AIDS, malaria, and tuberculosis kill 6 million people each year in developing countries, and another 7 million children die of infectious diseases that have long been forgotten in the rich world. This represents both the tragedy of lives cut short and the loss of productivity that stalls economic growth and poverty reduction.

Does anything really work to solve profound health problems that face poor countries? Does development assistance from rich countries make any difference at all? Under the auspices of the Center for Global Development's Global Health Policy Research Network, we invited 15 experts in international health, development economics, public policy, and other relevant fields to identify and examine experiences of large-scale success in international health - national, regional, or global programs that worked to improve health. To find those cases, we collaborated with the Disease Control Priorities Project of the National Institutes of Health and solicited nominations from many of the world's leading health authorities. The conclusions of the What Works Working Group leave little doubt that some efforts to save lives and livelihoods through health interventions have worked and have done so at remarkably low cost compared with the benefits.

This volume tells the stories of 20 of these successes. These stories (or, more formally, the evidence-based cases) show that major public health efforts can and have changed the world for the better - well beyond what would have occurred through income growth alone. The magnitude and profundity of current health challenges facing the developing world - from AIDS to chronic malnutrition to the looming threat of tobacco-related cancers - can seem daunting. But past challenges have been surmounted and serve as object lessons: Even in countries with few financial resources and limited health infrastructure, sensible and systematic efforts to improve health have worked.

Looking toward the future, the authors identify several factors that were common to these 20 cases and appear to have contributed to their success. They do not claim to prove statistically that these particular elements, alone or in combination, are necessary or sufficient for successful outcomes. Rather, they argue that with the international community focused as never before on accelerating progress toward better health for the world's poorest people, a close look at these stories provides valuable clues about ways to increase the likelihood of success.

This effort puts to rest the notion that nothing works in global health. But it raises new challenges: The first is how we make sure there are more and even bigger successes in the future. If the humanitarian impetus isn't enough, surely the knowledge that economic progress is hastened by health improvements should spur scientists, public health workers, government officials, and funders to action. The second is how we make sure that we know what works and what doesn't. Rigorous evaluation should no longer be seen as an optional academic add-on to major programs. It should be required so that both successful and failed experiences yield knowledge for smarter policymaking and program design in the future. Only with high-quality evaluation will we have a credible basis for claiming the effectiveness of foreign assistance.

I invite you to dip into this book - to learn a bit more about how people and institutions have worked together to save millions of lives and millions of dollars. This is inspiration for the challenges ahead.



Center for Global Development