Which Intervention Would Do The Most To Improve The Health Of The Extreme Poor?

The collected responses--from health researchers and activists, journalists, academics, and communities living in poverty--highlight effective, low tech, and remarkably cheap ways to make a profound difference to the lives of the poorest people on the planet.

Paul Farmer (Partners in Health and Harvard University) chose training of village health workers as the most effective intervention. "If we train village health workers, and make sure they're compensated," he said, "then the resources intended for the world's poorest--from vaccines, to bed nets, to prenatal care, and to care for chronic diseases like AIDS and tuberculosis--would reach the intended beneficiaries."

Other commentators, including Mushtaque Chowdhury (Bangladesh Rural Advancement Committee, Dhaka, Bangladesh) and Murugi Murekio (a health reporter in Ethiopia) stressed the crucial role of hunger alleviation. In Ethiopia, said Murekio, "antiretrovirals are free, but mostly women can barely afford a meal a day and so this diminishes their capacity to live healthily with HIV."

Jeffrey Sachs (Director of the United Nations Millennium Project) focused his response on prevention and treatment of malaria: "In tropical Africa, a mass distribution of free long-lasting insecticide-treated bed nets to fight malaria accompanied by free access to artemisinin-based combination anti-malaria medicines." But he added that he has "spent years objecting to posing the question this way, since at low cost we could achieve major health advances through more comprehensive approaches."

Many of the responses note the importance of the rich world fulfilling its obligations to the global poor, while other commentators highlighted the empowerment of women ("There's a saying that when you educate a woman you have educated a whole village," said reporter Rosebell Kagumire in Uganda), promotion of breastfeeding, provision of clean water, and childhood vaccination. Members of poor rural communities in Ayacucho, Peru, talked about the importance of housing, food, family, and social interactions--a view of health promotion that goes far beyond a strictly biomedical approach.

In a related Editorial, the PLoS Medicine editors argue that the global community "easily has the financial and technical means to scale up all of these interventions immediately--it has more than enough resources, for example, to distribute insecticide-treated bed nets and artemisinin-based combination therapy for malaria, train community health workers, promote breastfeeding, and vaccinate all children."

Citation: Yamey G on Behalf of the Interviewees (2007) Which single intervention would do the most to improve the health of those living on less than $ per day? PLoS Med 4( 0): e303.