[e-drug] WHO African Regional Health Report

["Andy Gray" <andy@gray.za.net>]

E-DRUG: WHO African Regional Health Report
------------------------------------------
[Crossposted with thanks from DRUGINFO; WB]

Hi all

The first African Regional Health Report has just been released by WHO AFRO.
The full report is accessible at
http://whqlibdoc.who.int/afro/2006/9290231033_eng.pdf (8.23MB). The press
release is below, followed by commentary from BMJ and Lancet. The latter is
markedly critical - " it will take much more than an assemblage of isolated
anecdotes to create a strategy for Africa's renaissance". Many health
policies are also "light on facts and heavy on well-rehearsed rhetoric".

regards
Andy

~~~~~~~~~~~~~~~~~~~
Andy Gray MSc(Pharm) FPS
* Senior Lecturer
Dept of Therapeutics and Medicines Management
* Study Pharmacist
Centre for the AIDS Programme of Research 
in South Africa (CAPRISA)
Nelson R Mandela School of Medicine
University of KwaZulu-Natal
PBag 7 Congella 4013
South Africa
Tel: +27-31-2604334/4298 Fax: +27-31-2604338
email: graya1@ukzn.ac.za or andy@gray.za.net
~~~

http://www.who.int/mediacentre/news/releases/2006/pr68/en/index.html
The African Regional Health Report
Africa is developing solutions for fighting disease and improving health,
new WHO report finds 

20 NOVEMBER 2006 | ADDIS ABABA/GENEVA/LONDON -- The signs are everywhere,
across the continent: Africa is finding African approaches to solving its
health problems.

In Uganda, 50 percent of all HIV/AIDS patients have been reached with
life-saving antiretroviral medicine through an innovative programme that
trains nurses to do some of the work traditionally done by doctors and
community health workers to take on some of the work of nurses.

In Mali, community cost-sharing schemes have provided 35 of the country's 57
community health centres with staff trained to deliver babies and perform
emergency caesarian sections, making skilled obstetric care available to
thousands of women who could not previously afford it.

In Rwanda, a police-led road safety campaign, which has included
introduction of fines for failure to wear seatbelts or helmets, resulted in
a drop of nearly one quarter in the number of deaths from road traffic
injuries in a single year.

And in South Africa, a health-care train routinely transports young doctors
and final-year medical students to isolated farming areas that would
otherwise have no access to basic medical services. To date the train has
provided health care to half a million people and health screening and
education to an additional 800 000.

These steps forward and others chronicled in The African Regional Health
Report: The Health of the People - the first report to focus on the health
of the 738 million people living in the African Region of the World Health
Organization - offer hope that over time the Region can address the massive
health challenges it faces, given sufficient international support.

"Africa confronts the world's most dramatic public health crisis, but this
report shows there are public health solutions that work in the African
setting. These can be extended to all Africans in need, if governments build
on lessons learnt from successful interventions while seeking better
coordination with the efforts of international partners", said Alpha Oumar
Konaré, Chairman of the Commission of the African Union.

The Report provides a comprehensive analysis of key public health issues and
progress made on them in the Africa Region.

HIV/AIDS continues to devastate the WHO Africa Region, which has 11% of the
world's population but 60% of the people living with HIV. Although HIV/AIDS
remains the leading cause of death for adults, more and more people are
receiving life-saving treatment. The number of HIV-positive people on
antiretroviral medicines increased eight-fold, to 810 000 in December 2005
from 100 000 in December 2003. 

More than 90% of the estimated 300-500 million malaria cases that occur
worldwide every year are in Africans, mainly in children under five years of
age, but most countries are moving towards better treatment policies. Of the
42 malaria-endemic countries in the African Region, 33 have adopted
artemisinin-based combination therapy--the most effective antimalarial
medicines available today--as first-line treatment. 

River blindness has been eliminated as a public health problem, and guinea
worm control efforts have resulted in a 97% reduction in cases since 1986.
Leprosy is close to elimination--defined as less than one case per 10 000
people in the Region. 

Most countries are making good progress on preventable childhood illness.
Polio is close to eradication, and 37 countries are reaching 60% or more of
their children with measles immunization. Overall measles deaths have
declined by more than 50% since 1999. In 2005 alone 75 million children
received measles vaccines. 

