Going to school, seeing a doctor and running water are taken for granted by most people in the West, but for millions of poor in the developing world, these public services are vital in transforming their lives, an Oxfam report said last Friday.
The lack of such basics means 4,000 children a day die needlessly from dirty water, while 100 million children -- mostly girls -- miss out on an education.
But government action and flexible aid could mean that within a generation every child in the world could be in school and everyone could have safe water.
The idea of building a strong public sector is not a new one, the charity says, but rich nations and international agencies such as the World Bank are failing to deliver sufficient debt relief and aid to these essentials.
Oxfam calculates that to meet the health, education and sanitation targets of the UN Millennium Development Goals would require ?25 billion (US$47.6 billion) more in aid a year. Compared with global military spending of ?500 billion a year or the ?21 billion the world spends each year on pet food, it is an affordable, feasible goal, it says.
"The message is one of possibility," said Max Lawson, one of the report's authors. "Some countries like Sri Lanka can achieve a great deal with limited resources when they concentrate on delivery of key public services. That was widely accepted in the 1970s but is now considered groundbreaking."
Oxfam's report, In the Public Interest, has been released ahead of the IMF/World Bank meeting later this month.
Lawson said that European countries, which provide the bulk of the World Bank development funding, needed to push public services higher up the World Bank's agenda, which is more focused on fighting corruption and financing infrastructure projects.
Furthermore, many poverty relief policies are tied to conditions that block progress and push private sector initiatives that do not benefit the poor.
Oxfam says if global institutions such as the IMF could work better with the developing world, the 4.25 million new health workers and 1.9 million teachers needed to provide basic health care and education for all could be trained.
"What we are trying to do is get a more pragmatic assessment of what actually works. It's about getting back to basics," Lawson said. "Greater involvement of the private sector and NGOs [non-governmental organizations] can only work if public services are good."
Governments in Sri Lanka and the Indian state of Kerala, which are heavily committed to social policies, prove the success of effective action. Despite more than a third of Sri Lanka's population living on ?1 a day, its maternal mortality rate is among the lowest in the world. In the 1990s the maternal mortality rate was halved to 250 a year.
When a Sri Lankan woman gives birth, she has a 96 percent chance of being assisted by a qualified midwife. Medical treatment for her and her family is free at a public clinic near her home. Her children go to primary school for free.
Similar progress has been seen in Uganda and Brazil, where the number of children in school has doubled, deaths from AIDS have halved and safe water has been made accessible to millions.
But such gains vary across the world. Kazakhstan has an income 60 percent higher than Sri Lanka, yet children are nearly five times more likely to die in their first five years and are far less likely to go to school, drink clean water or have the use of a toilet, the report says.
Ethiopia also falls short of these basic human rights.
Misra Kedir, a young Ethiopian woman, recalls giving birth: "I will never forget how I suffered owing to the lack of water. There was no water to wash the baby or myself. I was ashamed of the unpleasant smell, especially when my neighbors visited me."
As well as poverty, Yemen also highlights the deep inequality between the sexes. A woman has only a one-in-three chance of being literate. Women are more likely than men to fall ill but less likely to receive medical care. Yet investing in women's welfare, so they and their children survive, is the cornerstone of development, Oxfam says.
The charity's concerns are not limited to ensuring promises of money are kept and public service provision is encouraged. The report says rich states are aggravating skill shortages by taking skilled labor from developing nations.
Of the 489 nursing students who graduated from the Ghana Medical School between 1986 and 1995, 61 percent have been recruited by developed nations, with more than half going to Britain and a third to the US.
"Public sector workers must be seen for the heroes they are, and put at the heart of expanding public services for all," the report says. "Pay on its own does not always increase motivation but it is the first priority where earnings are currently too low. Better pay needs to be matched with better conditions."
In Malawi, such measures are being taken. Aid donors are funding a salary increase for health workers, curbing the number of doctors and nurses leaving for other countries, and improving the quality of care on the wards.
The report recommends that alongside training and retaining workers, governments in developing countries must abolish fees for basic education and health care, and subsidize water for the poor.
"Civil society can pick up some of the pieces but governments must act," Oxfam says. "There is no shortcut -- and no other way."
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