Yet only five out of 18 studies of coverage roll-out found a positive impact
on health indicators such as death rates or reduced sickness. In India, for
example, the government has started paying mothers who deliver children in
hospitals. As a result, from 2005 to 2011, the number born in a health facility
more than doubled in nine Indian states. But the massive increase in
institutional births had no impact on infant mortality. If anything,
according to World Bank researcher Jishnu Das, the rise of hospital births is
“remarkably consistent with the halting of a slow decline in infant mortality.”
Rwanda has seen a similar phenomenon: a big rise in births with a skilled
attendant with no impact on health.
Across countries, there is no relationship between overall levels of health
expenditures and health outcomes at a given income per head, nor a link between
health inputs such as doctors and nurses per capita and health outcomes. The
number of hospital beds per person worldwide actually fell by a
quarter from 1960 to 2005, even as global health massively improved—with
average planetary life expectancy climbing from 52 years to 69 years.
One reason for the gap between health inputs and health outcomes is the low
quality of care. Though many health-care practitioners are hard working and
honest, a lot aren’t. In 2003, if you turned up unannounced to a
health-care facility in India and asked to see a staff member, 40 percent of
staffers who were meant to be there were absent. Among doctors in rural
Bangladesh in 2004, that figure was above 70 percent.
And hospital staffers are often ignorant of the right approaches or face
incentives to provide the wrong treatments. A 2013 survey in Kenya found that
only a little over half of doctors and nurses could diagnose at least four out
of five common conditions when their major symptoms were described—malaria with
anemia, diarrhea with dehydration, pneumonia, tuberculosis, and diabetes. When
it came to treatment, health providers adhered to less than 43 percent of the
clinical guidelines governing management of these conditions. Public providers
only followed 44 percent of the guidelines for managing maternal and newborn
complications.
The lack of a relationship between the availability of health care
and life expectancy in developing countries goes beyond weaknesses in
hospitals and clinics. It’s also related to the fact that what kills most
people in poor countries are conditions that don’t require hospitals to fix. In
sub-Saharan Africa, the five leading killers are malaria, HIV, lower
respiratory infections, diarrhea, and malnutrition. Further and growing causes
of mortality across the developing world include traffic accidents, tobacco
usage, and health conditions related to being overweight. Clean water, access
to and use of toilets, condoms, soap, vaccinations, and and bed nets, alongside
better nutrition, tobacco controls, and road safety measures can prevent the
majority of these deaths. Doctors and nurses save thousands of lives a day, but
infrastructure and public health interventions—neither requiring highly trained
medical staff—save many millions each year. Often, the medical system can do
little more than provide palliative care when these other approaches aren’t
used or don’t work.For more details visit allindiayellowpage.com.