Study Shows Relative Ineffectiveness of UN Health Program
ENVIRONMENT & HEALTH, SUSTAINABILITY, HUMAN RIGHTS, LAW & JUSTICE
Wednesday, August 26, 2009
According to a recent study published in a leading medical journal, a United Nations program designed to reduce deaths of children under the age of five had no measurable effect on child mortality. The study results raise questions about the ability of the UN to effectively implement global health programs.
Published in the August 1, 2009 volume of the prestigious medical journal The Lancet, the study compares the effectiveness of a health facility operated pursuant to the UN’s Integrated Management of Childhood Illness (IMCI) strategy with a comparable non-UN health facility. The IMCI program was developed in 1996 by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) as the “principle strategy to improve child health.” Its goal is to reduce the number of children under the age of five who die from diarrhea, pneumonia, malaria, measles and malnutrition, diseases which, at the time of the program’s launch, caused 70% of all children’s deaths.
The IMCI program has three implementation components: improving the performance of health care workers who deal with children under five and their families; improving the quality and efficiency of health care services; and improving child health care knowledge within the home and the community.
In order to evaluate the comparative effect of the IMCI strategy on the mortality rates and nutritional levels of children under five, the study compared IMCI health care facilities in Bangladesh with Bangladeshi facilities that did not implement the UN program.
After conducting its analysis, researchers found that, though the IMCI program did show some improvements over non-IMCI facilities in “intermediate indicators” of health care, such as improved health worker skills, better health system support, a greater number of children who sought care when ill, a higher incidence of breastfeeding of babies up to the age of six months, and a decreased prevalence of stunting in children, IMCI health interventions did not result in a significant reduction of deaths of children under the age of five. Indeed, according to the study, improved economic and living conditions in Bangladesh, along with a handful of independent health interventions that were delivered to all Bangladeshi health care facilities, seemed to have had as much of an effect on mortality rates as the UN’s targeted health strategies. The study also cites several other possible reasons for IMCI’s failure to significantly reduce child mortality, including the tendency of Bangladeshis to continue to view their village practitioners as their primary source of health care, IMCI’s habit of using ineffective antibiotics, and IMCI’s ineffective community education programs.
In spite of such evidence, some continue to claim that the UN simply needs more funds to ensure the success of its health programs, saying that donors and governments must have “patience and persistence” to realize measurable results. Yet, according to the study’s conclusions, it is doubtful whether more money will yield improved health outcomes.
The ineffectiveness of costly UN health programs is further exemplified by the questionable results of United Nation’s efforts to combat AIDS. As reported by the London-based International Policy Network (IPN), “drowning a single disease in cash could be doing more harm than good to fragile health systems.” According to IPN, in regards to the fight against AIDS, the UN has wrongly focused on treatment of the disease over prevention, has poorly spent this treatment money, has falsely represented the “true nature of the pandemic,” and has exaggerated the actual number of people infected with AIDS globally. All of these factors lead to wasted spending on misguided programs. (For more information on UN mismanagement of AIDS programs, please see the May 28, 2008 Global Governance Watch post.)
By continuing to focus on politically popular but relatively ineffective programs, the UN is doing a disservice to the developing world, which truly needs health care assistance. Further, the UN’s poor stewardship of funds betrays Member States and individual donors who expect their money to be spent wisely and effectively. Rather than continuing to fund ineffective programs, perhaps even at higher levels, Member States should hold the UN accountable for its spending priorities.
Jim Kelly is the President of Solidarity Center for Law and Justice, P.C., a public interest civil and human rights law firm based in Atlanta, Georgia. The opinions expressed herein are his own.
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