Introduction
Issues of health in Africa have been of great concern to many organizations both local and foreign. These organizations are seeking ways and proposing to support the strengthening of African health system. In Africa, health system has suffered neglect for a long time and perhaps that is the reason why it has maintained its low and infancy status when compared to other health systems that have developed. However, health issues are taking a new course in Africa and many organizations are committed and are working hard to ensure that the populations have access to reliable and quality health care even though most African nations are still relying-albeit temporarily- on support from donors (Deininger, Garcia & Subbarao, 2003). There is need for the African governments to heavily invest in health systems. This way, they will be able to pay the cost of health for their people without depending on the donors. In a conference of African leaders and major donors that was held in Abuja in 2005, African leaders made an agreement that in their budgets, they will dedicate 15% to health care (Fayissa & Gutema, 2005). By 2007, a country like Botswana had developed and was spending 22% on health care (Golden et al., 2010).
In addition, it is important to note that health problems in Africa are getting worse and the rate of death is increasing among children and adults. This essay will examine how the health needs of an African country can be solved as well as meeting the impacts of funding limitations while at the same time remaining sensitive to the dire healthcare situation in the affected country in Africa.
Health issues in African countries
A bigger percentage of the global population that is ailing is coming from Africa (Fayissa & Gutema, 2005). According to WHO, the continent’s health problems are getting worse with 90% of worlds malaria cases and 60% of worlds HIV/AIDS recorded from Africa (Deininger, Garcia & Subbarao, 2003). This situation has risen to these levels because of a number of factors which include but not limited to poverty and lack of proper health care systems. Health issues affecting African countries are numerous. For instance, HIV/AIDS, Malaria, polio, measles and leprosy are commonplace. Others include stroke, diabetes and heart disease (Golden et al., 2010).
To begin with, malaria presents major health problems to African countries. Many factors have caused an upsurge of malaria with explosive epidemics in endemic-disease areas in many parts of Africa (Fayissa & Gutema, 2005). These factors include population movement, climatic changes and resistance to antimalarial drugs (Carlsson, Somolekae & Walle, 1997). It is important to note that malaria that is transmitted by the Anopheles gambiae complex has its cause from the Plasmodiun falciparum (Deininger, Garcia & Subbarao, 2003). Efforts to control the spread of malaria in Africa have not been well coordinated. In fact, those efforts have been piecemeal (Carlsson, Somolekae & Walle, 1997). In order to be able to understand the epidemiology and of course how to handle this healthcare menace, vector dynamics, pathogenesis and the socioeconomic aspects of malaria, proper strategies should be devised based on sound investment in research and development. Such a strategy will aid in developing vaccines and antimalarial drugs that can effectively counter this health issue (Golden et al., 2010). In addition, agencies or health organizations should work together and come up with a research that is appropriate and practical to curb spread of malaria. That strategy can be used to plan, network, coordinate partnerships and to develop approaches that are innovative.
The alarming and unprecedented rate at which malaria is spreading in Africa calls for a speedy global eradication program. The prevalence of malaria in Africa in the last decade has been escalating at an alarming rate with up to 1.5 to 2.7 million deaths per year resulting from 300-500 million new cases of malarial infections each year (Schermerhorn, 2011). It is important to note that after tuberculosis (TB) and pneumococcal acute respiratory infection, malaria’s threat ranks third with more than 90% deaths in children under the age of 5 (Deininger, Garcia & Subbarao, 2003). In addition, the resurgence of malaria in Africa has been contributed by a number of factors such as the behavior of malarial vectors like indoor to outdoor biting habits, an increased susceptible population of children under 5 years of age due to high birth rates, inadequacy of funds to buy drug and a much reduced budget because of adverse socioeconomic conditions and new breeding sites for mosquitoes such as dams and irrigation schemes built to trap water for development projects (Golden et al., 2010). Additionally, other factors include migration by people to regions where transmission is high from non-malarious areas, civil unrests and armed conflicts that causes people to be displaced and sometimes these people settle under in areas where transmission of malaria is high (Fayissa & Gutema, 2005). Another factor would be the resistance that mosquitoes have developed over the years to resist some drugs and insecticides.
As a precautionary measure, preventive rather than curative measures should be adopted by all African governments in lowering the mortality rate occasioned by malaria. In the 1960’s and 70’s, the Continental sub-Saharan Africa was left out of the global malaria eradicating program (Golden et al., 2010). This was probably due to the high cost and subsequent maintenance of a large land mass. This led to severity of malaria and the increase of Anopheles gambiae in terms of efficiency and density (Schermerhorn, 2011). Moreover, eradication of this health scourge at that time could not have taken place in some regions in Africa due to lack of indigenous capacity to initiate such a program that was caused by colonial and postcolonial activities (Abraham, 2004, February). Falciparum malaria is a complicated illness with a patchy, non-uniform distribution of symptoms (Deininger, Garcia & Subbarao, 2003). At this poimnt, it ids imperative to observe that there are other myriad of health challenges issues that African countries have to squabble with on a daily basis. In fact, budgetary allocation on healthcare matters is far from adequate.
