One of the lessons left by the Ebola epidemic is the need to improve the African countries’ public health services, which have suffered the consequences of decades of neglect. Africa needs to rapidly upgrade those services as well as to improve the capacity of its medical and paramedical workforce.
Although Africa bears one-quarter of the global burden of disease, it only has two percent of the world’s doctors. Progress has been hindered, particularly in rural areas, because the infrastructure and the health services are inadequate, and there is a widespread lack of trained medical personnel.
Effects of HIV/AIDS
The African continent has been greatly afflicted by the HIV/AIDS pandemic. Talking to a patient at a hospital in Mozambique at the height of the AIDS epidemic he told me, “My choice is to die from AIDS or from hunger.” In a few words, he was highlighting two of the African continent most pressing problems: disease and poverty.
East and Southern Africa is the region most affected by HIV in the world and is also home to the largest number of people living with HIV (19.6 million in 2017.) This pandemic has reversed decades of improvement in life expectancy, educational progress, and economic growth. For example, in Lesotho, where life expectancy was 60 years in 1995, life expectancy had plummeted to around 50 years in 2017 due, to a large extent, to the HIV/AIDS epidemic in the country.
Although the number of deaths of AIDS-related illnesses has fallen significantly in the last decade, the high cost of treating HIV/AIDS, when coupled with the indirect costs resulting from loss of workers’ productivity, has had a serious negative effect on African economies. HIV/AIDS is estimated to have decreased agricultural output by as much as 20 percent in several African countries.
In addition, public health officials still have to deal with the stigma of AIDS that persists in most African countries, and that is a huge barrier to gathering people tested for the infection. Fortunately, self-testing kits have improved the proportion of people being tested and this has allowed more people to be treated for the infection.
In addition to HIV/AIDS, South Africa has the highest tuberculosis death rate per capita worldwide, followed by Zimbabwe and Mozambique. This is due to a large extent to the increasing number of cases of multidrug-resistant tuberculosis (MDR) as well as drug-resistant (XDR) tuberculosis. TB is the leading cause of death for people living with HIV.
In recent times, there has also been a sharp increase in non-communicable diseases (NCDs) such as diabetes, cancer, and heart and lung diseases. The World Health Organization estimates that NCDs will rise in the region by 27 percent over the next 10 years, resulting in 28 million additional deaths.
Mental health problems have traditionally been neglected by African governments. As a result, most mental health patients remain untreated. This “treatment gap” ranges from 75 percent in South Africa to more than 90 percent in Ethiopia and Nigeria. As Dr. Crick Lund, a Professor of Psychiatry and Mental Health at the University of Cape Town has remarked, “By neglecting mental health, it will be difficult to attain many of the Sustainable Development Goals related to poverty, malaria, gender empowerment, and education.”
Many diseases affecting both children and adults could be addressed with minimum resources if they are adequately employed. This is the case of diarrhea and respiratory infections, measles, malaria, and malnutrition, which represent the greatest threats to children’s health. Malaria is the leading cause of death among African children under five years old. African women are approximately 175 times more likely to die during childbirth and pregnancy than women in industrialized countries.
Health problems are worsened by the lack of health professionals, due in part to the continuing exodus of doctors and nurses to industrialized nations. If health care systems are to be effective, resources must be redirected from curative care in urban settings with high tech equipment to primary and preventive health care.
Consequences of corruption
In addition to problems directly related to the health sector, corruption and illicit financial flows (money that is illegally earned, transferred or utilized) drain critical resources needed to improve people’s health and education. According to Kar and Cartwright-Smith, Africa is estimated to have lost in excess of $1 trillion in illicit financial flows. This amount is roughly equivalent to all of the official development assistance received by Africa during the same time frame.
The widespread practice of bribing government officials by foreign companies must be curtailed through the enforcement of national and international laws dealing with this issue.
Importance of reliable statistics
Lack of reliable statistics is a hindrance to improving health systems in Africa. They range from defective systems for civil registration to poor data on maternal and child health indicators, including immunization rates for the most common diseases. A World Bank study showed that half the population of African countries had not been included in a census.
Reliable statistics are critical for assessing the magnitude and kind of health problems affecting the population, for determining access to health services, particularly in rural areas, for allocating resources for different programs, for assessing the effectiveness of the interventions, and for monitoring different projects.
In the last few years, the emphasis has been placed on economic aid to Africa. African countries, however, need a different kind of aid. They need their human resources to be trained in their own countries. They need more help in preventing major diseases. They need more education for all age levels, and they need better conditions of trade for their products. African countries do not need more monetary aid given irresponsibly, which ends up in the hands of government officials and members of the countries’ elites.
To improve people’s health in Africa more efforts are needed to increase primary health care, especially in rural areas, accompanied by health promotion, disease prevention, and improved education for all ages. For too long, Africa has been a photo-op for movie and music stars, whose patronizing attitudes disregarded the Africans’ capacity for solving their own problems. As writer Paul Theroux wrote about Bono, “There are probably more annoying things than being hectored about African development by a wealthy Irish rock star in a cowboy hat, but I can’t think of one at the moment.”
Africa has a tremendous human potential that, well directed, will help overcome the countries’ difficulties. According to current population trends, Africa is set to have the largest youth population in the world. It is estimated that by 2050, the median age for Africa will be 25 years, compared to 36 for the rest of the world. The role of Africa’s youth in guiding the continent’s progress can be considerable if we appeal to its own capacity, creativity, and resilience.
Dr. César Chelala is an international public health consultant. He has carried out health-related missions in over 50 countries worldwide, many of them in Africa.