthened community-based health services. Our teams provide primary and preventive care, vaccination programs and perinatal services, and treat the likes of malaria, tuberculosis, HIV, malnutrition and the complications of pregnancy and childbirth.  
In 2005, Partners In Health was invited to work in a rural region of Rwanda that lacked even a single doctor for its more than 200,000 people. Partners In Health now supports the Rwandan government in providing health services to more than 860,000 people via three hospitals, 42 health centers and roughly 7,200 Rwandan community health workers that Partners In Health and the Rwandan Ministry of Health recruited and trained. This investment in health care and the remarkable associated improvements in health related outcomes are major elements of Rwanda’s storied recovery from the devastation of a genocide in the context of overwhelming poverty.
Our experience in Sierra Leone, Rwanda and elsewhere around the world is the practical realization of a decades-long commitment to our mission “to provide a preferential option for the poor in health care,” which turns out to be tonic to sustainable economic development. Consider our work as a proof of concept for the strategy that USAID is pursuing today. As USAID’s Dr. Ariel Pablos-Méndez put it, “A grand convergence in health, in which women and children in the poorest communities have the same access to quality health services as those in the wealthiest, is within our grasp.” 
That is what we at Partners In Health believe too. We not only can deliver first-world health services to women and children, we must do so. Global health is key to global order and security. 
In a world increasingly concerned about the contagion of disorder and chaos, USAID has outlined a path to a safer, more secure future for everyone.  

Dr. Gary L. Gottlieb is the CEO of Partners In Health, a leading medical organization that builds and sustains public health systems in poor communities around the world.


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