Control tools
The strategy that is being used today to control the spread of malaria and other infectious diseases in Africa is aimed at reducing socioeconomic loss, decrease illness and preventing death. The tools required to accomplish this strategy include drugs and insecticide treated nets (Golden et al., 2010). Drugs are important in ensuring early treatment of the disease, for prophylactic use on pregnant women and for managing complicated and severe cases. On the other hand, insecticide-treated nets are very important for protection against bites from mosquitoes. The first-line drug for malaria therapy referred to as Chloroquine received an alarming increase in resistance in southern and eastern Africa. Currently, highly resistant strains of malaria have reached 20%-30% with in vivo levels of 40%-60% (Schermerhorn, 2011).Over the years, malaria has offered resistance to several drugs such as chloroquine, melfoquine and Sulfadoxine-pyrimethamine (Fayissa & Gutema, 2005). This has prompted researchers to seek ways to develop replacement each time there is a resistance. Also, resistance is increasing in the intravenous quinine method. Therefore, more research needs to be done so that standardized methods are found that will initiate systematic monitoring of drug resistance in Africa (Carlsson, Somolekae & Walle, 1997). There are some drugs that have been standardized by WHO and taken to East, West and Central Africa.
Additionally, there is need to monitor resistance and to develop management guidelines concerning under what conditions or when to change treatment regimen for central, regional and district levels of resistance (Golden et al., 2010). There is an urgent desire to replace present drugs that are becoming unusable due to resistance with inexpensive and effective drugs. For example, artemisinin and its derivatives artesunate, areteether and artemether are promising ones and are being used in some countries in Africa (Schermerhorn, 2011). Insecticide-treated nets are important for reducing infant death. This efficacy of insecticide treated nets was proved by researchers who carried out research in Dakar and other six countries in Africa (Carlsson, Somolekae & Walle, 1997). However, there is still a big challenge that inhibits its wide scale use. The challenge remains to be the element of cost. Although this has been partially tackled through free treatment of nets, proper procurement of insecticides, having most appropriate nets and cost effective treatment method for nets, the hallmark has not been achieved yet bearing in mind that most African countries are still struggling with how to combat myriad of health issues affecting people (Fayissa & Gutema, 2005).
Challenges
The fight against malaria in Africa faces several growing challenges stemming from the African traditional perspective and perception about causation and management of diseases (Deininger, Garcia & Subbarao, 2003). The Africans consider that some diseases can only be managed by local health practitioners while others are suitable for management by western medicine. This indicates that the control of malaria in Africa will not only need drugs and insecticide treated nets. There is a crucial need to change the behavior and perceptions of some African nations on malaria and the best way to manage it at the household level (Carlsson, Somolekae & Walle, 1997). They should be educated and trained, and especially, the public should be in a position to recognize malaria symptoms and provide home management or take the sick individuals for immediate treatment.
The key to rural health care in Africa lies in cost recovery of health care including cost of drugs (Golden et al., 2010). The governments and health service organizations need to devise policies and other important health functions to control malaria. It has become cumbersome to involve international community in research and development (R&D) since most local health policies and systems on research have been neglected (Abraham, 2004, February). There is need to integrate into the general health care system, programs related to vertical malaria control, refine and improve different interventions of malaria control. Medical services should be decentralized and drug supply chains should function optimally. In addition, there is need to reform the health sector in Africa for it is the focal point of the local and central governments and the population as well as being that it holds great potential for controlling malaria and other diseases. Other areas that need healthcare reforms are access to equity in health care, access to health services and health policies (Deininger, Garcia & Subbarao, 2003). Indeed, these are some of the elements that require sufficient funding if malaria and other infectious diseases in Africa will have to be curbed once and for all.
Most African nations lack funds to tackle the challenges posed by diseases. Malaria has been grossly underfunded in the same manner as other diseases in low-income countries. From 1990-92, an estimated $56 billion was spent per year on R&D on health issues in the world while only $58 million a year was spent on malaria research. Moreover, in comparison to HIV/AIDS that receives US$3,270 and asthma that receives US$789 for research investment per death, the amount allocated for malaria was a paltry US$ 42 for research per fatal case (Schermerhorn, 2011). Therefore,the spirit of cooperation and a common goal towards the fight against malaria is necessary. This will not only require funding, but also skilled human resource capital on healthcare management.
