Health has long been a gift that we have attempted to give to the rest of the world. Disease eradication programs, vaccination outreach campaigns, and the Western biomedical system have all been spread to countries near and far. These gifts were often colonialist in design, given without community consent, and without regard to culture or custom. Contrary to Thomas Friedman‘s thoughts, the world is not flat. Rather we live in a world that is increasingly connected by technology, but still remains sharply separated by those who have and those who don’t.

When it comes to global health, we no longer have the luxury of saying, “those people over there have health issues.” There is no simple separation between “us” and “them.” Health problems aren’t over there any more than they are right here. In the US, lifestyle choices contribute to heart disease, diabetes, obesity, and lung cancer. When we talk of disparities in access health in other parts of the world, we cannot forget the glaring health disparities in US inner cities and across communities of color.

The curtain has been lifted and hopefully we have looked in the mirror to see that we too have health issues in our country. While the ideas to make health better have long come from the West and developed countries, that paradigm is no longer applicable to global health today. Our world is still expansive, but we are more connected than ever before. With the internet at our finger tips and friends across the ocean only a skype call away, solutions in global health come from around the world. The past demonstrated that “developed” countries believed they were giving something valuable to those who didn’t have what they had. The result was a plethora of failed aid goals, missing life-saving medications, and decrepit health care systems.

Innovations for better health come from all around the world. It is no longer the “developed” giving ideas to the “developing.” The increasing use of mobile phones have inspired some exciting programs for health records management while SMS and texting have led to revolutions in access to health knowledge and care. However, it isn’t always technology ideas that are most effective. Developing countries have reminded us how important and critical health insurance can be, while at the same time demonstrating the severe need for more trained health care workers. Models that train community health workers, access micro-health insurance on your mobile phone, and social enterprises that provide ambulance emergency services have all been launched in “developing” countries. I can only hope that our health care system can take the time to look around the world for ways to improve.

For many years, complex issues in international development and global health have been tackled by simplified single-issue campaigns that have created short-term “band-aid” solutions. This can be attributed to the limited view most Americans have of the world. For many, issues of global health remain remote and abstract. We, young people, have grown up with the internet in our laps, basic knowledge of different cultures around the world in our classrooms, access to easier communications and travel, and more opportunities to study abroad and participate in global exchanges. These factors have made the world seem more connected, and have bestowed upon us the capability to serve as the key drivers of social change.

We must bridge the divide between rich and poor, privileged and oppressed, developed and developing. We, as privileged young people, can be the voice that changes the actions of our largest institutions to focus on programs that work, projects that benefit people in need, and efforts to build healthier communities.

Reposted from the Blog of Americans for Informed Democracy, where I am writing as a Global Health Issue Analyst.

As the least glamourous or well-known position in any health care system, community health workers often have the most difficult jobs, the smallest pay, and the greatest impact on many people’s lives. This is a video from an organization committed to “better health for Africa.” AMREF is best known for its “flying doctors” service among many other programs that strengthen community health systems. This is part of the story about a community health worker in Ethiopia, Almaz Nagade.

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.

Western international development agencies tend to portray the continent of Africa as a basket-case, a place that needs to be saved by the “highly developed” western countries. Contrary to the conventional and paternalistic wisdom, African people throughout the continent represent huge sources of technological, environmental, and – especially – health innovations.  The western world could take a few notes from scientists and inventors throughout the African continent.

For example, the Clay House Project, a non-profit health organization based in Namibia has recently introduced new advanced dry toilet technology to improve sanitation throughout the world. The inventor of the dry toilet, a device that does what the name suggests, provides a sanitary mechanism that does not require precious water supplies and could improve the health of 2.6 billion people. Lack of access to proper sanitation, currently causes major sanitation problems that can be avoided by utilizing the new technology.[1]

Elsewhere, in South Africa, researchers have invented a vaginal gel which radically reduces a woman’s risk of the contraction of HIV.[2] According to World Health Organization (WHO) statistics, more than 30 million people are living with HIV/AIDS on the planet.  It is well known that South Africa has a high rate of HIV infections.  New technology like this is a truly significant innovation and improvement in South African health.

An especially interesting and impressive environmental innovation was made by a Malawian inventor, William Kamkwamba. When Kamkwamba was 14 years old, he engineered and built an electricity-generating wind

mill for his family from parts he found around his home and village.[3] He taught himself this relatively complex technology from instructions he found in a book. Kamkwamba is featured in an inspiring video produced by the non-profit,

TED, featured here and pictured below.

