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WORLDVIEW: If They Can Do It, Why Can't We?

We often hear about the developed world assisting developing nations so it was refreshing to read the recent Wall Street Journal article that tells us it can also be the other way around. U.S. health programs are drawing lessons from medical practices in developing countries. When the AIDS clinic at the University of Alabama at Birmingham recognized that their patient no-show rates were growing, they looked far and wide for solutions. They found one in southern Africa.

Alabama's "Project Connect" has adapted a model developed in AIDS clinics in Zambia. Doctors see patients within five days of an initial call to clinic to gather psychosocial and medical history along with blood tests. A social worker also interviews new patients to try to identify and address issues (which often turn out to be complex and mutli-layered) that might prevent patients from coming back for ongoing care. The strategy is getting the job done. The Journal reports that "the no-show rate dropped from 31 percent in 2007 to 18 percent through June 2009."

I remember visiting an AIDS clinic in South Africa in 2004 and was shocked to see how empty it was. I asked a doctor why, and he said that they get patients in and out quickly by collecting all needed information before the patient actually saw a doctor. This was a stark difference from the AIDS clinic in San Francisco where my aunt worked, and where lengthy waits were the norm. I asked the same question many are asking today: "If they can do it, why can't we?"

Another program in Boston has cast its eye on Haiti of all places. The Prevention and Access to Care and Treatment Project (PACT) is based on the accompagnateur program in Haiti where a "domestic healthcare program trains and employs community members to check in on HIV patients on a daily or weekly basis, making sure they attend medical appointments, take their medications and have access to other essential needs and social services." Dr. Heidi Behforouz, who runs the Boston program, hopes it "will reduce rates of emergency-room use and hospitalizations, big drivers of health costs." It seems to be working. "According to data PACT collected, total medical expenses for 20 patients fell 40%," writes the Journal.

Not everything considered an advance overseas will be considered acceptable or suitable here. A recent paper by AEI states that "the developing world needs medicine, and it will seek out poorer alternatives if it cannot get high-quality Western medicines at affordable prices." Low-cost health technologies are easier to launch in the developing world where they are not subject to the same rigorous testing and legal barriers like the U.S. The Journal took Daktari Diagnostics as a case in point. The Cambridge, Mass. company "developed a hand-held, $8 device that takes a critical blood test in six minutes to determine when to start AIDS treatment...That is much faster and cheaper than the more sophisticated version of the test performed in the U.S., which can cost more than $50, requires an expensive machine and takes a couple of days to get results back," reports the Journal. This technology will be rolled out in several developing countries but not the U.S. The lower tech version is 90 percent accurate; the costlier U.S. one is 97 percent. Dr. Rodriguez (founder of Daktari) said, "In the developing world, people are willing to make the tradeoff in accuracy for simplicity and low cost. In the U.S., that kind of trade-off is a hard sell."

According to the Centers for Disease Control, an estimated 56,000 people become infected with HIV/AIDS every year in the U.S.-- a 40 percent increase over previous estimates. This means increased health care costs for communities and the nation and a decrease in available skilled and productive labor. We previously wrote on how every 9 1/2 minutes another person in America becomes infected with HIV but that a recent Kaiser survey found that the public's sense of urgency is down, even among some higher risk groups.The Journal states that in "In Alabama, the high rate of new HIV infections in rural parts of the state-estimated 1 percent to 2 percent annually -- is lower than in Zambia. But it is on a par with some African countries, such as Niger and Benin. And the challenges of poverty and stigma associated with AIDS are the same in rural Alabama as they are in parts of Africa." Stigma is one reason people don't seek timely treatment , and the delays can lead to more costly health interventions (and worse outcomes) down the line.

Mark Dybul, U.S. Global AIDS coordinator under President George W. Bush, quotes in the Journal, "We have learned from Africa that in a very resource-limited setting, you can do very effective chronic care delivery that doesn't have to be overmedicalized." U.S. health programs are following suit. It seems that reinventing the wheel and learning from cost-effective medical practices used in developing nations is paying off.