This week saw a number of exciting advances in dealing with health worker shortages as well as building the capacity of developing health systems. Africa now has its own association for public health, schools of medicine are working to meet the need for professional health workers, new state of the art hospital facilities are built in northern Rwanda, young people ask for more information and more sexual education, and African countries still work to meet the need for their health systems to deal with infectious diseases as well as non-communicable diseases.

Africa Federation of Public Health Associations Launched

Public Health is a growing field across the African continent. The WHO Regional Director for Africa, Dr Luis Sambo said the launch of the African Federation of Public Health Associations provides a useful platform to harness complementary capabilities and resources for better public health outcomes in the region. He said it will facilitate exchange of information and experiences among national public health associations and promote inter country cooperation.

Partners in Health completes Butaro District Hospital

With extensive research and architectural design efforts, the Burera District in northern Rwanda now has a state of the art hospital. PIH expanded the existing health center to grow into this pinnacle of treatment since 2007.

Safe Sex – Out of Fashion?

In a study published on World Contraception Day with support from the International Planned Parenthood Foundation (IPPF), young people in 29 different countries said that they needed more sexual health education and information. ”Sexuality is often a politically loaded subject which governments don’t want to burn their fingers on,” says Henk Rolink of Dutch sexual health and rights organisation Rutgers WPF. ”What’s more, health care budgets are often very low. Family Planning gets a low priority. In many other countries sex education mainly concentrates on abstinence. This is often the case in Western countries too, but of course it doesn’t square with reality. Young people do have sex.”

Obesity is Contagious 

This article’s title comes from research that shows individuals with close friends who are obese are more likely to also be overweight. Nigeria’s health system works to address NCDs, particularly obesity, as growing health concerns. At the gathering of health experts during the International Conference Centre in Abuja for the 2nd International Conference of the Federation of African Nutrition Societies (FANUS), the focus was on series of health concerns particularly the growing global obesity epidemic.

Hospital Turns Back Doctors Amid Doctor Shortage

In one of the more developed countries of Africa, there are still significant shortages in health workers and doctors. In scenes that can be replicated in many burdened health systems, one of Ghana’s port cities’ hospitals has closed its doors because there aren’t enough medical doctors. Director of Health Services Dr. Irene Agyepong said that actions had been taken to return the hospital to normal operations.

354 Students Enrolled in Orota School of Medicine

It is no doubt that increasing programs for medical education will be key to meeting the shortage of health workers across Africa as well as building the capacity of health systems. With the increases in enrollment at the Orota School of Medicine, Eritrea has seen the patient burden on the health system decrease from 29,000 people per doctor to 20,000 people per doctor. The school has a goal of school of having a doctor for 6000 every people in the year 2020.

We have been following MedAfrica (formerly called MedKenya) as it develops new ideas to share health and medical knowledge through the growing number of mobile phone users across the African continent placed against the extreme lack of doctors available in many African countries. Increasing access to better health information with technology and knowledge.

This is a video from September of last year when PBS visited Rwinkwavu, Rwanda to see the innovative work of Partners in Health (PIH) and their efforts to develop the capacity of the health care system. In 2005, SCOUT BANANA fundraised to support PIH’s increased efforts in Rwanda. This video gives an excellent visual example of their work and the focus on community based work. It also gives us the opportunity to think more critically about how our health care is delivered.

Watch the full episode. See more NOW on PBS.

This week comes with controversy and numerous calls for the eradication of various diseases by the WHO. Health workers in go on strike in another African country after South Africa’s months long strike. Liberian doctors said they would only treat “critical” patients. Tuberculosis is becoming more resistant among young people and HIV positive individuals, but more effort is being put into research.

WHO sees end to TB

Last week TB was discussed as a “forgotten disease for forgotten people,” but now it seems that the WHO has released a plan that identifies gaps in research to create faster treatment regimes. “There is an urgent need to scale up action against TB – 10 million people, including 4 million women and children, will lose their lives unnecessarily between now and 2015 if we fail,” Dr. Margaret Chan, the WHO director-general, said.

Its Time to End the Double-Standard of Food Aid

Tido von Schoen-Angerer, Executive Director of Doctors Without Border’s “Access to Essential Medicines Campaign” wrote on Huffington Post about how the US government continues to send sub-standard food supplies to areas in need. The United States, the world’s biggest food aid donor, continues to send the corn-soy flours that do not address childhood malnutrition. You would be hard pressed to find these foods in American grocery stores, because it’s food we would never feed our own children.

