- There Are No Quick FixesA Talk with Dr. Sam Zaramba
Dr. Sam Zaramba is chairman of the executive board of the World Health Organization (WHO) and served as the Director General of Health Services in Uganda. As an early advocate for integrated disease control, Dr. Zaramba is credited with the success of the "Child Health Days Plus" campaign in Uganda, which included a deworming program and vitamin distribution for children. He initiated several other public health related projects including routine immunization, health and hygiene education, and distribution of insecticide soaked nets. Dr. Zaramba has also published a number of articles on neglected tropical diseases, such as river blindness and sleeping sickness. Trained in Uganda as a physician, he retired from his post as the country's top medical officer and now devotes much of his energy to the WHO, the United Nations agency overseeing its global health strategies. He spoke with World Policy Journal from Geneva, where the WHO has its headquarters.
You have an interesting take on international health, both from a global and African point of view. From this perspective, I'd like to hear your thoughts on the primary health emergencies facing the world today.
There are the age-old challenges—tropical diseases like sleeping sickness and tuberculosis—that have been mostly eliminated in the first world, but continue to plague the developing world. Such diseases have been particularly lethal, especially since the advent of newer viruses like HIV/AIDS, which have led to further health deterioration in at-risk populations. If you look at some African countries, particularly a country like Uganda, we have had the HIV/AIDS crisis alongside the Ebola epidemic—a combination of diseases we never imagined.
Do these problems need to be addressed on a local level, country by country, or globally?
There is no such thing as a solution that fits all countries. The approach to so many of the diseases we've talked about should be local. The health challenges facing Sub-Saharan Africa are not the same as those facing Southeast Asia, and often we try to provide quick fixes with input that ultimately overlooks the systems in place. Instead, we should be focused on the systems themselves, assessing whether they are capable of managing whatever solutions are offered. This is where the global community is quite often mistaken. It is eager to prescribe solutions and imagine that they will apply universally, but this is not the case.
Has the WHO been effective in building competent local health care systems? [End Page 41]
The principles and guidelines are very clear: the WHO aims to complement countries, while at the same time it doesn't dictate what goes on there. On the other hand, WHO depends on contributions from the member countries and donors. I would say that the WHO has done a lot and it has tried its best, but quite often programs are derailed in one way or another because of the competing priorities and concerns of partners and donors.
What do you think needs to be done to build programs that are determined and managed by individual nations?
I think we should listen. That is the most important thing. It is important to go into a country, study the situation and analyze what is on the ground. We must also expect countries to contribute to discussions rather than having global decisions imposed upon them, which often has not worked very well.
Where should the funding come from for these country-led programs?
First of all, I must say, I am disappointed with the response from many developing countries. I think they need to make health a priority. I don't know how much certain countries are influenced, but I believe they're facing pressures from the global community, and as such, have not put health first. The budgeting has been slightly lopsided, which has caused a lot of problems. So developing countries must make health a priority before they can accept contributions from the rest of the world.
I have the impression that many diseases and medical issues, particularly in the...