[e-drug] WHO/AFRO: Medicines and hospitals in Africa

[Leela McCullough <leela@healthnet.org>]

E-drug: WHO/AFRO: Medicines and hospitals in Africa
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//\\// HealthLink Bulletin 05 ­ 09-2003 \\//\\] 

Half of Africa has no medicines
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http://news.hst.org.za/view.php3?id=20030905

Half of Africa's population, mostly the poor and disadvantaged, do not
have access to existing essential medicines and many more are
denied new medicines for treating common diseases like malaria and
HIV according to the WHO Africa Region report released on Monday.

The 2002 Regional Director's Report of the World Health
Organisation says that 50 000 of the 4.5-million people who need
antiretroviral therapy have access to treatment despite significant
reductions in cost, 6% have access to voluntary counselling and 1%
have services for the prevention of mother-to-child transmission.while
the HIV/AIDS epidemic continues to spread relentlessly in the African
region.

About 29-million HIV-positive people, 70 percent of the global total,
are in Africa, and an estimated 3 million died of AIDS last year. The
overall adult HIV-prevalence is about 9%, while in different regions it
varies from 1% to over 30 %. Botswana, Lesotho, Swaziland and
Zimbabwe have adult infection rates exceeding 30 % Due to
HIV/AIDS, tuberculosis has become a growing problem. The average
treatment success rate is 68 percent, compared to the target of 85
percent. "Frequent shortages of anti-TB drugs, inadequate human
resource capacity and insufficient diagnostic and treatment facilities
are some of the challenges which are frustrating control efforts."

Effective vaccines are available but diseases that they could prevent
still constitute major public health problems in Africa. These include
measles which is responsible for 445 000deaths annually; pertussis
which causes 106 000 to 190 000 deaths annually, while yellow fever
is still endemic in 34 countries, causing about 30 000 deaths
annually; and mortality from neonatal tetanus is about 510 per 1 000
live births."

Malaria makes 270 000 people in Africa acutely ill every year, kills
over 900 000 and causes significant loss in household earnings. The
report says the annual economic loss from malaria is estimated at
$12-billion.

"Due to drug resistance and difficulties with implementation in the
African region, tools, methods and technologies once considered
effective for the management of communicable diseases are failing
rapidly.At the same time, the acceptance of new and effective drugs
and vaccines by national health systems has been slow due to
inadequate investments."

Also non-communicable diseases, mental disorders and substance
abuse, including tobacco consumption, are becoming major problems
in the region. Countries do not give such diseases enough attention,
and treatment is not universally available or affordable.

The lack of long-term commitment, coupled with the progressive
increase in non-communicable diseases, contributes to widening
health gaps between and within countries, the document states. At
940 per 100 000 live births, Africa has the highest maternal mortality
ratio in the world. 

The average lifetime risk of maternal death is estimated at one in 14.
However, more than 75 percent of the 600 000 annual deaths from
pregnancy and childbirth-related causes could be prevented through
timely access to essential obstetric care.

The prevalence of female genital mutilation varies, ranging from 10 %
in Niger to over 98% in Guinea.

According to the report, over 450-million poor Africans do not have
access to safe water, 490-million do not have adequate sanitation
and one out of five children dies from a communicable disease linked
to environmental conditions. Poverty causes food insecurity and the
consumption of unsafe food.

"The regional office aims to support member states to make health
central to sustainable development through promoting a strategic,
systematic and integrated approach to poverty and other
determinants of health." (Source: SAPA, 1 September 2003).

Africa: Hospitals are getting worse ­ WHO
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http://news.hst.org.za/view.php3?id=20030906

Shortages of essential medicines and medical equipment, a staffing
crisis and inadequate infrastructure are undermining the quality of
hospital care across sub-Saharan Africa. This could jeopardise plans
to provide anti-AIDS drugs to people living with the HI virus, the World
Health Organisation (WHO) Regional Committee heard this week.

According to a report presented at the WHO meeting, hospitals in
Africa are "getting worse in terms of both the scope and quality of
health care they provide" - despite receiving a "significant" portion of
public resources. Also negative attitudes, high turnover of health and
care practitioners , unprofessional behaviour and have compromised
service provision. "This has led to provision of care far below
expected standards, resulting in client dissatisfaction, increasing
mortality rates, hospital-acquired infections and other side-effect
conditions," the report said. 

The number of hospital beds was inadequate in many countries, and
unevenly distributed between rural and urban areas, with availability
ranging from 0.9 to 2.9 beds per 1,000 people. 

The report points out that lack of national health infrastructure
development planning and irrational interference in the location of
hospitals account for this situation.

Health ministers and government officials attending the
Johannesburg meeting were urged to increase funding for their health
sectors and allocate more funds to hospitals although they currently
consume a greater portion of ministry of health budgets (sometimes
more than 70 percent of the total). 

Despite advances made in new health infrastructure, most countries
were still faced with dilapidated health facilities, where beds, medical
equipment and vehicles were often in disrepair. In addition some
hospitals have inadequate water, sanitation and waste disposal
facilities, and are therefore hazardous to both health workers and
patients Nevertheless, WHO Director-General Dr Lee Jong-Wook
proposed a "3 by 5" plan to provide antiretrovirals (ARVs) to three
million people living with HIV/AIDS in developing countries by the end
of 2005 - well short of the numbers of people who need the drugs, but
a significant improvement in the current levels of access. 

A comprehensive strategy on how to meet the WHO's goal will be
announced on World AIDS Day, 1 December 2003. He noted that
implementing the plan, however, would be impossible without
sufficient human resources, he warned. The report recommended
that "policy-makers should consider offering flexible modes of
practice, such as allowing health workers in the public sector to
engage in part-time private practice, research or training; and
compensating health workers based on work done, rather than fixed
salaries." (Source: IRIN 3 September 2003) 


Dr. Leela McCullough
Director of Information Services

SATELLIFE
30 California Street, Watertown, MA 02472, USA
Tel: +617-926-9400 Fax: +617-926-1212
Email: leela@usa.healthnet.org
Web: http://www.healthnet.org

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