Possible solutions
In Africa, malaria has become an important problem affecting individuals, families, communities, and countries in terms of social and economic development. A lot of collaboration especially with those responsible for research and control provide the best chance for successfully combating the disease. Also, there is a need for sustained government support, a strong international collaboration and a control strategy based on strong research (Abraham, 2004, February). Malaria control and eradication should follow the same path that smallpox eradication program did. The latter was eradicated through replacement of mass vaccination by selective vaccination, development of a multiple-use bifurcated needle and nozzle jet injector (Carlsson, Somolekae & Walle, 1997). Furthermore, alongside developing a freeze-dried vaccine, the fight against small pox received a strong international support (Deininger, Garcia & Subbarao, 2003). Therefore, combating malaria calls for a concerted effort between the affected communities and research control teams liaising with international community.
African countries work together with the Malaria regional program of the WHO to set up strategies of controlling eradicating malaria. Some of the strategies they have come up with include early diagnosis of malaria cases especially among children under the age of five years, prompt and effective treatment, effective preventive measures to individuals and the communities such as the use of indoor residual spraying and insecticide treated mosquito nets (Carlsson, Somolekae & Walle, 1997). Other preventive measures can also be used to protect pregnant women from malaria and reduce human vector contact and disease transmission (Schermerhorn, 2011). Also, a strategy has been set for adequate forecasting to be able to detect a malaria epidemic early enough and contain it. In addition, they have come up with some supportive approaches that include community based interventions, formative supervision and capacity building for appropriate program implementation, monitoring, surveillance and evaluation, communication and advocacy fro behavior change, resource mobilization and partnerships at country and regional levels, research to improve program performance and national planning and development policies including integrating malaria control interventions with other primary health care and development interventions (Abraham, 2004, February).
Secondly, HIV/AIDS presents a major health problem to most African countries. Before the close of 1999, approximately 2.6 million out of a total of 5.6 million Africans who had been infected with the virus were proclaimed dead (Golden et al., 2010). Reports indicate that less developed countries in Africa are faced with an increase in new HIV and AIDS infections. Multilateral agencies and foreign donors have developed HIV intervention strategies aimed at implementing efforts to solve the health and social problems associated with HIV/AIDS. The efforts being implemented include interventions targeting specific risk groups such as sex workers and truck drivers, peer and mass media educational HIV efforts, and aggressive condom marketing. In some regions, there is little access to voluntary counseling and testing services (VCT) even though the concentration of HIV-positive patients is high in such areas (Neondo, 2002, October). In a country like Uganda, there are centers that offer support to those with HIV infection at relatively low cost (Neondo, 2002, October).
Africa has been severely affected by AIDS compared to other continents in the world. In 2005, UNAIDS reported that the population adults and children who were HIV-positive was about 25.8 million including fresh infections the same year of about 3.2 million people (Abraham, 2004, February). The population of Africa forms 11.3% of the total world population and with a global HIV-positive rate of 64% (Simon, 2001). This African epidemic, HIV that causes AIDS is spread primarily by heterosexual contact among other ways. The President’s Emergency Plan for AIDS Relief (PENFAR) has made medical HIV transmission prevention its primary component (Deininger, Garcia & Subbarao, 2003). In addition, UNAIDS reports indicate that about 13.5 million African women are HIV-positive making a total of 77% of HIV-positive females globally. It is important to note that the risk group affected most is normally the young women with about 4.6% being HIV-positive compared to 1.7% in young men aged 15 to 24 (Kaasalainen, 1998)
In the recent years, prevalence rate has stabilized as infection has increased. Stabilization means that the numbers of new infections approximate the numbers of death. In many African nations, HIV has become endemic since the future generations will still be affected even by today’s minimum levels of the infection (Davies, 2008). In Southern Africa, the prevalence is high compared to countries like Uganda and Kenya where it is declining. It accounts for 45% of infected people in Africa and 30% of the infected people worldwide. Nigeria has the largest population of the infected people with approximately 3.6 million people HIV-positive. The population that is greatly affected by AIDS epidemic is children (Davies, 2008). The effect is proportionally much greater than any other region in the world. According to UNAIDS, most infections to children occur during infancy through mother to child transmission (Abraham, 2004, February). This transmission happens during at birth and or during breast feeding. The total infected population of the infants according to reports by the UNAIDS is over 600,000 and most of them die at the age of two.
