Warning: Hospitals May be Unsafe for the Poor

Most public health initiatives in developing countries focus on controlling infectious diseases in the community. The morbidity and mortality caused by diseases such as malaria, tuberculosis, schistosomiasis, and pediatric pneumonia and diarrhea certainly justify such priorities. But another aspect of the public health system in nations with limited healthcare resources – hospital�acquired infection – has been largely ignored by the public, press, and funding agencies.

Developing nations lavish their limited resources on hospitals, which consume more than 50% of healthcare budgets in many poor countries. Officials in these countries are striving to identify sick patients in the community and to triage them to regional facilities that have the expertise to provide appropriate diagnosis and treatment. Some of these facilities may be modest local clinics with a few beds. Others are regional or national tertiary care centers offering as much high�tech diagnosis and treatment as the country can afford (or persuade industrialized nations or philanthropists to provide).

The craving for expensive, technologically sophisticated care is noteworthy. In part, poor countries make these large investments because they are devoted to improving the quality of diagnosis and treatment. In part, they make them to keep their best physicians. These doctors, trained in advanced countries, return home with a keen desire to use their newly honed skills, only to find themselves hamstrung by outdated radiology equipment, a limited range and unreliable supply of drugs, and primitive life�support technology. High�tech hospitals are also status symbols, and some countries seek prestige by building the most modern facilities. The industrialized countries that build and help fund these projects may be motivated, at least in part, by pressure from the companies that make high�tech equipment and supplies.

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