While drawing the world's attention to recent successes, the Report offers a
candid appraisal of major hurdles, such as the high rate of maternal and
newborn mortality overall in the Region. Of the 20 countries with the
highest maternal mortality ratios worldwide, 19 are in Africa; and the
Region has the highest neonatal death rate in the world. Then there is the
strain on African health systems imposed by the high burden of
life-threatening communicable diseases coupled with increasing rates of
noncommunicable diseases. Basic sanitation needs remain unmet for many: only
58% of people living in sub-Saharan Africa have access to safe water
supplies. Noncommunicable diseases, such as hypertension, heart disease and
diabetes are on the rise; and injuries remain among the top causes of death
in the Region.

"We know what the challenges are, and we know how to address them - but we
also recognize that Africa's fragile health systems represent an enormous
barrier to wider application of the solutions highlighted in this report. If
we are to continue moving forward, African governments and their partners
must make a major commitment and invest more funds to strengthen health
systems," said Dr Luis Gomes Sambo, Regional Director of the WHO Regional
Office for Africa.

For more information contact:

Addis Ababa
Sam Ajibola
Communications Officer, Regional Office for Africa
Mobile phone: +242 653 7022
E-mail: ajibolas@afro.who.int 

Geneva
Iain Simpson
Communications Officer, WHO Geneva
Mobile phone: +4179 475 5534
E-mail: simpsoni@who.int 

London
Judith Mandelbaum-Schmid
Communications Officer, WHO Geneva
Mobile phone: +41 79 254 6835
E-mail: schmidj@who.int 

~~~
http://www.bmj.com/cgi/content/full/333/7578/1088-c 
WHO report highlights Africa's health challenges 
Peter Moszynski 
1 London 

Africa will never climb out of poverty unless its devastating health
challenges are tackled, says the World Health Organization's first African
regional health report. It gives an insight into why Africa has such a heavy
burden of disease and premature death and suggests interventions that are
known to work within the regional context. 

The continent faces a "silent epidemic" of maternal and child mortality, it
says. Of the 20 countries with the highest maternal mortality ratios in the
world 19 are in Africa. Africa also has the highest neonatal death rate in
the world. 

AIDS continues to decimate the population of Africa, which has 11% of the
global population but 60% of the world's people infected with HIV. More than
90% of the 300-500 million cases of malaria in the world each year are in
Africa, mainly in children aged under 5 years. 

One key reason for Africa's health problems is that basic sanitation needs
remain largely unmet, says the report: "Only 58% of people living in
sub-Saharan Africa have access to safe water supplies." 

However, some diseases, such as river blindness, guinea worm disease, and
leprosy, have been virtually eliminated, through the adoption of effective
solutions at a community level and with outside support. Immunisation
campaigns are now successfully tackling polio and measles. 

"We know what the challenges are, and we know how to address them," said
Luis Gomes Sambo, director of the WHO regional office for Africa, "but we
also recognise that Africa's fragile health systems represent an enormous
barrier to wider application of the solutions highlighted in this report. If
we are to continue moving forward, African governments and their partners
must make a major commitment and invest more funds to strengthen health
systems." 

As well as detailing the burden of disease that has led to "the world's most
dramatic public health crisis," the report shows examples of "African
solutions for African problems" that have worked in the region. 

In Uganda 50% of all patients with HIV or AIDS have been given access to
antiretroviral drugs through an innovative programme that trains nurses to
do some of the work traditionally done by doctors-and that trains community
health workers to take on some of the work of nurses. 

Community cost sharing schemes have provided 35 of Mali's 57 community
health centres with staff trained to deliver babies and do emergency
caesarean sections, making skilled obstetric care available to thousands of
women who could not have previously afforded it. 

A road safety campaign in Rwanda has introduced fines for failure to wear
seat belts or crash helmets, resulting in a drop of nearly a quarter in the
number of deaths from road traffic injuries in a single year. 

The report stresses that "African countries will not develop economically
and socially without substantial improvements in the health of their
people." It concludes, "The health care interventions-treatment, diagnostic
and preventative methods-that are needed in this region are known. The
challenge for African countries and their partners is to deliver these to
the people who need them." 

The Health of the People: The African Regional Health Report is available at
www.who.int. 
~~~
http://www.thelancet.com/journals/lancet/article/PIIS014067360669747X/fullte
xt 
The Lancet 2006; 368:1843
DOI:10.1016/S0140-6736(06)69747-X
Addressing Africa

