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.
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.
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.
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.”
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.
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.
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.
The growing resistance to the most effective malaria treatment on the market, Artemisinin therapy is a grave concern in Southeast Asia. Resistance to the drug has spread across most of Asia, and has the potential of spreading in a significant way to Africa. This is especially detrimental because African countries are the most affected by malaria and this resistance to treatment could put millions of lives at risk.
According to the World Health Organization (WHO), nearly half of the world’s population is at risk of contracting malaria and one million people die each year from the disease. In African countries, 1 out of 5 childhood deaths are malaria-related. If resistance to Artemisinin treatment for malaria becomes a reality in African countries, like it has throughout Asia, what does that mean for efforts to promote African health and welfare, and efforts to reduce childhood mortality?
As of 2007, resistance to Artemisinin therapy in 55 countries worldwide was below 5%. WHO has called for a broad and up-to-date study of the efficacy of malarial treatment throughout Africa. According to one report, health experts in African nations believe that the problem doesn’t lie with the efficacy of Artemisinin therapy but poor manufacturing and use of “fake drugs and substances,” replacing and mixing with the drug components in Artemisinin.
One Zambian public health official said, ‘We have to try to find other drugs and new regimens to avoid a catastrophe.” Overall, resistance to a drug that has made strides in reducing malarial rates throughout the world, especially African countries, is not a death sentence. There are alternatives to Artemisinin therapy. With research, cooperation and utilization of resources the growing resistance to malaria treatments is a solvable problem.
Follow the Polio outbreak in real time with HealthMap
Smallpox has been globally eradicated since 1980, so why is the eradication of Polio so much more difficult? The World Health Organization (WHO) recently released that the Global Polio Eradication Initiative (GPEI) would be conducting a new targeted 15 country effort to vaccinate 72 million children in Africa. The new campaign follows numerous failed efforts of the past and reemerging outbreaks. Why does the African continent remain prone to Polio outbreaks that spread rapidly? Why did the organized campaign to eradicate Smallpox take only 21 years while Polio is going on almost 40 years?
Since 1796, when cowpox was used to protect humans from Smallpox, eradication efforts have taken place. It wasn’t until the WHO intensified the eradication of smallpox in 1967 that efforts were coordinated around the world. The Smallpox Eradication Program (SEP) was jointly run by the WHO, CDC, and National Ministries of Health in various countries. Doctors and epidemiologists from the US volunteered to help with the efforts. In many instances US volunteers were overbearing and controlling of their local counterparts. A report by Paul Greenough documented the use of intimidation and coercion in the final stages of the SEP. Foreign volunteers were sent to kick down doors (literally), force vaccination of those who refused, and fix the mistakes of local staff members (1995). These coercive tactics evoked resistance from local communities, but the SEP prevailed. The SEP was run in a structured, militant fashion, where individual human rights were overridden for the global public good. Similar issues with resistance have been seen in Polio eradication efforts, but responses to resistance have not been as militant. Could this be why Polio has continued to resurface?
The earliest documented case of Polio in Africa is traced back to 1580 B.C. in Egypt and still the virus continues to spread across the continent. The eradication of Polio relies heavily on National Immunization Days (NIDs), but these events are ineffective because they aren’t comprehensive vaccination efforts, positive cases are missed and some children aren’t vaccinated causing continued Polio outbreaks. Organized Polio eradication efforts began when the World Health Assembly launched the Expanded Programme on Immunization (EPI) in 1974, a program implemented through the NIDs . In 1988, the World Health Assembly said that by the year 2000 Polio would be eradicated and they launched the Global Polio Eradication Initiative (GPEI) to make it happen. Many prominent people and organizations put their support behind the program including Rotary International and Nelson Mandela, who in 1996 launched the “Kick Polio Out of Africa” campaign which vaccinated 420 million children. In the 90s, the UN Secretary General negotiated peace treaties to vaccinate in war-torn Liberia and Sierra Leone. Most recently in 2004, 23 African countries coordinated NIDs focused on Polio vaccination.
After all these efforts, Africa remains the only continent where Polio remains alive and well in multiple countries. A series of studies completed across West Africa showed that due to misconceptions about the vaccine, lack of adequate funding and corruption at the local level, and ineffective immunization campaigns, Polio has persisted on the African continent (Melissa Leach & James Fairhead, 2007). The year 2007 marked an outbreak of 25 cases in Angola which spread to 28 cases in the Democratic Republic of the Congo (DRC). In 2008, after an outbreak in northern Nigeria, where there have been vaccination conspiracy theories, spread to a dozen other countries, the WHO made Polio eradication their “top operational priority.”
