laurie garrett @ us council on foreign relations speaks to senate subcommittee 4-18-07

<>laurie garrett : "health systems are the key. Those targeted programs, such as PEPFAR (the President’s Emergency Plan for AIDS Relief), are terrific, but without functioning public health and medical systems in place, PEPFAR and its like are just big band-aids that barely cover gaping wounds."


excerpt from garrett's statement:

Treatment, yes: But not without prevention

Let me give you an example. About a year ago I was in a small town in Haiti. The people in this town were overwhelmed with infectious diseases. Their illnesses swamped the beleaguered clinics, where long lines of mothers and children stood in the tropical sun for hours on end, waiting to see a doctor. The children’s growth was stunted; mothers couldn’t produce enough milk to feed their babies; long-infected teenagers fought to keep their eyes open in class. In the parking lot of the town’s main hospital sat two rusted-out, broken USAID jeeps, the American insignias clearly evident. Though American charities were helping to subsidize the medical training and services in the hospital, nobody --- no Haitian government agency and no foreign donor, looked at this town and asked the obvious question: “Why are so many people sick with dysentery, typhoid fever, and intestinal problems? Why are so many children in this town dying before they hit their fifth birthdays?”

The answer: Water. The colonial-era water filtration and pumping system had long ago broken down. For about $200,000 the system could be fixed, children would drink safe water, and the disease and death rate would plummet. But no donor chose to take on that water problem. Instead, at the cost of far more lives, and dollars, the donors – including USAID – funded treatment of entirely preventable diseases, and supported the operation of a very busy morgue.

The emphasis my colleagues placed on maternal and child health is wise. What is killing babies and toddlers? The lack of essential public health services: clean water, mosquito control, basic nutrition, healthy moms.

What is killing their moms? The lack of medical systems: No safe C-sections, no sterile equipment for episiotomies, no prenatal care.

Public health systems keep babies and children alive. Medical delivery systems keep their moms alive.

Systems: Not individual, disease-specific programs – health systems are the key. Those targeted programs, such as PEPFAR (the President’s Emergency Plan for AIDS Relief), are terrific, but without functioning public health and medical systems in place, PEPFAR and its like are just big band-aids that barely cover gaping wounds.

We – Americans and the wealthy world, generally – have given, and given, and given for decades. Yet the gap between longest and shortest lived societies has widened, now a full five decades long. And despite mountains of foreign aid from the OECD nations, basic health markers such as life expectancy and child survival have barely budged over the last 60 years in any sub-Saharan African country – except, thanks to HIV, to go backwards in a few.

http://www.blogs.opc.on.ca/?p=111

Prepared Statement Before the Senate Subcommittee on State, Foreign Operations and Related Programs:

http://www.cfr.org/publication/13130/