If the Namibian inventors of dry toilet technology, the South African HIV/AIDS researchers, and innovators like William Kamkwamba can produce and distribute their innovative technology, they could improve the combined health of nearly 3 billion people.  That’s nearly half the world’s population, and three-quarters of the developing world.

[1]Smith, Jana-Mari. “Namibia: Locally Invented Toilet to Improve Lives of Millions.” AllAfrica.com. 5 July 2010

[2] Brown, David. “Gel Found to Reduce AIDS Risk in Women.” The Washington Post. 20 July 2010

[3] http://www.ted.com/talks/william_kamkwamba_on_building_a_windmill.html

[4]http://summerfeyfoovay.com/foovays_cauldron/wpcontent/uploads/2009/07/william_kamkwamba_windmill.jpg

Malnutrition and water are HUGE issues when it comes to health. Listen to the interview with Jim Hocking of ICDI. The video covers some potentially disturbing, but everyday health problems associated with malnutrition and water. In 2007 SCOUT BANANA organized a Year of Water Project in Michigan with twelve different universities and colleges participating to raise almost $8000 while educating over 50,000 students in Michigan. The work of Charity:Water benefited from the project and they continue to take incredible actions! Learn more about why good food and clean water are essential to good health.

The Mo Ibrahim Prize for African Leadership hasn’t been given out since 2008, but the Mo Ibrahim Foundation has launched the Ibrahim Index as a measure for African countries and their progress. This is an interesting and important development as a number of the indicators for the index focus on health. Check out other interesting news from across the continent. Check it out for yourself!

Reducing poverty with water!

“Water is more valuable than oil, more precious than gold,” said Amy LoPresti, co-founder of Africa Water is Life. “It is the essential ingredient of our life, our culture, our history, and our future. Yet, 1.2 billion people in the world do not have access to clean, consumable water.” Unsafe water and a lack of basic sanitation cause an estimated 80 percent of all diseases in the developing world and together kill more people than all forms of violence, including war.

Modified bananas to fight child and maternal mortality

This is a story that really invokes our organization’s name. High rates of chronic malnutrition and micronutrient deficiencies of Vitamin A and iron among women and children remain Uganda’s most common malnutrition problems. However, an edible banana could solve this problem.

How fight against Guinea Worm was won

Africa Water News highlights a CNN article that suggests we are close to eradicating the disease. Once called the “forgotten disease for a forgotten people” the Carter Center believes that every country in Africa except Sudan will be rid of the disease.

Healthcare is a Moral Obligation

The ANC’s National Health Insurance scheme has yet again opened up the deep economic divisions in South Africa. The economic divisions are best represented by access and quality of health care. Doctors are very difficult to find in poor, crowded townships and settlements, but major towns with many wealth have centers for plastic surgery. 60% of funds for health services are directed at the 15% of the population which is covered by private health insurance. Only 40% of the funds are used to pay for the public sector that serves 85% of the population.

Medical Education in Africa to receive $1.3million in American Grants

Over the next five years and in partnership with the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the department is awarding grants to African institutions in a dozen countries under its Medical Education Partnership Initiative (MEPI), which works with U.S. medical schools and universities to form a network that includes about 30 regional partners, country health and education ministries, and more than 20 U.S. collaborators.

Ghanaian belief and Healthcare

This article is being featured because of the subject matter. Voice of America (VOA) has a habit of generalizing, especially in Africa and about African people. I suggest reading the interview transcript on how traditional beliefs guide health practices in Ghana, something that I studied during a 6 week study abroad covering disparities in health care. The US health care system could learn a thing or two from the Ghanaian health system.

Hope Expanded Protection Against TB

With a vaccine and drugs available to treat tuberculosis (TB), you would think that it should no longer be a problem. 1.3 million people worldwide died from TB in 2008, according to the World Health Organization most lived in Africa and Southeast Asia. Is this becoming another “forgotten disease for a forgotten people?”

How many people actually understand charts, graphs, and spreadsheets? Likewise, how often are these displays of data constructed to make us think a certain way? Thanks to the innovation of Hans Rosling and others we can now sift through our own data however we want to in a way that is simple and understandable. This is a great innovation for health since it allows everyone to understand various indicators of good health around the world. Listen to Hans Rosling’s TED talk and check out his program called Gapminder. I recommend the “Africa is not a Country” installation of Gapminder.

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!

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[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)

SCOUT BANANA, in conjunction with James Madison College and the MSU African Studies Center, invites you to submit a manuscript to

Volume III, Issue I of Articulate: Undergraduate Research Applied to Development in Africa.

