(Image credit: thisispublichealth.org)

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.

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.

Before you have anything else, you have your health. Hopefully if you have nothing else, at least you have your health. Unfortunately, for millions across the African continent this is not an absolute fact. Even more unfortunate is the fact that many Africans have no ability to change their health status. They are trapped in a system that is driven by Western market based, profit driven health care systems. As the failures of Western development practices come to light, alternatives to what has been are becoming increasingly visible. These alternatives will form a revolution in African health care delivery. This revolution will be fueled by health care delivery models that will give local communities agency in the provision of their own health care. Community-based models involving cooperative financing, proven para-professional training, new information technology, and social enterprise for the social good will drive the revolution in African health care. People will be able to determine for themselves, their level of health.

What does “Health” mean anyway?
This is a question often left to remain ambiguous. For the purposes of my writing I will provide a comprehensive view of “health” and all that is entailed in sustaining and maintaining health. “Health” in all instances will refer directly to the “basic needs” of a person in regards to health care.

Healing, like health, is obviously rooted in the social and cultural order. [...] To define dangerous behavior, and to define evil, is to define some causes of illness. As the definition of evil changes, so does the interpretation of illness. To understand change in healing, we must understand what it is that leads people to alter the definition of dangerous social behavior. It can easily be accepted that health and healing in Africa are shaped by broad social forces.

As Feierman and Janzen state, health (and healing for that matter) are directly linked to social forces. If a comprehensive understanding of health is to be understood, it must be studied in the context of politics, economics, and other societal structures.

Health is defined by the World Health Organization (WHO) as, “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” The WHO and many other international organizations recognize that this broad and encompassing definition of health. Where this definition becomes ambiguous is what qualifiers meet, “a state of complete physical, mental, and social well-being.” In 1978 the WHO made primary health care its number one objective with the Declaration of Alma Ata. However, even this statement had no clear definition of health or its qualifiers.

Feierman and Janzen provide a more clear definition of the qualifiers of health in the preface to their volume: The Social Basis of Health and Healing in Africa,

[…] it [health] is maintained by a cushion of adequate nutrition, social support, water supply, housing, sanitation, and continued collective defense against contagious and degenerative disease. Such a view is necessary if we are to understand those contexts in today’s Africa where health levels deteriorate, and where they improve.

These authors provide a complete set of qualifiers, or “basic needs,” of health that can be researched further to understand where political, economic, and social structures interfere with sustaining and maintaining health and where health care is inadequate.

Health care should thus be understood as the system and structure that works to provide the above defined “basic needs” to each individual. Often this role falls to governments, but sometimes is taken up by communities and organizations when government’s fail to provide these basic needs.

This blog series will cover four key areas identified that will fuel this revolution in African health care: cooperative financing, para-professional training, information technology, and social enterprise. SCOUT BANANA works to tackle social medicine (social, economic, structures) while enabling others to provide medical services. Be sure to follow closely to learn more!

(photo credit: WHO)

From the UN Declaration to Amnesty International, between Paul Farmer and William Easterly it seems that everyone has a different understanding of what constitutes a basic human right and the cause of its absence. Michael Keizner has been building the discussion on health and human rights on Change.org’s Global Health blog while NYU Professor, William Easterly has recently entered the debate as a response to Amnesty International’s position on poverty related to human rights. This fueled a response from Amnesty International, which stated that Easterly was “pretty off base.” Easterly followed his Amnesty International response with an end to his “human rights trilogy” by asking Paul Farmer who should be held responsible for satisfying the right to health care?

The World Health Organization (WHO) states health as a human right as:

“the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being…”

It seems that Easterly’s human rights criteria is trapped in an old international law paradigm where there must be someone at fault or someone to blame. He also forgets that health is directly linked to food. You cannot have good health and not have food. Effective aid, not seen in today’s aid schemes, based in sustainable practices (not just buzzword reporting) that supports an individual’s right to develop themselves should look comprehensively towards the needs of a community of individuals. The ideas of human rights, foreign aid, and development should be less focused on international systems and more focused on building strong communities that meet their own human needs: health care, food, water, etc.

