Confronting Africa's health crisis: more of the same will not be enough

doi:10.1136/bmj.331.7519.755

BMJ 2005;331:755-758 (1 October), doi:10.1136/bmj.331.7519.755

Education and debate

Confronting Africa's health crisis: more of the same will not be enough

D M Sanders, director¹, C Todd, general practitioner³, M Chopra, director of health systems research²

¹ School of Public Health, University of the Western Cape, Bellville, 7535, South Africa, ² Health Systems Research Unit, Medical Research Council, Tygerberg, South Africa, ³ Wendover Health Centre, Wendover, Aylesbury, Buckinghamshire HP22 6LD

Correspondence to: D M Sanders dsanders@uwc.ac.za

The international community needs to rethink its approach toAfrica if it wants to produce sustained improvements in health

The first 150 words of the full text of this article appear below.

Introduction

At current rates of progress, sub-Saharan Africa will not achieveany of the millennium development goals.¹ In health, the situationis especially bleak, with little or no substantive progresssince 1990. All key health indicators are at much worse levelsthan those in any other of the world's developing regions (withthe exception of malnutrition in children under 5 in South Asia,but there the situation is improving).^2
3 In this article, wecritically examine the main approaches currently supported bythe international community for accelerating progress towardsthe health related goals—increased aid, reform of thehealth sector, and global health initiatives—and outlinean alternative approach for improving the health of Africanpeople.

Why is the health of people in Africa so poor?

At the heart of the poor state of health in Africa lies a failureto tackle extreme poverty. Today, 46% of the population liveon less than $1 (£0.55; ${euro}$ 0.82) a day, a greater proportionthan 15 years . . . [Full text of this article]

Increasing overseas aid and debt relief

Health sector reform

Global health initiatives

An alternative approach

Promote social mobilisation and welfare of poor people

Increase numbers and capacity of health workers

Strengthen the community base of health care

Conclusion

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