diagonal approach

With less than 1000 days until the Millennium Development Goals expire, the process for setting post-2015 goals continues to ramp up.  We take this opportunity to reflect on the current state of community health systems in low- and middle-income countries and consider how the post-2015 agenda could reshape them—perhaps dramatically.

Community health systems today

Integration moves ahead

Poor and rural communities in low- and middle-income countries are leaving behind the “one clinic, one service” approach. So-called vertical programs, which organized resources according to single health conditions, created a patchwork of health services at the community level. You could get HIV care from one provider, but would have to go down the hall, down the street, or often much farther to get maternal health care or malaria care.

Eugénie, a widow in Rwanda, farms to provide for her children. In January 2012, she had surgery to remove a tumor, a procedure that would have devastated her family economically if she did not have insurance. Rwanda’s health insurance program is the most successful of its kind in sub-Saharan Africa: it supports the health of more than 90 percent of the population, including the most vulnerable, like Eugénie.

Chronic diseases --- notably cancers, cardiovascular diseases, chronic lung diseases, and diabetes --- now account for nearly 35 million deaths annually. The human and economic burden of chronic diseases are staggering, especially in developing countries. Left unchecked, by 2030 the epidemic will kill twice as many people in low- and middle-income countries as it does today.

One year ago, the world came together to address this emerging global epidemic. Country representatives, policy makers, and civil society convened in New York for the United Nations (UN) High-Level Meeting on Non-Communicable Diseases (NCDs), and the UN General Assembly adopted a declaration, promising to strengthen and accelerate the response.