Health obstacles to African development

by Cesar Chelala

NEW YORK — According to the U.S. Census Bureau, by 2010 sub-Saharan Africa will have suffered 71 million deaths from AIDS. By comparison, the bubonic plague of the Middle Ages killed some 30 million people. These are staggering figures, particularly if one considers that deaths from AIDS are only one of the problems affecting African women and children.

Experts at the United Nations warn that most sub-Saharan countries will be unable to reach the Millennium health goals related for 2015, particularly those related to improved health for mothers and children.

Solving Africans’ health and development problems need more than statements of good intention, promises of aid (often empty) or movie stars’ adoption of African children. Yet, many diseases affecting children and adults can be addressed with minimum resources if they are used strategically.

Childhood malnutrition is a critical issue. Almost 60 percent of deaths of children under 5 in developing countries are due to malnutrition and its effects — such as greater mortality from infectious diseases. Malnourished children are up to 12 times more likely to die from easily preventable infectious diseases (such as measles, malaria, diarrhea and pneumonia) than are well-nourished children.

It is estimated that African women are 10 to 100 times more likely to die during pregnancy and childbirth than women in industrialized countries. Most of these deaths and disabilities are caused by delays in recognizing complications, difficulties in reaching a medical facility and lack of adequate medical care. Skilled health workers are vital in addressing these challenges but their numbers are pitifully low.

Malaria, HIV/AIDS and tuberculosis continue to be major threats facing both children and adults. Recent experiences in Africa and Latin America show that malaria can be controlled without use of DDT, an important new approach to dealing with this disease. It can be done through rapid-case detection and drug treatment, as well as through prevention efforts at a community level emphasizing the use of insecticide-impregnated bed nets, sanitation measures to eliminate vector breeding sites and use of chemical substitutes for spraying houses.

Recent studies have shown that HIV treatment is “failing” in many African countries. The rates of failure vary depending on the program and the country under consideration. Treatment failure in many patients is due to their starting to take medication too late in the course of the infection.

Other patients have problems in accessing the drugs, either because they are too poor or live too far away from the health center providing the medication.

Throughout Africa, the stigma associated with HIV/AIDS is one of the main barriers in dealing successfully with that infection, both in terms of prevention and treatment.

Education, public health campaigns and the active participation of members of the clergy have contributed in many areas to overcoming the stigma but much remains to be done and progress is slow.

HIV/AIDS has also had a significant though rarely discussed effect on the education sector. In sub-Saharan Africa, the HIV/AIDS pandemic is killing teachers at a rate faster than replacements can be trained. Another effect of the pandemic is teacher absenteeism, loss of educators, planners and management personnel. It is estimated that close to 30 percent of South Africa’s teachers are HIV positive, a higher rate than among the general population.

According to statistics from Zambia’s education ministry, every day one teacher dies from an AIDS-related disease. This is the equivalent of the closure of one school per week due to loss of teachers.

In Africa’s rural areas, not only are health services and infrastructure inadequate but there also is a lack of properly trained medical personnel. To compound the problem, there is an exodus of trained personnel to higher paying jobs in industrialized countries.

It is estimated that there are more Malawian physicians in Manchester, England, than in Malawi, a country of 12 million people with only 100 doctors and 2,000 nurses. Over 15 percent of Malawi’s population is HIV-positive. Many of its health-care workers are infected with the disease or have died of AIDS.

According to the World Health Organization, 23,000 health-care workers leave Africa annually. Equally serious is the distribution of health-care workers within the countries themselves. They tend to remain in urban areas.

Solving the problem of poverty and the resulting malnutrition and disease it engenders requires three distinct steps: developing efficient and effective health-care systems; increasing access of the poor to adequate health care; and redirecting resources from acute care hospitals using high-tech equipment to investment in low-tech, but effective, community-based primary and preventive care.

Health problems in Africa cannot be considered in isolation — and are not only the responsibility of Africans themselves. Foreign technical and financial assistance is required. Aid must bypass corrupt governments and find ways to help people directly, for example through nongovernmental and U.N. organizations with a proven record of effectiveness. Aid can strengthen civil society and community-based organizations, which are the basis of a democratic society.

To bring hope to a continent ravaged by poverty and disease, effective and urgent action is required. It is available and it can be done.

Cesar Chelala, an international public health consultant, has conducted health-related missions in several African countries. He is a cowinner of an Overseas Press Club of America award.