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March 13, 2019

Health in Africa


March 13, 2019

One of the lessons of 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.

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 addition, there has 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.

This article has been excerpted from: ‘Improving Health in Africa’.


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