Latin America’s experience with the H1N1 virus has shown that a strong public health surveillance system is critical in mounting an effective response to the virus.
Such health surveillance measures pay dividends in that they also help strengthen health systems to deal with regular health challenges as well as emergencies and pandemics, says Keith Hansen, World Bank Sector Manager for Health in Latin America and the Caribbean, in a feature H1N1 Virus Update: Latin America's Experience Shows Communication, Surveillance Are Critical.
The Bank has been working with the United Nations and WHO to increase countries’ pandemic readiness through strengthening health systems.
Hansen was online Tuesday, October 6, and answered questions about strengthening health care systems in developing countries.
Mark Hiew:
Can efforts to improve developing countries' healthcare measures towards H1N1 also be utilized to improve existing programs for existing pandemics, such as HIV/AIDS and malaria?
Keith Hansen:
Absolutely. In fact, other than the vaccine (which is specific to this strain of flu), most of the smart measures countries can take to address H1N1 are also good for the health system as a whole. This includes strengthening surveillance and other parts of the public health system, building up laboratory networks, and improving public communications and understanding of health. All of these things are helpful to identifying and dealing with many other diseases, and especially epidemics. In fact, given how much uncertainty remains about what H1N1 could do next, it is good to focus on measures that will benefit the health system no matter what happens with H1N1.
Julia Ross:
Having lived in Shanghai during the 2003 SARS epidemic, I remember well how rumor and misinformation fueled panic. Should H1N1 worsen in coming months, do you think public health leaders in developing countries are prepared to communicate openly with the public about the scope of the illness? Or have the lessons of SARS been lost?
Keith Hansen:
Excellent question. Actually, the lessons of SARS are being used every day. The first lesson was that the world needed a better-organized system for addressing epidemics, since so many actors need to be involved. This led to the enactment of the International Health Regulations in 2007. The Regulations are a set of rules and procedures that governments and international health bodies have agreed to follow, to improve coordination, harmonize messages, and speed the response. They have been used from the first moment that H1N1 was announced, and have produced far-better coordinated action than we had in prior epidemics. A second lesson of SARS was that it’s crucial to handle public communications well. Leaders need to be repetitive, realistic, and reassuring with the public, giving them frequent and factual information and encouraging appropriate responses while discouraging panic. The general public in every country can act responsibly if it trusts public information, knows where to get it, and understands what measures it can take. The mass closings of schools, businesses, and sports events and the deserted streets we have seen in some countries are very dramatic, but show that people are listening. There are also a number of less visible measures that agencies are taking to improve coordination. So the lessons of SARS are informing everything we do in H1N1.
Rolando Lahera:
How can combine in Latin America health care for the children of poor people with the difficulties to get a good nutrition to grow up healthy?
Keith Hansen:
You’ve made an important point here. Nutrition is essential to the physical and intellectual development of every child. What happens before birth and in the first two years of life puts each child on a particular path, which cannot be changed much after the second year of life. Too many children in Latin America are still growing up malnourished (more than a quarter of all children in several countries) and it is stunting their potential. Contrary to what many people think, malnutrition in Latin America is not a result of inadequate food consumption. Rather, it results from inadequate breast-feeding practices; childhood diseases such as diarrhea which are treated late, poorly, or not at all; and an inappropriate balance in the child’s diet as he or she is weaned. Fortunately, there are many successful and promising examples of programs that are solving these problems. These include integrating more nutrition into core health services, supporting community-based services and information, and conditional cash transfers. For more information on programs in a particular country, please contact the local World Bank office.
emily:
Considering the developed world is having some issues dealing with this potential crisis, what can developing countries do to prepare, especially given the drop in foreign investment and empty government coffers?
Keith Hansen:
You’re quite right that a global epidemic is the last thing we needed on top of a global economic crisis. Besides the suffering and loss of life it creates, it can also place immense stress on health systems that are already having difficulty coping. This is why it is important to blunt the impact of H1N1 (and other epidemics) as much as we can. The good news, as I said in an earlier answer, is that most of the measures that can help against this flu can also help strengthen health systems in general, and better prepare them for future threats. This includes improving surveillance, public information, laboratory networks, and immunization programs. This means that a dollar or a peso spent on addressing H1N1 does not have to take a dollar away from other health priorities, because it can benefit both. Partners such as the World Bank have made large sums available to countries to meet both the immediate needs such as vaccines, as well as the broader needs of strengthening public health systems.
olumide:
despite the unquestionable role the private sector is playing in delivering healthcare in developing countries;there is still a lot of skepticism on the part of partners/donors to involve this vital sector rather emphasis is more on improving regulation etc (still more support for state).How really can we engage the private sector to improve what it is doing,how can improved services by private sector drive performance at the public outlets and where are the real PPP health projects(e.g privately funded public hospital projects etc)?