The epidemic has left a trail of orphans in many African countries. In 2003, the number of HIV/AIDS orphans had grown to 12.3 million in Africa and by 2010 it rose to 18.4 million (Neondo, 2002, October). In addition, most orphans face stigmatization and therefore end up without education, get abused and malnourished (Davies, 2008). Therefore, there is a need for the communities as well as the families to strengthen their efforts in offering the orphans protection and care. Also, the governments should offer the orphans and vulnerable children (OVCs) social and state protection. It has been observed by the Human Rights Watch that the education barriers faced by the AIDS affected OVCs have not been addressed by the African governments (Davies, 2008). In November 2005, an act was passed into law. The act was referred to as The Assistance for Orphans and Other Vulnerable Children in Developing Countries Act of 2005 and it authorized the US to offer assistance to the OVCs in developing countries (Neondo, 2002, October). The aid included AIDS care, protection of inheritance rights, psycho-social support, education, employment training, school food program and assistance for basic care.
Social and economic consequences
HIV/AIDS epidemic has been attributed by experts to a variety of social and economic factors. This situation can be blamed primarily on poverty that has hit the region and deprived it of effective health care, health education and effective systems of health information (Neondo, 2002, October). Due to this, not only do most Africans suffer from AIDS but they become susceptible to HIV due to high rates untreated sexually transmitted infections. They cannot access counseling and testing and other AIDS prevention services because of the limited capabilities that their health systems have. Due to migration to far away regions by African men and women to search for jobs and end poverty, they engage in sex activities if maybe they are commercial sex workers thereby increasing their chances of getting infection (Abraham, 2004, February). Others might carry the infection back home to their partners. Public transport and long distance truck drivers are key agents in spreading HIV (http://proquest.umi.com). In addition, according to UNAIDS, the epidemic is increasing because of some behavior patterns of some Africans. The rate of infection among the young women is higher than among the young men. This is due to the fact that they get such infections from relationships with older men (Sweat et al., 2000). The rate of infection of the older men is higher than in the younger men but due to the impoverished conditions most African girls find themselves in, they prefer dating old men for reasons of social security, material and financial gain. In addition, these women lack comprehensive knowledge on ways and modes of transmission of HIV (Neondo, 2002, October).
The social and economic consequences of AIDS in Africa are severe. It has slowed democratic development and increased political instability as well as seen sharp drops in life expectancy (Abraham, 2004, February). Also, it has affected rural livelihoods. The devastating effects are seen when a bread winner falls ill and quickly family resources are sold to pay for treatment. Children may be forced to take care of the parents should they both fall ill. In the case of death the children would be left orphans. According to a report by the UN Food and Agriculture Organization in 2001, the number of agricultural workers in 25 hard hit countries in Africa who have died of AIDS is 7 million with a likely hood of 16 million more deaths by 2020 (Neondo, 2002, October). The losses in agriculture due to these deaths are between10% to 26%. In 2002 and 2003, the shortages due to shortages from AIDS resulted in food shortages in southern Africa.
Moreover, it leads to depletion of workforce. Many skilled workers and teachers as well as many people in the upper and middle levels of private and public sector management have been claimed by AIDS increasing the shortage of workforce. It therefore poses a great challenge replacing trained personnel even though unemployment is high in Africa. For instance, reports from different quarters indicate that 10% of the African workforce has died of AIDS while in Uganda and Malawi, 30% of teachers are HIV positive,12% in South Africa and 20% in Zambia.
Furthermore, it has brought serious security consequences. It has been reported that there is an increase in HIV infection in many militaries. The security forces have been unable to perform their duties well threatening domestic political stability of many countries in Africa. It also puts at risk the peacekeeping forces that are important in Africa in ensuring peace in most countries that have insecurity issues. For instance, in KwaZulu-Natal province, an estimated 23% of security forces are HIV-positive (Sweat et al., 2000).
Impacts to funding limitations
Africa has a global public health challenge of a frail health system and a disease burden of about 24% embedded in a broader context of ill-managed or weak government institutions, conflict, underdevelopment, and poverty (Rita, 2001). These interrelated and complex challenges demand an integrated, patient and sustained response. The response by the African governments, non-governmental organizations (NGOs) working in Africa and donor governments to health issues in Africa have been geared towards trying to ameliorate damages done by these diseases to economies, societies and families (Sweat et al., 2000). There is urgent desire to mount prevention programs aimed at reducing the number of new infections. Programs and projects such as anti-malarial and Anti-AIDS need to be set up to provide information on how diseases are spread and how they can be prevented through skits, lectures, posters and the media. Donors have sponsored certain programs like the voluntary counseling and testing (VCT) in many African nations. This has enabled many people to know their status (Columbus & Wusu, 2006).
