Hospitals are getting worse - WHO

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, delegates attending the World Health Organisation (WHO) regional committee meeting in Johannesburg, South Africa, 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. "In addition, negative attitudes, unprofessional behaviour and high turnover of health care practitioners 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. "Lack of national health infrastructure development planning and irrational interference in the location of hospitals account for this situation," it noted. Health ministers and government officials attending the Johannesburg meeting were urged to increase funding for their health sectors and allocate more funds to hospitals. "Funding for hospitals presents a dilemma, as they generally consume a greater portion of ministry of health budgets (sometimes more than 70 percent of the total). However ... they remain underfunded." 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. "Some hospitals have inadequate water, sanitation and waste disposal facilities, and are therefore hazardous to both health workers and patients," the study said. To make matters worse, another WHO report released on Monday found that half of Africa's population did not have access to existing essential medicines, while many more were denied new medicines for treating common diseases like malaria and HIV/AIDS. 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. Implementing the plan, however, would be impossible without sufficient human resources, he warned. "We face big challenges, particularly in this region which, on top of everything else, suffers heavy losses to the brain drain," Lee commented. 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."