Keith Hansen:
The paramount lesson of improving health systems in any country is that we have to start from where we are. And you’re quite right that a substantial share of health services around the world are provided and/or funded by the private sector. This means that any effort to make things better must take account of the role of the private sector, how it connects to the public sector, and how patients and the public see the situation. This is often presented as an ideological issue, but that doesn’t really help answer any of the key questions. The truth is, both the public sector and the private sector have performed magnificently in some situations and dismally in others. What is important is not what precise share the private sector “should” have or whether it has a role at all. What’s important is the structure of incentives, financing arrangements, standards, regulations, and relationships that control how the manifold parts of the health system (including the private sector) will interact and whether they are collectively promoting the greatest attainable health at affordable cost, while protecting households from suffering onerous health costs. That’s a complex problem with guiding general principles but no simple answer, and one that needs to be worked out in the specific context of each country’s circumstance.
Rose Njiraini:
Thank your a chance to ask a question. There seems to be a lot for focus on Latin America. Is the bank doing any work in Africa?
Keith Hansen:
Good morning,
thanks for joining the chat and thank you for your question. Let's get started.
Yes, the Bank is actively supporting health systems in all regions of the world. Africa is a major focus for Bank activities, which are geared to helping African countries achieve their national and MDG goals and to build health systems sustainably. Bank support includes projects that cover the full range of health system challenges, HIV/AIDS, and malaria, as well as analytic work and policy advice. Information on all Bank projects is available at
the Bank's Projects Website.
Elianne:
Viendo la íntima relación entre las muy sencillas medidas preventivas de comunicación de las enfermedades como la gripe H1N1 - cosas simples como lavarse las manos con frecuencia y mantener una buena disposición de recursos sanitarios (agua potable y sistemas de cloacas funcionales), ¿En qué proporción afecta a la diseminación de una epidemia las enormes faltas de estos servicios en muchas areas pobres de las grandes capitales de países latinoamericanos, por ejemplo las favelas de Brasil o los "ranchos" de ciudades como Caracas, Venezuela?
Keith Hansen:
Question translation:
Having seen the very close link between very simple communication measures and prevention of the H1N1 virus (for example, frequent hand washing and the availability of proper sanitation services such drinking water and functioning sewerage systems), to what extent is the spread of an epidemic attributable to the acute shortage of these services in many poor areas in the big capitals of Latin American countries such as the favelas of Brazil or the ranchos in such cities as Caracas, Venezuela?
Thank you for raising this, which is a very important question. Poor sanitary and living conditions are indeed a major contributor to illness and vulnerability in poor communities around the world, including in Latin America. In fact, this is one of the main reasons that there is such disparity in the rate of infectious diseases between poor communities and non-poor communities in Latin America. In the case of H1N1, it’s too early to say how much living conditions have contributed as opposed to other factors. Because it is a “new” strain which people have not been exposed to, it is tending to infect people from all socioeconomic classes. But it is certain that over time, communities with better services and living conditions overcome most diseases more quickly than poor communities do. This is why the Bank and many other agencies working on health put such emphasis on support the many contributors to better health, such as water, sanitation, and education.
Carlos Ferreyra:
¿Es cierto que los países ricos están acaparando las vacunas?
Keith Hansen:
Question translation:
Is it true that wealthy countries are hoarding the vaccines?
The wealthy countries will be the first to do large-scale immunization programs, as the flu season resumes in the northern hemisphere. At the same time, many of them have pledged to donate a certain share of the vaccines they acquire to the World Health Organization, which will then provide them to poor countries to give to groups at greatest risk. Middle-income countries will be obtaining vaccines by buying from manufacturers or through special fund arrangements. For more information, you can visit WHO’s website at
http://www.who.int/csr/disease/swineflu/notes/pandemic_influenza_vaccines_20090924/en/index.html
Latin America’s experience with the H1N1 virus has shown that a strong public health surveillance system is critical in mounting an effective response to the virus.
Such health surveillance measures pay dividends in that they also help strengthen health systems to deal with regular health challenges as well as emergencies and pandemics, says Keith Hansen, World Bank Sector Manager for Health in Latin America and the Caribbean, in a feature H1N1 Virus Update: Latin America's Experience Shows Communication, Surveillance Are Critical.
The Bank has been working with the United Nations and WHO to increase countries’ pandemic readiness through strengthening health systems. “The goal is not to just chase the disease du jour, but to really be prepared for what else may be coming down the pike, and strengthening countries overall in their readiness,” says Hansen.
Hansen was online Tuesday, October 6, and answered questions about strengthening health care systems in developing countries.
Sector Manager for Health, Nutrition, and Population in Latin America and the Caribbean
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