Within this debate of health and human rights, where does SCOUT BANANA fit. As an organization that makes and stands behind the statement that:

“global health is everyone’s responsibility and every individual’s human right”

Paul Farmer has the right idea, as Easterly quotes from his Tanner Lecture in 2005:

“only a social movement involving millions, most of us living far from these difficult settings, could allow us to change the course of history….troves of attention are required to reconfigure existing arrangements if we are to slow the steady movement of resources from poor to rich—transfers that have always been associated… with violence and epidemic disease… whether or not we can say “never again” with any conviction—will depend on our collective courage to examine and understand the roots of modern violence and the violation of a broad array of rights, including social and economic rights”

This is exactly similar to SCOUT BANANA’s understanding of health as a human right and a responsibility. It is a right where we do not attempt to place blame or hold the past accountable because those become frivolous exercises that produce no results. When we delve deeper into the root causes of issues, for example the driving forces of slavery, we must focus on a responsibility to not repeat the past and make ourselves accountable in the future.

There is no way that the entire European population and its descendants can be held accountable for the evils of the slave trade. While the same ideas of human rights did not exist in the time period of slavery, it is similarly difficult to place blame on systems (and populations) that drive the causes of poverty and lack of access to health care. Many people that I work with on development projects feel guilty that they are so privileged and wealthy compared to the communities that they work with that are so poor. SCOUT BANANA teaches its members to not feel guilty, but instead to feel responsible. Understanding personal privilege related to the oppression of certain populations within societal structures can assist in creating positive impacts. Human rights don’t necessarily have to be about placing blame, but rather developing an understanding of responsibility.

So Professor Easterly when you ask who is responsible for satisfying human rights: it is you, it is me, it is all those who dream of making a difference, and it is also those who lack the very human rights that we hold dear. Placing blame is not a concrete step forward, learning from history and recognizing where our privilege fits can be a first step towards effective actions. I too see Paul Farmer’s vision of a movement of millions, near and far, taking actions to shape a better future where human rights are everyone’s responsibility and every individual’s human right.

From the Article 25 of the Universal Declaration on Human Rights:

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”

Nyala, Kalma camp, South Darfur - March 2007 (MSF Photo Blog)

The impact of conflict on the environment and then the subsequent, direct effect on human health cannot be overlooked. This internally displaced peoples (IDP) camp in Sudan shows the seriousness of that impact.

Your Old Cell Phone Can Make a Difference in Global Health

Everyone in the global health sector is writing about the incredible reach of SMS technologies working for health in developing countries, and rightly so. Hope Phones has partnered with FrontlineSMS to provide old cell phones to communities in need through SMSmedic partner organizations.
More:
Your Old Phone Can Change the World

TeleMed
A service that I just recently came across is one that is not being as widely talked about. TeleMed is different from FrontlineSMS: Medic because it connects local health care workers directly to patients in need via SMS technology. SMS: Medic is focused on health infrastructure. TeleMed does not have a website up yet, but is definitely one to watch:

Paul Farmer and the US Government?

The other big talk within global health is whether Paul Farmer will take a job within the US government. Some have expressed great hope for potential reform others voice their plea with him to continue his incredible community based work outside the bureaucracies. My opinion is that Partners in Health has developed into a strong organization and does not depend on Paul Farmer to further their work. If he wants to take on the inefficiencies and inadequacies of the US government and global health, then all the more power to him.

Southern Africa: Global Financial Crisis Leads to HIV Budget Cuts

Broken promises abound as the economic crisis deepens and the right to health falters, but activists are coming together to ensure that funding for health and HIV are not cut. International donors are expected to slash budgets for health due to the economic crisis and health experts fear that this will lead to, “less food security and quality of nutrition, which will in turn put more stress on already weak health systems.” Paula Akugizibwe, regional treatment literacy and advocacy coordinator of Windhoek-based AIDS and Rights Alliance for Southern Africa (ARASA) in Namibia demanded, “We need to ensure that African lives do not become a silent casualty of the global financial downturn. Our lives are not cheap or expendable. We expect health to be prioritised over weapons, sports and lavish politics.” Tanzania was the first sub-Saharan country to announce a 25 percent cut of its annual HIV/AIDS budget.
Other budget cut impacts:
Guinea: Medicines Running Out

Zambian High Court to Hear Groundbreaking HIV Case

On Wednesday, the Livingstone High Court was supposed to hear a ground breaking case about whether mandatory testing for HIV and discrimination solely on the basis of HIV status is constitutional in Zambia. Unfortunately two days later news came that the trial was postponed until mid-July. Be sure to keep watching this story.
More:
Trial postponed until 15 July

