How to Fight Poverty: 8 Programs That Work #8
Tuberculosis is curable. Millions of people alive today can personally attest to the power of antibiotics. A simple course of four antibiotics, which costs as little as $11, can now vanquish a dreaded killer.
So why do nearly 2 million people a year still die of it? Because these antibiotics must be taken daily for six to nine months. That means that the local health clinic must have a steady supply. Patients must continue to take the full course even though they stop coughing, and the medicine causes nasty side effects. TB strikes mostly the poor, especially those living in crowded conditions. Many of them are migrants, who may be lost to the health system when they move.
If they don't finish the course, terrible things can happen. Patients stay sick, but now with a form of TB resistant to the basic drugs. Medicines that can cure this form of TB can cost $10,000, and the course of treatment is two years. Because of poor adherence, resistance has reached the point where some forms of TB are incurable. South Africa is battling an outbreak of this extremely resistant TB, and no doubt many other places are as well – they just don't know it yet.
The solution is a strategy invented in Tanzania in the 1970s and now in use all over the world, called DOTS, for Directly Observed Treatment, Short-course.
DOTS has several components – among them good supply management and diagnosis – but what is key is what it is named for. Someone becomes a pill pal, with the job of watching the patient swallow the medicines. This can be a neighbor, a family member, or a community health worker.
DOTS is now widespread – it covers about 60 percent of the world's diagnosed TB cases. It greatly improves the chance of cure. DOTS gives patients a social incentive to take their pills. But sometimes other layers of incentive are necessary as well. In her book " Millions Saved ," Ruth Levine, the director of programs at the Center for Global Development in Washington, writes about China's TB program. In 1990, TB in China was the leading cause of death in adults, killing 360,000 people that year. The next year, China switched to DOTS.
China found a way to make DOTS even more effective – by relying on the market. With help from the World Bank, China's government pays village health workers to find TB patients, get them to the lab for periodic sputum checks, and see them through the full treatment course. The pill pal gets a bonus, too, as does the health center. China's TB cure rate went from 52 percent to 95 percent, which prevents 30,000 TB deaths per year. Rates of resistant TB are far lower in the parts of China where DOTS is used.
DOTS is one of the most cost-effective health programs around. Each cure costs just $100, and brings a return of $60 for every dollar spent. It works because the drugs are cheap and it relies on community workers instead of doctors. The DOTS strategy recognizes that the promise of being cured is not always enough to change the way people behave. It uses social – and occasionally monetary – incentives to get the community and the patient working towards health.
These are not the only good programs. There are many more out there – family planning, provision of small amounts of nutrients such as Vitamin A , agroforestry to restore the fertility of soil, to name a few. But the above eight are some of the best.
A few common threads link these eight programs. Many of them rely on the market. Microcredit and property legalization help poor people to start businesses. Other programs pay people for desired behavior. Another common element is a focus on women and girls, who tend to be poorest of the poor and use help more efficiently than men. A lot of these programs got their start when one individual looked at a familiar landscape in a fresh way. The most important things these programs share, however, is that they work -- and with more money they could be working on a grander scale.Credit: NYtimes,
By TINA ROSENBERG