AIDS, malaria, and tuberculosis kill 6 million people each year in developing countries, and another 7 million children die of infectious diseases that have long been forgotten in the rich world. This represents both the tragedy of lives cut short and the loss of productivity that stalls economic growth and poverty reduction.

Does anything really work to solve profound health problems that face poor countries? Does development assistance from rich countries make any difference at all? Under the auspices of the Center for Global Development's Global Health Policy Research Network, we invited 15 experts in international health, development economics, public policy, and other relevant fields to identify and examine experiences of large-scale success in international health - national, regional, or global programs that worked to improve health. To find those cases, we collaborated with the Disease Control Priorities Project in Developing Countries Project of the National Institutes of Health and solicited nominations from many of the world's leading health authorities. The conclusions of the What Works Working Group leave little doubt that some efforts to save lives and livelihoods through health interventions have worked and have done so at remarkably low cost compared with the benefits.

The book, Millions Saved: Proven Success in Global Health, is about part of that success story: 17 cases in which large-scale efforts to improve health in developing countries have succeeded - saving millions of lives and preserving the livelihoods and social fabric of entire communities. These stories (or, more formally, the evidence-based cases) show that major public health efforts can and have changed the world for the better - well beyond what would have occurred through income growth alone. The magnitude and profundity of current health challenges facing the developing world - from AIDS to chronic malnutrition to the looming threat of tobacco-related cancers - can seem daunting. But past challenges have been surmounted and serve as object lessons. Even in countries with few financial resources and limited health infrastructure, sensible and systematic efforts to improve health have worked.

Looking toward the future, the authors identify several factors that were common to these 17 cases and appear to have contributed to their success. They do not claim to prove statistically that these particular elements, alone or in combination, are necessary or sufficient for successful outcomes. Rather, they argue that with the international community focused as never before on accelerating progress toward better health for the world's poorest people, a close look at these stories provides valuable clues about ways to increase the likelihood of success.

This effort puts to rest the notion that nothing works in global health. But it raises new challenges: The first is how we make sure there are more and even bigger successes in the future. If the humanitarian impetus isn't enough, surely the knowledge that economic progress is hastened by health improvements should spur scientists, public health workers, government officials, and funders to action. The second is how we make sure that we know what works and what doesn't. Rigorous evaluation should no longer be seen as an optional academic add-on to major programs. It should be required so that both successful and failed experiences yield knowledge for smarter policymaking and program design in the future. Only with high-quality evaluation will we have a credible basis for claiming the effectiveness of foreign assistance.

One of the greatest human accomplishments has been the spectacular improvement in health since 1950. In developing countries, life expectancy has risen from 40 to 65 years, and the chances that a child will survive to the age of five has doubled. In addition to directly improving people's lives, this progress contributes to economic growth. While some of the improvements in health is the result of overall social and economic gains, about half of it is due to specific efforts to address major causes of disease and disability -- such as providing better and more accessible health services, introducing new medicines and other health technologies, and fostering healthier behaviors.

From the eradication of polio in Latin America, to the elimination of measles in southern Africa, to HIV prevention in Thailand, the cases provides clear evidence that large-scale success in health is possible. The book provides policy-relevant information about how major successes can be achieved in the future, and clear evidence that global health challenges, which are often perceived as daunting are indeed solvable.




Read the Book
Millions Saved: Proven Successes in Global Health
by Ruth Levine et al.
Center for Global Development, November 2004, ISBN 0-88132-372-1

This unusual book from the Center for Global Development presents 17 proven success in global health that have saved many millions of lives - and dollars. The case studies were prepared by CGD Senior Fellow Ruth Levine and the What Works Working Group, which included more than a dozen prominent experts in international health, development economics, public policy and other fields. These case studies meet a set of rigorous selection criteria: being large scale, having a duration of five years or more, employing a cost-effective intervention, and having a major impact on an important health problem. Importantly, for these cases sufficient investment was made in data collection and analysis to attribute changes in health conditions to the large-scale interventions or programs themselves. This fascinating new book shows that success is possible even in the poorest countries and that a variety of approaches can be successful.

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Read the Case Studies Online

Read the Conclusions Online

Download an Instructor's Guide

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Contributed by Ruth Levine, Director of Programs and Senior Fellow, Center for Global Development. She is a health economist with 15 years of experience working on health and family planning financing issues in Latin America, Eastern Africa, the Middle East, and South Asia. At CGD, she sets priorities and manages programs that use research to address practical policy challenges and manages the Global Health Policy Research Network. Reprinted with permission from Center for Global Development.

To read another Global Envision success story, see "We Are Now Stepping on Top of Money".



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