In addition, awareness programs should be set up in hospitals, schools and workplaces to give people information on how to prevent themselves from infections. In addition, provision of individuals with condoms and to educate them on proper usage (Columbus & Wusu, 2006). Anti-HIV drugs like nevirapine or AZT have been used successfully to reduce the transmission of mother to child, before, during birth and during infant nursing (Rita, 2001). Moreover, humanitarian organizations as well as church groups have set care and education programs to deal with the consequences of AIDS. Public-private companies have sponsored research on vaccines and other diverse AIDS programs that the governments and donors are pursuing (Carlsson, Somolekae & Walle,1997). Other bodies like Gates Foundation, Merck and Company, Bristol-Myers Squibb and Rockefeller Foundations have worked with UNAIDS to improve AIDS care programs in Africa as well as undertaken programs aimed at providing treatment for AIDS and improving the health infrastructure of many African nations (Columbus & Wusu, 2006).
In 2002, The Global Fund was created to help fight Malaria, Tuberculosis and HIV/AIDS. About 60% was granted to fight diseases in Africa while the remaining 40% of its grants went to fighting AIDS worldwide (Columbus & Wusu, 2006), However, significant gaps still remain to fund HIV/AIDS and malaria programs. More funding is needed to counter the rise of illnesses in the coming years. Another source of funding was the President’s Emergency Plan for AIDS Relief (PEPFAR) which focused on getting quickly to those who are in need of medical help; provide antiretroviral therapy, prevention, care and treatment (Carlsson, Somolekae & Walle, 1997). PENFAR has made huge steps in providing ways of tackling AIDS, offering relief to AIDS victims by offering life-saving treatment, and drawing in more support and new actors to the cause (Carlsson, Somolekae & Walle, 1997). PENFAR was reauthorized into its second phase by the president of America in 2008 (Columbus & Wusu, 2006). It came with a broadened program and strategies to prevent HIV and address and reach the vulnerable group comprised of women.. In addition, it broadened its funding by adding $5 billon for malaria control and $4 billion for TB control (Simon, 2001). In its bid to offer treatment, PENFAR II authorizes food purchase and supports assistance for food and nutrition. Moreover, it intends to strengthen health systems by training at least 140,000 new health workers with an emphasis to build an efficient health workforce and to promote commitment in integrating HIV services (Schermerhorn, 2011).
Further, the program by PENFAR opened doors for tackling other health issues challenging Africa. The Global Fund received financial and diplomatic support of $2 billion from the US to fight Malaria, TB and AIDS (Columbus & Wusu, 2006). The Malaria program received $1.2 billion from the President’s Malaria Initiative which is a five-year program. This program is intended to
reduce malaria deaths in 2011 by over 50% (Sweat et al., 2000). Additionally, with focus to neglected tropical diseases that are affecting African nations, the White House announced an initiative to raise $350 million between FY2009 and FY 2013 (Schermerhorn, 2011).
Impacts on American Citizens and their health system
A lot of reactions have come from organizations and citizens of the US on donor funding to Africa and its impacts in the U.S. The private sector owns and operates a huge portion of health care in United States. It also provides health insurance with an exception of sections like veterans Health administration, Children’s Health Insurance Program, TRICARE, Medicaid, and Medicare. In 2009, it was reported by the U.S Census Bureau that 16.7% or about 50.7 million residents in US were uninsured (Rita, 2001).
The issues of quality, value, choice, cost, efficiency, fairness, access and right to health care are raising questions and active debate. A lot of arguments have been brought up that the money spent outside and inside US does not deliver equivalent value (Sweat et al., 2000). Despite supporting other nations, its infant mortality rate is higher than any other industrialized nation and life expectancy is going down (Abraham, 2004, February). In addition, the Institute of Medicine gave a report in 2004 of unnecessary deaths totaling to 18,000 citizens and a further 44,800 excess deaths in 2009 due to lack of health insurance (Rita, 2001). It is the role of the government to provide health care programs for the poor, children, military service families and veterans, disabled and the elderly. However, most of the funding from U.S public expenditure on health should have taken care of this limited population but most of it goes to the OECD countries (Columbus & Wusu, 2006). Americans argue that this could have been used to provide primary healthcare insurance to the population and save unnecessary deaths (Sweat et al., 2000).
To sum up, there is need for healthcare organizations and the donor bodies to work together with African governments in developing vibrant strategies that will improve the health system in Africa. African leaders and medical experts should set up programs that will assist in raising funds and allocate resources as per the local needs rather than in a donor driven manner. In addition, the African health systems should be integrated and strengthened in order to cope with multiple health challenges and ensure equitable and affordable access to health care.
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