Global Health Watch 1 in one file

Health care systems | B1
health care workers as their focus narrows to achieving selected targets rather
than addressing the immediate and pressing needs of sick people when they
present to health care services. Instead of training scarce health workers to
provide essential and appropriate health care, such programmes train them
to be efficient conduits of medical technology. Thousands of family planning
volunteers have been deployed in many countries, for instance, but many opportunities
to promote health were lost because their training focused on the
single technical issue of contraception and did not include other elements of
community health promotion, such as nutrition and hygiene education (Toole
et al. 2003).
Vertically organized health services are inconvenient to service users. The
need to make several visits to access different services constitutes a significant
barrier to access, while the inability of some selective programmes to address
co-existing conditions could result in untreated morbidity – for example, family
planning workers being unable to treat sexually transmitted infections;
or ante-natal care providers being unable to provide immunization services
(Brown 2000).
Although selective health care is often advocated on the grounds that basic
health care infrastructure is inadequate, it is rarely implemented in conjunction
with a plan to strengthen such infrastructure at the same time. As a result,
many selective and vertical programmes have short-lived results because they
are not followed by the establishment of permanent health services to sustain
the on-going control and prevention of disease. Worse still, they may actually
undermine the development of health care systems. Mass immunization campaigns,
for example, have often been prioritized to such an extent that other
services have been disrupted and the long-term development of sustainable
routine immunization services hindered.
The inadequate development and protection of basic health care infrastructure,
and the lack of sustained donor funding for child health, is more
apparent now than a decade ago. In spite of the child survival revolution, 11
million children die each year from mainly preventable causes. Globally, the
target set by the World Summit for Children in 1990 to reduce child mortality
below 70 deaths per 1000 live births by the year 2000 (or a one-third reduction
if it yielded a lower mortality rate than this target) has not been met (UNICEF
2001). In many countries, immunization coverage rates are stagnant or declining
(see Figure B1.1). In others, the reduction in child mortality rates has
slowed down (Black, Morris and Bryce 2003).
Some argue that the gains in child health made between 1980 and 2000
were a result of tackling illnesses that are most amenable to vertical interven-
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