Health and Healthcare Systems

Bill Gates: These countries can teach health lessons that could save millions of lives

Bill Gates, Co-Chair of the Bill & Melinda Gates Foundation gestures next to his wife Melinda French Gates during the session 'Sustainable Development: A Vision for the Future' in the Swiss mountain resort of Davos January 23, 2015. More than 1,500 business leaders and 40 heads of state or government attend the Jan. 21-24 meeting of the World Economic Forum (WEF) to network and discuss big themes, from the price of oil to the future of the Internet. This year they are meeting in the midst of upheaval, with security forces on heightened alert after attacks in Paris, the European Central Bank considering a radical government bond-buying programme and the safe-haven Swiss franc rocketing.                         REUTERS/Ruben Sprich (SWITZERLAND  - Tags: BUSINESS POLITICS TPX IMAGES OF THE DAY)   - LR2EB1N1DUY4Z

Rwanda achieved a staggering 67% reduction in deaths among under-5s. Image: REUTERS/Ruben Sprich

David Elliott
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This article is part of: Sustainable Development Impact Summit
  • The Exemplars in Global Health project compiles data on the countries that have made the most progress on health with limited resources.
  • It considers areas including stunting, under-5 deaths and community health workers.
  • Peru, Rwanda and Senegal are among the nations that have made great strides.

“Whenever you’re looking at a health problem, the first thing to do is see which country solved it the best.”

That’s Bill Gates, talking about Exemplars in Global Health, an international research project working to identify countries with limited resources that have outperformed their peers in key areas of health.

The initiative, backed by Gates Ventures, works with a local and international network of academics, health experts and leaders from universities, research bodies and organizations including the World Bank and UNICEF. It compiles and analyzes data on how countries are performing in several areas, including stunting, child mortality and community health workers.

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Through this work – which includes an online platform and a community of experts to help nations use the data and invest in effective health programmes – it wants to help other countries replicate successes.

Here are some of the “exemplar” countries and the remarkable progress they’ve made.



Between 2000 and 2015, the South American nation reduced both neonatal and under-5 mortality by more than 50%. It engaged community-level care, drew up clear priorities for national health, and worked to address the health needs of a diverse country through research and innovation. Among key interventions were effective and equitable vaccination campaigns focusing on high-risk areas.


In the decades following the genocide that devastated the country, Rwanda brought about a 67% reduction in deaths among under-5s. It increased training and accountability at every level of its health system, committed to make healthcare available to all, and invested in strategies that focused on community needs, such as developing an integrated case management for diarrhoea and pneumonia. It also put in place major programmes to address malaria and malnutrition, and put community health workers at the centre of efforts to roll out these interventions.

Under-five mortality rates in regions around the world.
Under-five mortality rates in regions around the world. Image: IHME GBD 2017/Exemplars in Global Health


After two civil wars and an Ebola epidemic, the West African nation moved quickly to design, test and launch a community health system to care for its most vulnerable citizens, who had been out of reach for more than a generation. Strong government leadership and a detailed financial plan supported this vision. Today, about 70% of its 700,000 rural residents have access to care, while the proportion of women giving birth with skilled assistance has shot from 55% to 90%.



Brazil has one of the world’s largest community health worker programmes, helping nearly two-thirds of its population access care. It wasn’t always this way. When, in the mid-1980s, it emerged from military rule, there were big problems with access to healthcare. But backed by innovative financing such as incentives for municipalities to adopt key strategies, decentralization of the health sector, and an emphasis on community ownership, its community health worker programme has helped cut under-5 mortality by 75%. The country has also achieved near-universal immunization.


Senegal improved its nutrition, health and education coverage rates to halve its rate of stunting – when poor health results in a child being too short for their age – from 34% to 17%. The project says the country has reduced stunted growth more than would be expected based on its economic growth – and that its story will be relevant to many similar nations struggling with their own stunting crises.


In 1992, when it was one of the world’s poorest countries, Ethiopia set about cutting its stunting rate. By 2016 this had fallen from 67% to 38%. In this period, agricultural productivity more than doubled, primary school enrollments quadrupled, immunization rates more than doubled and open defecation fell by more than 50%. The government’s creation of community-based health systems that could deliver services at scale was instrumental.



Community-based approaches also helped Nepal cut under-5 deaths by more than 50% between 2000 and 2015. It also strengthened its network of health facilities, focused on neonatal health, and drew on data and local research. Over two decades, the country has also halved its rate of stunting.


In the early 1970s, when Bangladesh was the poorest country in the world, its massive rural population had little access to healthcare. Today, 130,000 mainly female community health workers deliver health education and care to more than 100 million people. Under-5 mortality has dropped by 56%, and the percentage of rural kids with access to a critical vaccine for diphtheria and tetanus has increased. Consistent government support and rigorous monitoring of problems helped address these challenges.

Kyrgyz Republic

For Central Asia’s Kyrgyz Republic, investments in basic health services for all, the distribution of small plots of farm land to families to help boost food security, and strategic policy-making were key to reducing the number of stunted children. Between 1997 and 2014, it fell from more than 200,000 to 95,000. The country experienced a rapid decline in poverty in that period too – but it was policies to ensure the most vulnerable had access to nutrition and care that made the difference.

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