Focus on health crisis

Southern Africa has the worst performing health care systems in the world, the UN’s World Health Organisation (WHO) says in its latest report. In ‘World Health Report 2000’, WHO noted that countries in the region were “least likely to provide their citizens with a long and healthy life”. According to the report, HIV/AIDS was among the major causes of ill-health and that the AIDS epidemic had dramatically cut life expectancy in the majority of the countries in the region to 40 years or less. “Health life expectancy in some African countries is dropping back to levels we haven’t seen in advanced countries since medieval times,” Alan Lopez, coordinator of the WHO Epidemiology and Burden of Disease Team said. Latest statistics from the UN’s AIDS programme - UNAIDS - shows that by the end of last year there were over 24 million people living with HIV/AIDS in sub-Saharan Africa. It said that in 1999 there were four million new infections. The worst hit countries are all in southern Africa: Botswana - 35 percent infection rate, Swaziland - 24 percent, Zimbabwe - 25 percent, Lesotho - 23 percent, Zambia - 20 percent and South Africa - 20 percent. How southern Africa ranked Of the 191 countries rated globally, Zimbabwe scored the highest in southern Africa with a ranking of 155. Malawi scored the lowest with a ranking of 185. Surprisingly South Africa, long thought of as the most developed country in the region, was ranked 175. Botswana and Namibia were both ranked above South Africa scoring 168 and 169 respectively. The report said that although South Africa was rated 57 in terms of the amount of money it spent on health care, it was ranked 182 when it came to the effectiveness of its spending and only scored 142 when it came to the fairness with which health resources are distributed. Main failures According to the report the impact of failures in health care systems were “most severe on poor everywhere” and that the poor where being driven deeper into poverty by a lack of financial protection against ill-health. “The poor are treated with less respect, given less choice of service providers and offered lower quality amenities,” Dr Gro Harlem Brundtland, the WHO Director-General said. In Zambia, the report noted, more than 1 percent of the population had to spend, on an annual basis, more than half of their income on health care pushing them closer to or further down the poverty line. WHO said that many countries were under-utilising the resources that were available to them and that this often led to large numbers of preventable deaths and disabilities, unnecessary suffering, injustice, inequality and denial of an individual’s basic right to health. “Poorly structured, badly led, inefficiently organised and inadequately funded health systems can do more harm than good,” the report warned. Health care workers in developing countries are often underpaid and work in crumbling obsolete facilities. One result of this is the so called “brain-drain”. Another short-coming of health care systems was that many governments failed to prevent a “black market” in the health sector where, according to the report, widespread corruption, bribery, “moonlighting” and other illegal practices flourished. It said that these “black markets” were themselves caused by malfunctioning health systems and low incomes among health workers. The report noted that too often, health policy and strategic planning had envisaged unrealistic expansion of the public funded health care system, often exceeding national economic growth. “Many health ministries are seriously short-sighted ... their vision does not extend far enough to help construct a healthier future,” it added. The way forward The report said that the most obvious way to improve health care in the region would be to raise the level of public finance for health, but that this was “difficult if not impossible for poor nations”. However it said that governments could encourage other ways of improving the quality of health care by better managing the resources that they had. Some countries such as South Africa have taken a step in that direction by implementing a community internship for all newly qualified doctors. Under this programme the young doctors have to spend a year doing community service at a rural or under-resourced hospital. In Zambia and Zimbabwe more health care workers are being trained to take care of the primary health care needs of the community thereby reducing infant and maternal mortality rates through these early warning mechanisms. According to the report the ultimate responsibility for the overall performance of a country’s health was with the government. “The careful and responsible management of the well-being of the population is the very essence of good governance,” it added. Governments have to educate people about their health rights and to improve their levels of information gathering so that they know what kind of health care provision is required. WHO said that health needs to be an all inclusive policy in which all sectors of society are involved. Health care should be made a national priority with a clear health vision which defined the direction of national policy. According to the report, there should be a partnership between the private and public sector to ease the burden on the government. It added that a public process of establishing priorities had to take place and that consumers had to be better informed about health issues. WHO said that on an international level, the large privately owned pharmaceutical and vaccine research industry should be encouraged to “address global health priorities, and not concentrate on lifestyle products for more affluent populations”.