More: Can the story on US food aid get any worse from Aid Watch posting Financial Times

“Paradigm” Shift Needed in Health Care, Experts Say

In Africa there needs to be a greater focus on prevention and treatment of noncommunicable diseases like diabetes and hypertension and not just infectious diseases like HIV/AIDS, health experts told the 2010 U.S.-Africa Private Sector Health Conference October 6. “Health is as critical as institutions, infrastructure and education for Africa’s economic competitiveness and growth. It is a prerequisite for human energy, entrepreneurship, dynamic markets and a productive society,” said Haskell Ward, vice-president of Seacom Corporation and chairman of the Global Health Strategic and Advisory Committee of the American Cancer Society.

Ending Africa’s Hunger Means Listening to Farmers

Africa is hungry – 240 million people are undernourished. Now, for the first-time, small African farmers have been properly consulted on how to solve the problem of feeding sub-Saharan Africa. Their answers appear to directly repudiate a massive international effort to launch an African Green Revolution funded in large part by the Bill and Melinda Gates Foundation. “Food and agriculture policy and research tend to ignore the values, needs, knowledge and concerns of the very people who provide the food we all eat – and often serve instead powerful commercial interests such as multinational seed and food retailing companies,” said Michel Pimbert of the International Institute for Environment and Development (IIED), a non-profit research institute based in London.

African cholera outbreak kills 2000

A preventable disease that is linked to the need for clean water sources has continued to kill people in a number of countries. WHO officials report that, as of October 3, there have been 40,468 reported cases of cholera and 1,879 reported cholera deaths in four countries, including Cameroon, Chad, Niger and Nigeria. The outbreaks started a few months ago, officials said.

Obesity: an underestimated “silent killer”

There is a new “silent killer” in town. It joins the ranks of malnutrition, malaria, hypertension, diabetes, HIV/AIDS, etc. It is obesity. “We are eating our way to the grave’’ and “obesity is rising in rural areas.’’ Adults are overweight or obese, while children are malnourished – a paradox. In the men still look at a potbelly as a badge of pride and success.” The World Health Organization reports that more than one-third of African women and a quarter of African men are estimated to be overweight, and predicted that it will rise to 41 percent and 30 percent respectively in by 2016. Once considered a problem only in high income countries, overweight and obesity are now dramatically on the rise in low- and middle-income countries, particularly in urban settings.

With the growing difficulties in providing health care to everyone, governments sought solutions. Among those solutions were: privatization, decentralization, and integration of traditional health workers. It has become ever more apparent that government planning and policies are inadequate. It is time to put the power back in the hands of the people. The authors, Sama and Nguyen, remind us that,

Years ago, organised health systems in the modern sense barely existed. Few people alive then would ever visit a hospital. Most were born into large families and faced an infancy and childhood threatened by a host of potentially fatal diseases – measles, smallpox, malaria and poliomyelitis among them. Infant and child mortality was very high as were maternal mortality rates. Life expectancy was short.[1]

The financing of health systems has changed only slightly over the years. The modern, Western approach is still pursued even when this is not the most effective approach for African health needs. Turshen notes that,

Economists at international financial institutions have taken a radical, free-market approach to financing health care. They say that even strong economies can no longer afford to pay for public services and that weak economies in the third world [developing] must strip their large bureaucracies if they are to remain eligible for loans and foreign investment.[2]

This “radical, free-market” approach has led many African countries to rely on private health services for their citizens. This is an effective way for health care to be provided to citizens, but it further marginalizes those who cannot pay. Unfortunately, “universal health care” schemes are also ineffective in reaching everyone in need because government financing quickly runs out as both the wealthy and poor access health care for free.

Decentralization of health care is by far an approach that has incredible potential for effective health care systems. Joseph Stiglitz wrote in a World Bank report,

In many cases innovative approaches to service delivery will involve greater participation by local communities and decentralization of decisionmaking.[3]

The model that many top (and top-down) economists should use is best known as “autonomous development.” Development that is defined and controlled by local people is autonomous. This type of development is exemplified by indigenous groups in the Andes, where they define development as “wellbeing not only of the individual, but also of the world around them (Saravia qtd. in Ruonavaara). Related to this, Esteva writes that people sought to liberate themselves from their economic chains and so created new commons in their neighborhoods, barrios, and villages (20). This decentralized approach is often referred to as a hub-and-spoke model within health care. Halvorson writes on the needs and benefits of this model,

Physician-centric, fee-based, Western-style medical-care systems will clearly not work in most of rural Africa […]. They are too expensive, too unfocused, too haphazard, and there are just not enough doctors. We need to abandon attempts to recreate this business model in the third world and replace it with a team-care model that uses a hub-and-spoke approach to maximize available resources, create new resources where needed, reduce costs, and multiply the quality and quantity of local care delivery. We need people who can provide the basic care villages need—and we need those people to be part of an integrated system. This new model of care would require new categories of basic health care workers who are linked with higher levels of caregivers in more central locations. The frontline caregivers should be the functional equivalent of well-trained military medics—able to diagnose and prescribe drugs for a few common diseases, get advice, and perform first aid, including basic cut suturing, leg setting, and wound repair.[4]

The Western health care model is one about money and not effective care. Replicating this will only perpetuate, or make worse, health issues across Africa. African communities need a model that has low capital need, easy integration of para-professionals, and is more decentralized within areas of coverage.