Articulate is an undergraduate journal that publishes academic papers and writings on development in Africa and African issues. It is a forum for students to contribute to, as well as initiate, debates in international development, as undergraduates remain a vital, untapped force for new ideas and perspectives within the development dialogue.

Primary criteria for inclusion in the journal are quality of research, relevance, and originality. All manuscripts must have been written as an undergraduate student. For Scholarly Articulates, we ask for submissions of roughly 15-20 pages double-spaced with citations formatted according to the Chicago Manual of Style, and an abstract of 200 words. We also ask that the author’s name, major, college, and university appear on a separate cover sheet, with no reference to the author within the manuscript.

Potential topics include, but are not limited to:

• The effectiveness of foreign aid, microfinance, and social enterprise in Africa
• Intersections of gender, religion, ethnicity, and sexuality in African development
• Consequences of globalization, especially financial and trade integration
• Historical analyses and case studies of health care policies in Africa
• Politics of water and medicine in Africa
• The role of African youth in development programs and projects
• Effects of conflict and migration on health care and development

Articulate is also seeking brief reflective essays on your experiences in Africa, as well as reviews on literature relevant to Africa, development, and health care.

Reflective essays are 2-3 single-spaced pages and can take a variety of creative forms. They should explore development work from the perspective of a young person (under 30) from the Global North entering the Global South. Was it how you thought it would be? What did you like and/or dislike about it? What do you wish you had known when you were just “studying,” as opposed to working, in Africa on health-related issues? Other themes may be considered with consultation from the Editor-in-Chief.

Literature reviews are 2-3 single-spaced pages and are meant to keep Articulate’s readers abreast of current works and on-going debates pertinent to development, Africa, and health care. Reviews must provide a careful, thoughtful analysis and critique of a work’s main themes, objectives, arguments, and conclusions. They should include at least three titled sub-sections: an introduction that includes a synopsis of the work; an analysis that considers what, if any, assumptions underlie the author’s thinking and, if evidence is cited, how well it supports the work’s main objective; and a conclusion that summates your analysis and states the overall merits and/or shortcomings of the work.

Manuscripts will be accepted until Wednesday, September 15, 2010, with publication intended during November 2010. For submissions or inquiries, please contact the Editor-in-Chief at articulate@scoutbanana.org.

For more information, check out http://scoutbanana.org/articulate.

Army Takes Over, Access to HIV Treatment Halted by Strikes in South Africa

As South Africa’s health system is crippled by strikes the Government warns health workers of contributing to murder. HIV/AIDS treatment access has also been halted as the health system ceases to function. Strikers are demanding increased pay due to their insubstantial compensation. Should they be paid more?

Army Medical Teams Move into Strike-Bound Hospitals

Health Minister Warns of Murder as Staff Strike at Hospitals

Strike Jeopardizes HIV Treatment

Government Threatens Action Against Health, Security Strikers

National Public Sector Strike Hits HIV Treatment

Nation Becomes a Victim of its ARV Treatment Success

Public Health Strained by Nurses Strike

Botswana: Acquiring a Taste for Recycled Water

The Water Utilities Corporation in Botswana is breaking ground on a facility to treat waste water in order to supply a water source for the country. Many citizens have expressed disgust at the thought of drinking waste water, but the program holds great potential as water scarcity increases across the continent and around the world.

Hillary’s “new approach” to Global Health

David Rieff takes on the US Secretary of State’s approach to global health and development calling it naive, contradictory and muddled.

Donor Fatigue New Threat to HIV/AIDS Fight

Doctors Without Borders has raised the alarm that this is, “No time to quit! The HIV crisis is far from over.” As economic recession hits, many countries around the world  are decreasing their aid funding for HIV/AIDS treatments. The Obama Administration has come under fire for their cuts to HIV/ AIDS and PEPFAR funding.

• Is Obama Failing on AIDS?
• Optimism as U.S.  HIV Program Lifts Funding Caps

Mozambique: Maputo Central Hospital Bans Use of U.S. Dollars

Patients in Mozambique will no longer be forced to use U.S. Dollars to pay for treatments. This is an important move to increase access to health care in the country.

Cholera Outbreak Grips Nigeria

The need for clean water is demonstrated as cholera rapidly spreads across Nigeria and neighboring countries. As a common disease and treatable disease, the recent cholera outbreak calls for greater access to clean water sources for impoverished communities.

Cholera claims 352 lives

Cholera Outbreak Highlights Vulnerability of Children, Mothers

Cholera Outbreak – FG Moves Drugs, Officials to Bauchi, Borno

Cholera, Measles claim more lives

Cholera Outbreak hits 3,000 in Three Nations