Africa’s Healthcare: Advances and Concerns (Part 2)
In conclusion to the two-part series on Africa’s Healthcare: Advances and Concerns, the focus today is on neglected diseases and the need for more medically trained personnel in order to meet the needs of Africa’s citizens.
Neglected Diseases – South Sudan
Kala azar (visceral leismaniasis) in recent months has become a major cause of worry for the citizens of South Sudan after its biggest outbreak in eight years in the last quarter of 2010, leading up to the South Sudan referendum. A neglected and deadly tropical disease which affects poor regions, it is the second largest cause of parasitic deaths. Kala azar is transmitted by the bite of sand flies and characterised by symptoms such as fever, weight loss, anaemia, depression and a heavily suppressed immune system. It is also known to attack internal organs, including the liver.
According to WHO, kala azar is endemic in 88 countries worldwide and puts approximately 350 million men, women and children at risk of infection, with an annual incidence rate of 500,000, and 90 percent of these cases occur in India, Nepal, Brazil and Sudan, especially in the south. Prior to the recent December 2010, outbreak in Southern Sudan, which is feared, will worsen until April 2011, WHO reported an upsurge of infections in october, with 9,330 cases and 303 deaths, a case fatality rate of 4.7 percent since outbreaks began in September 2009. The number of cases was six times higher than the same period starting in 2007, when 758 cases and in 2008, 582 cases were recorded. In Southern Sudan, it is estimated that 70 percent of those affected are children, under the age of 15, who already suffer from malnutrition and other illnesses and 75 percent of recorded deaths in current outbreaks are also in the same age group. Kala azar is treatable and treatment involves a daily injection of pentavalent antimonials for 30 days but early diagnosis makes the difference. However, if untreated, it can be fatal.
Since 1988, MSF has treated over 95,000 kala azar patients in Sudan, Ethiopia, Kenya, Somalia and Uganda. In response to the crisis in Southern Sudan, it has set up an additional base in Pagil, Jonglei State in order to expand its capacity to deal with the increase of patients being infected. According to MSF, it is impossible to know the death toll as 75 percent of South Sudanese do not have access to healthcare facilities following decades of civil war. Vanessa Cramond, medical coordinator for MSF in South Sudan, said “Its access to healthcare in Southern Sudan which only serves to compound the major health crisis that a neglected disease such as kala azar can cause. With only one quarter of people in southern Sudan having access to the most basic form of healthcare, treatment for this disease is difficult to come by for the vast majority of people. An already weak healthcare system simply cannot cope with large outbreaks, such as we saw last year. MSF treated eight times the number of people than in 2009 – up until the end of December 2010, we treated 2,766 patients. A big concern for us also is the number of people returning to live in southern Sudan, particularly to Upper Nile and Jonglei States where the disease is endemic. Many people, who have been living in the north where kala azar is non-endemic, would have had no or little previous exposure to the disease and are therefore vulnerable. We anticipate an increase in cases over the next few months, the time it takes for kala azar related symptoms to appear.”
Training of health personnel
In the last decade, the ‘brain drain’ has seen mass migration of qualified African medical professionals to Europe, the US and other developed nations where they are guaranteed better living conditions and higher wages.
It is estimated by the UN Economic Commission for Africa and the International Organisation for Migration (IOM) that since the 90s, over 20,000 leave the continent for greener pastures annually and these include doctors, nurses and healthcare workers in various capacities. At the end of 2010, it was reported that there is a critical shortage of workers in over 50 countries and Africa requires 800,000 health workers by 2015, if it stands a chance of achieving the UN MDG goals. While a complex set of factors such as failing economies, high unemployment, human rights abuses and armed conflicts compel people to leave. The exodus of healthcare professionals is an acute problem in Angola, Liberia, Mozambique, Sierra Leone and Tanzania. A grim reality best demonstrated in Malawi, where it is estimated that there are now just two doctors and 26 nurses for every 100,000 people and in Southern Sudan, there are only 50 doctors and 20 midwives for a population of 10 million. A start contrast to the UK, where there are 250 doctors for every 100,000 people.
Given the dire statistics, there are initiatives to address the gap and one of such is led by the African Medical and Research Foundation (AMREF,) an African based NGO with offices across the world delivering projects and programmes, which includes, training doctors, providing emergency care and tackles disease like malaria and TB, in six African countries, including Tanzania and Ethiopia, and trains health workers from over 40 countries across the continent. Every year AMREF trains people in different capacities, this includes, more than 10,000 community health workers, helping 20,000 nurses in Kenya to upgrade their skills through its innovative eLearning programme and surgeons train over 1,000 doctors in more than 100 remote hospitals in seven African countries. Dr Peter Ngatia, AMREF’s director of capacity building said “Healthcare workers are meant to be the glue that binds the health system. Without them, the system fails.” Adding that it was time people stopped talking and “Walk the talk, which means investing in innovative methods of training and retaining health workers. Scaling up of human resources production cannot happen unless we invest in the use of technology to train the numbers that are required. The 105 medical schools in Africa do not have the capacity to meet the urgent demand for doctors, nurses and midwives among many other cadres of health workers.”
Images are the copyright of AMREF UK
Fly image: Google