HIV Prevention and Behavior Change

Mara Gordon writes on Change.org’s Global Health Blog about a direct campaign in Tanzania discussing behavior change. “This campaign is partially paid for by the President’s Emergency Plan for AIDS Relief, U.S. government money to fight HIV that’s notoriously had lots of conservative strings attached. Had I seen this ad a year ago, I probably would have dismissed it as unrealistic abstinence-only propaganda. But behavior change works. Behavior change – in combination with access to condoms, comprehensive sexual education, open discussion about HIV and sexually transmitted infections in general, all that good liberal stuff.”
More:
Changing Human Behaviors: Sexual and Social
During a course on Africa’s environmental history I wrote about the need for changing human behavior in both the sexual and social arena to make a real impact in HIV prevalence. The major social change is the response from Western institutions and organizations in how they talk about HIV/AIDS and Africa while seeking to change sexual behavior.
Lesotho: Cultural Beliefs Threaten Prevention of Mother-Child HIV Transmission
Health workers note an encouraging response to the PMTCT program. The number of facilities providing PMTCT has risen from nine in 2004 to 166 by the end of 2008. The number of women who received PMTCT and subsequent antiretroviral (ARV) treatment increased from 421 in 2004 to about 5,000 by end of last year, according to 2009 National AIDS Council statistics. “The primary health care coordinator at St. James Mantsonyane Mission Hospital, Khanyane Mabitso, says stigma and cultural beliefs make it difficult for medical personnel to follow up on HIV-positive mothers and their babies.”

Progress on health-related MDGs mixed

Many advances have been made in health. Some argue that these advances have been dwarfed by the HIV/AIDS epidemic, the economic crisis, or the failures of African governments. The WHO report shows that the only statistic with concrete results was the number of children dying before the age of five. Is this a solid example of the failure of big plans and blanket goals for development?

Sierra Leone: ACC Recommends Reform At Health Ministry

The Anti-Corruption Committee report provides a number of recommendations for reform all focused on improving the health care delivery services in Sierra Leone and eliminating the risk of corrupt practices in the health services across the country.
More on health service scale-up:
Chad: Paving the Way for Better Obstetric Care
Government meetings with UNICEF to help scale-up of health services for better obstetric care across the country.

Ten Things You Can Do to Fight World Hunger

The Nation provides an interesting set of things you can do in your everyday life to fight world hunger. They properly focus on how food, a basic human need, has been commodified in our global capitalist structure. “Our planet produces enough food to feed its more than 960 million undernourished people. The basic cause of global hunger is not underproduction; it is a production and distribution system that treats food as a commodity rather than a human right.” When in February I wrote that agricultural experts had said the food crisis of the last year was over evidence from this past week point to the contrary.
More:
Tanzania: Food Shortage Unnecessary
“Tanzania has since independence sang the song of ‘Agriculture is the backbone of the economy’, but little has gone into strategizing and implementing viable actions towards surplus food production.”
Kenya: UN Agency Makes First Local Food Purchase from Small Scale Farmers
The United Nations World Food Programme (WFP) has for the first time bought food from small-scale farmers in Kenya under a new initiative aimed at boosting agriculture by connecting farmers to markets.
Zimbabwe: Another Year Without Much Food
Rwanda: Nearly Half the Country’s Children Are Malnourished
Kenya: Over Three Million Face Food Shortages

Africa: High Level Engagement with Continent Has Started

Speaking at a gala reception in Washington marking the beginning of “Africa Week,” Carson said: “Most of the Obama administration’s Africa team is in place, and we are gearing up. We will continue to build on and strengthen the strong bipartisan consensus in Congress and among the people of America that has motivated U.S. policy towards Africa. Over the next four years, we will be focusing our efforts on strengthening democracy, promoting sustainable development, resolving or mitigating conflict, and dealing with transnational issues such as climate change and agriculture,” he pledged. While Obama has built a great team, the White House has yet to announce any Africa Policy, greater control and influence for the Bureau of African Affairs, or take any serious (or effective) action for the continent.
More:
Tanzania: Obama, Kikwete Meet in Oval Office on Africa’s Conflicts

World Bank Resumes Zimbabwe Aid

Zimbabwe owes the World Bank and the African Development Bank more than $1bn, how much potential does renewed aid really hold for the country. If the debt is not forgiven there will be no way the country will be able to rebuild necessary infrastructures for health, water, etc. There are countless case studies to show this historical fact. It must also be noted that Western sanctions were a huge detriment to a country in need, maybe this marks a turnaround?