Armed with a “more effective” version of the oral vaccine, the new GPEI organized effort across 15 countries hopes to eradicate Polio for good. However, just yesterday the New York Times wrote that the WHO reported 104 deaths and 201 cases of paralysis from Polio in the DRC. Is the renewed GPEI effort, launched Oct. 28, 2010, even working? Is eradication even a desirable goal at all, if past experience with Smallpox Eradication Program requires militancy?
Recent cholera outbreaks in earthquake-stricken Haiti, a flooded Benin, and the newest natural disasters in Indonesia beg the question: what can be done when natural disasters are the cause of health problems in developing nations? While cholera has long been a disease most people see as irrelevant and outdated, new cases have sprung up in both nations and disease will most likely threaten Indonesia in the near future.
In rural Haiti, cholera took the lives of 150 people, and several worry that the disease will spread into a full-on epidemic if it makes its way to the densely populated capital, Port-au-Prince. Despite media and supposed aid agency attention there are reports that cholera has spread to the Artibonite Valley, three hours away from Port-au-Prince.
Benin faces a similar threat. Cholera is threatening the already precarious health situation in the country, following the “worst flooding in the last forty years.” A World Health Organization (WHO) official said, “…the disease risk is imminent and means solid epidemiologic surveillance will be paramount.” As multiple natural disasters hit Indonesia, including an earthquake, tsunami and volcanic eruption disease and health concerns will be an inevitable issue.
What should aid agencies be doing to combat health issues brought on by an erratic, unpredictable and blameless force? How should nations, NGOs, and other agencies help prevent the spread of completely preventable and treatable diseases that threaten to kill thousands?
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.
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.
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.
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.
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.
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.
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.
Is 39% reduction enough? The dust has barely settled after the announcement of the first positive results from a microbicide trial, but scientists and policy makers are already asking themselves, ‘What’s next?’ “It’s very early, we still need to analyze all the data – and the study collected a lot of very good data – and understand it better before we get to the point of developing a product,” Mitchell Warren, head of the AIDS Vaccine Advocacy Coalition (AVAC), said at the International AIDS Conference in Vienna. More:
UNAIDS has launched a “simpler, more cost-effective approach to HIV treatment” The approach, dubbed “Treatment 2.0″, aims to drastically scale up testing and treatment using current best practices and future innovations in antiretroviral (ARV) drugs and diagnostics. UNAIDS estimates that successful implementation of Treatment 2.0 could avert 10 million deaths by 2025, and reduce new infections by one-third.
At the 15th African Union (AU) Summit in Uganda leaders and health experts will meet to reassess key health goals. In 2000, African governments agreed to reduce by two-thirds the number of mothers and children who die annually from pregnancy-related complications and preventable childhood illnesses. Ten years later, little has been achieved on that noble commitment, as statistics show an African woman’s risk of dying in child birth is still one in 11 compared to a 1 in 7,300 risk among women in developed countries.
In South Africa’s KwaZulu Natal Province, Dr Sibongiseni Dhlomo told the heads of the seven major hospitals that they will be held accountable for failing systems at their institutions. “If we want to turn around the tide of health outcomes that are terrible in this country, then you have to look at KwaZulu-Natal,” said Dhlomo. “We have the highest rates of TB, HIV and infant mortality and a large population.”
WHO estimates that 1.2 million more people received HIV treatment in 2009 than in 2008. In addition HIV-related mortality can be reduced by 20% in the next five years if guidelines for early treatment are put into action.
A malaria-proof mosquito has finally been developed and Kenya is expected to use it to eradicate the disease in seven years. Researchers at the University of Arizona, US, say they have made the perfect insect. The Ministry of Public Health and Sanitation, which starts a national data collection exercise on malaria indicators Saturday morning, says it will use a combination of tools, including bed nets, education, new innovations and medicines to meet the 2017 targets.
Victims of the 1996 Pfizer meningitis trovan vaccine test which caused over 200 deaths and several others permanent disability have again sued the drugs manufacturing giant for a whopping sum of $384 billion.
In poverty-stricken Niger, it comes as no surprise that drought is pushing the most vulnerable people to the brink of hunger. Right? But then you hear a statistic like this one, with the power to shock even the most cynical: right now, fully half of the country’s 13.4 million inhabitants are facing famine.
Withdrawn aid due to Al-Shabab’s bombings in Kampala have left the Somali people with even less international assistance. It is vital to ensure adequate funding to assist the 3.2 million people – or more than 40 per cent of the population – who rely on international aid, a senior United Nations aid official stressed this week.
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.
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:
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.
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
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
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.”
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?
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.
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
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?