The first African Regional Health Report, finally released this week more
than a year after its initial launch target, is one of the first products to
emerge from Luis Sambo's Directorship of WHO's African Regional Office. In
his inaugural speech on Feb 1, 2005, Sambo urged his colleagues, in country
offices and regional headquarters, to ?intensify efforts at identifying the
best practices in health? and ?document and disseminate? them so they can be
replicated. This regional health report is, he believes, a key step in
upgrading WHO AFRO's stewardship role in the region.

It is a disappointing effort, one that reveals WHO's weaknesses rather than
its strengths. It is clearly intended as an overview rather than as a
detailed analysis, but even so it still suffers from being light on facts
and heavy on well-rehearsed rhetoric. Much is simply lifted from past World
Health Reports that have emerged from Geneva headquarters, supplemented by
data from the World Bank and other institutions. There are some useful
asides: briefly reported successes, such as a remarkable reduction in road
traffic deaths in Rwanda and improvements to health-service access in South
Africa's rural areas. However, it will take much more than an assemblage of
isolated anecdotes to create a strategy for Africa's renaissance.

Moving from small-scale success to sustainable improvements will require
effective cooperation between the UN's many agencies and other multilateral
institutions that implement projects in developing countries. For this
reason, a report delivered to outgoing UN Secretary-General Kofi Annan last
week by the High-Level Panel on UN System Wide Coherence is of particular
relevance. Entitled Delivering as one, the report puts forward a series of
recommendations to overcome the fragmentation of the UN with the aim of
creating workable partnerships between UN agencies, and therefore increasing
the likelihood that the system will achieve its desired results.

The panel describes the UN as struggling to cope with unpredictable funding
streams, bad governance, and out-of-date business practices. These
conditions result in policies and programmes that are ?fragmented and weak?.
Although the panel's criticisms are damning, it concludes that the
overwhelming need for a multilateral system, particularly given the
increasing interconnectedness between security, health, trade, and the
environment, means the only answer is for the UN to change, rather than to
continue in its present mediocre and marginalised way.

A ?one UN? policy is what the report suggests as a solution. There would be
one presence at country level, with one leader, one budget, and possibly one
office. Five countries should be selected for piloting this strategy during
2007, followed by a further 20 by 2009. The panel also recommended
establishing an independent task force to further eliminate duplication
within the UN system and also to measure outcomes against progress towards
the Millennium Development Goals. These changes, if followed through by the
next Secretary-General, could deliver the long-awaited increases in
efficiency; estimates put forward in the report suggest it could even save
20% of the annual budget. But for Africa's health as a whole, there is a
larger issue that requires multilateral commitment from the whole system:
reviving the collapsed round of Doha trade talks.

This year is the 5-year anniversary of this ?development round? of
trade-liberalisation discussions, which has been marked this month by a
scathing report from Oxfam. Despite agreements by all WTO members to allow
poor countries to issue compulsory licences to bypass patent protection on
essential drugs, many governments are failing to make use of this
flexibility*and some have even agreed strict bilateral agreements that erode
their rights under TRIPS. But the patent system is not the only issue
holding back Africa in health. Getting the trade talks going again could add
to poverty-reduction benefits. Agricultural trade is the key. Offers were
made in Hong Kong to end export subsidies by the EU and USA by 2013, but
despite the fact that there are agreements that poor countries need the
right to protect certain products necessary to food security or livelihoods,
they are still not seeing the benefit.

Margaret Chan has said her term as WHO Director-General should be measured
by its impact on the health of Africa. But to address the real causes of
Africa's problems the two new multilateral incumbents*both Chan and UN
Secretary-General elect Ban Ki-moon*must change the way these organisations
do business, and quickly.

The Lancet