The coming revolution in African health care is one where systems will be structured more and more with community integration and participation. Carino and her colleagues researched five mechanisms for effective rural health care delivery. The combination of greater integration in a rural community and participation of community members created the most effective health care outcomes.[5] This fact is also confirmed by social movement strategist Tarrow,

The most effective forms of organization are based on partly autonomous and contextually rooted local units linked by connective structures, and coordinated by formal organizations.[6]

With a hub-and-spoke health care system model focused on decentralized para-professional health workers on the frontlines of health care delivery utilizing new technologies to remain in communication with the broader health care system, access to health care and meeting the basic needs of African populations can become a reality. The coming revolution in African health care will depend on four main components that allow people the power to be involved in their own health care: (1) cooperative financing, (2) increased opportunity to training community health workers (para-professionals), (3) capacity of information technology to share knowledge, and (4) improved accessibility to preventative health care measures. The revolution has come!

---

[1] Sama, Martyn and Vinh-Kim Nguyen. Governing Health Systems in Africa. Council of Development of Social Science Research in Africa, 2008. (1)

[2] Turshen, 1.

[3] Stiglitz, Joseph. Assessing Aid: What Works, What Doesn’t, and Why. World Bank: November, 1998.

[4] Halvorson, George C. Hub-and-spoke health care. What Matters. 29 February 2009. <http://whatmatters.mckinseydigital.com/health_care/hub-and-spoke-health-care>.

[5] Carino, Ledivina V. and Associates. Integration, Participation and Effectiveness: An Analysis of the Operations and Effects of Five Rural Health Delivery Mechanisms. Philippine Institute for Development Studies. 1982. (6)

[6] Tarrow, Sidney. Power in Movement. Cambridge: Cambridge University Press,1998. (137)

American Food Aid: Saving Lives, or US Jobs

Change.org takes on US food assistance and its implications for foreign countries. Most often US food aid has very negative and often damaging effects on local communities and economies.

Swaziland: Poor Health Services Hamper PMTCT Progress

While much progress has been made in reducing HIV transmission, many are worried that the lack of adequate health workers and centers will reverse the advances that Swaziland has made.

Who’s Tracking the World’s Biggest ARV Programme?

South Africa runs what is probably the world’s largest ARV programme – over 700,000 people are receiving ARVs at public sector facilities. The South African National AIDS Council (SANAC) reports on the national program to fight HIV/AIDS. With good and bad news, the report demonstrates that there needs to be better implementation, monitoring, and evaluation.

Cameroonians Arrested for Operating Illegal Hospital

The largest issue with this article was not that there was a hospital started by local Cameroonians, but instead that they were distributing unregistered and illegal Chinese medicines. Is this an example of the growing influences of Chinese investment and aid? The hospital registered and defrauded over 2,000 people.

Why Studying Human Migration Can Help Stop Malaria

You may often hear this argument when talking about the spread of Tuberculosis, HIV/AIDS and other STDs, but not often for malaria. One of Change.org’s authors gives a great history and background on the spread of malaria. The World Health Organization (WHO) has written since 1957 that population movement exacerbates the spread of malaria.

Uganda: HIV/AIDS Centers Turn Away New Patients

As a direct cause of the reduction in funding from US government agencies, centers that provide treatment and prevention have begun turning away patients because they have to make budgetting cuts.

Read more about the Obama Administration’s Global Health Initiative that is causing issues across Africa in regards to funding for HIV/AIDS treatment and prevention.

Also on Health in Uganda:

• Public Irritated by Yet Another Condom Shortage
• Why Uganda Shouldn’t Criminalize HIV/AIDS Transmission
• Want to Help Uganda? Send Condoms 95% of condoms are supplied by foreign donors

In Mali, Using Cell Phones to Create Patient Records

New Echoing Green fellow Josh Nesbit and his organization FrontlineSMS:Medic have partnered with the Mali Health Organizing Project (MHOP) to streamline and clean up patient records to improve health services.

Other Articles of Interest:

• Troubled Water Aid Watch chronicles the issues with PlayPumps
• A Miner-Led Tuberculosis Crisis
• West Africa: 10 million face Hunger in Region
• Nigeria: Researchers seek ways to End Maternal Deaths
• Africa: Enticing Health Workers to the Outback