Health Sector Overview
The world was becoming in healthier place as a result of some amazing
advances in medicine and some well organized international interventions to
intervene to end some terrible diseases like smallpox and polio.
But something appears now to be going wrong. Instead of further progress in eradicating
disease and reducing mortality and morbidity, there is tremendous backsliding.
Health Sector Financing
There are financial constraints in public health that are constraining everything
in the health sector. The amount of money for public health in almost every
country in the SOUTH is so limited that health services are bound to be
inadequate. International official development assistance (ODA) is not enough
either. ODA does not start to address the health funding deficit.
The Secretary General of the United Nations, Kofi Annan, to his credit, raised the issue of the growing crisis of healthcare financing at the UN, and was instrumental in having a Global Fund for HIV-AIDS, Tubruculosis and Malara (GFATM) launched. In its inaugural year the GFATM was able to mobilize
around $3 billion, a substantial achievement, even though the requirements
were for something more like $10 billion.
But the health sector is a problem area. It is something of a symbol of failed
development. Progress was made, but the progress has not been sustained, and
now there is a high probability that poverty is going to be more and more
accompanied by health crisis as well.
HIV-AIDS and other killer diseases
But beyond the financing issues, there appear to be medical and scientific issues
as well. The HIV-AIDS pandemic has changed the population dynamics of the
whole of Africa, and in the hardest hit countries the expectation of life has
dropped by more than 10 years in less than 5 years. Instead of moving up into
the 60s, and a continuation of thirty years of steady progress, expectation of life
has started to drop dramatically. With more than 3 million dying prematurely of
AIDS related disease in a single year, the people of Africa are having to face an
incredible crisis.
But it is not the only health crisis. Malaria continues to be a tremendous killer,
and where it does not kill it still has a debilitating impact on an individual.
Children are badly impacted by malaria. And the easy curatives for malaria are
becoming less effective as more and more malaria becomes resistant to
medication.
And after years of progress with tuberculosis, TB infection is again growing and
becoming more and more widespread. And again, the TB strain that is
spreading is one that is resistant to easy and low cost medication.
While there are many views about why disease is growing so fast now after
years of progress, it is highly likely that poor medical services and lack of
higuene are part of the problem. The writer is convinced that unsafe medical
practices are feeding into the growing health crisis, especially unsafe injections
and other procedures that result in blood contamination. The use of dirty
needles is widespread, especially in the informal settings where people expect a
health intervention to include getting an injection.
Public Finance in Africa
I have not been quiet about the need for better financing for health in
developing countries such as the following posted to the AFRO-NETS list in
October 2002
AFRO-NETS: HIV/AIDS through Unsafe Medical Care (8)
Dear AFRO-NETS colleagues,
Thank you Agnes Moses for your reference to labour wards. When I
first got concerned about the HIV/AIDS crisis in Africa and started to
try to understand the issues..... one of my friends.... who sadly has full
blown AIDS.... told me of her concern about the procedures that are
commonplace in labour wards in Africa including not only the re-use of
'single use disposable' syringes but also the use of latex gloves over and
over again during the birthing of infants.
All of these practices are easy to correct..... BUT ONLY IF THERE ARE THE RESOURCES TO DO IT RIGHT.
BUT..... there is not a health ministry in Africa that has the resources to do it right.
Public finance is in complete chaos after 40 years of international
assistance and prioritization of African economies and now more than
20 years of structural adjustment. The human capacity to do much
better exists. The financial capacity in the SOUTH to do much better
does not.
Sincerely,
Peter Burgess
Health situation
The health status of Iraq has deteriorated relatively in the past years. Health and
health related services are limited because of shortages arising during the
economic sanctions and the war conditions. Coverage is low with the
distribution biased towards the urban population. Most health facilities in Iraq
are understaffed and the quality of training of some of the current health
workers is poor. Moral is low because of the state of chaos.
Management capacity at all levels is very limited and whatever management
information system existed previously has almost ceased to function.
Rehabilitation of health sector
The rehabilitation of health sector is a priority. Funding is needed for the
necessary construction work that needs to be done to rebuild and expand the
infrastructure. There is also a need to rehabilitate equipment and funding is
needed for this. The infrastructure includes both urban hospitals and health
clinics in smaller communities.
Many of the projects are an integral part of the Health Ministry's program and
are designed to facilitate their integration into the mainstream of the health
development of the region.
Education and training
Training nurse is a very high priority. There are not enough nurses. The need for
nurses is very high. Furthermore, nursing is a training and employment
opportunity for women. Training of nurses should be encouraged through all
means.
Training doctors and medical professionals is a long (and expensive process).
However, the long terms success of the area economy depends on having
trained professionals from the area in the area. Funding long term professional
training should be a part of the ongoing development strategy for the area.
Mother and child health programs
Mother and child programs should remain a priority in the health sector, with
continuing efforts to reach the mothers and children of pastoral families.
Immunization programs for children should remain a priority in the health
sector, with continuing efforts to reach the children of pastoral families.
Mental health
Mental health is a problem that is not enough of a priority. Mental health
practices are ones that became unacceptable in industrialized societies several
decades ago. The traumatic experience of the area in the last twenty years (or
more) has created a serious mental health problem.
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