Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Confronting Africa's health crisis: back to basics .
- Albert M.E. Coleman (1 October 2005)
-
The heroes of African medicine
- Mark Struthers (2 October 2005)
-
Invitation to contribute in Problem solving conference for the Health sector in Nigeria
- Nnamdi E Ojimadu (5 October 2005)
-
Health in Africa – needs an end to extreme poverty.
- J Gordon Avery, None (12 November 2005)
|
|
|||
|
Albert M.E. Coleman, Associate specialist psychiatrist Greenarces CMHT, WSHSC NHS trust, Homefield Road, Worthing, W.Sussex. BN11 2DH
Send response to journal:
|
EDITOR-The paper by Sanders et al makes interesting reading (1).However as an African with training and work experience in international health, I think Africa's health crisis require's going back to basic notions. Poverty reduction may be a starting point. However, when it comes to rational use of the meagre monetry resources in Sub-saharan Africa, inefficient management of resources and corruption becomes serious stumbling blocks. Granted that corruption is almost worldwide, its rampant nature as documented in Africa; is a problem with monies available, recieved and disbursed by the apppropriate agencies in some of these countries (2). As to efficient use of meagre resources, it is well documented that there are countries, outside Africa (example Jamaica), within the same developmental bracket as some African countries who do far better with less (3). The general determinants of the health of populations among others show that an efficient, robust and performing health services organisation is basic to the health of nations (4). Human capacity building, as the mainstay of all organisations, especially for health service delivery, research etc, has suffered in most African countries; more so in recent times from net migration from Sub-saharan Africa to the developed world, (or much wealthier developing countries,(5). Sub-Saharan African governments and their developed counter -parts need to work together and hard to find pragmatic solutions to the brain drain problem. All said the health crisis in Africa will continue to be "more of the same", unless we seriously tackle the underlying issues driving the crisis. 1) Sanders DM, Todd C, Chopra M. Confronting Africa's health crisis:more of the same will not be enough. BMJ 2005;331:755-758 (1 October) 2)Eaton L. Global fund toughens stance against corruption. BMJ;331:718 (1 October) 3)Evans DB, Tandon A, Murray CJL, Lauer JA. Comparative efficiency of national health systems: cross national econometric analysis. BMJ 2001; 323:307-10(11 August) 4)Blum HL. Planning for health. Generics for the eighties. Human sciences press 1981, pp2-9. 5)Johnson J. Stopping Africa's medical brain drain. BMJ 2005;331:2-3 (2 July) Competing interests: None declared |
|||
|
|
|||
|
Mark Struthers, General Practitioner Bedfordshire, UK. mark.struthers@which.net
Send response to journal:
|
Fred Zayinga is an unsupported hero. Fred graduated as a medical assistant and progressed to senior clinical officer. He is not a doctor. Such vital workers as he are the bulwark on which the future of African health care depends. Many Malawian doctors, trained at home and abroad, have joined the African brain drain to tend the pampered sick and worried well of the US and UK. The nurses are going too. Fred Zayinga does everything with skill and competence, but fortunately, his experience and training do not transfer abroad. Africa does not need expensive doctors who then disappear. Africa needs Fred Zayinga and many enthusiastic men like him – heroes - and cheap at the price. Africa (and its overseas donors) must support its life saving heroes. Competing interests: spent a medical student elective period in Malawi in 1979 and visited Chikwawa and Nsanje during my stay. |
|||
|
|
|||
|
Nnamdi E Ojimadu, Resident Doctor Family Medicine , Jos University Teaching Hospital PMB 2076 Jos
Send response to journal:
|
Dear Editor We have read with keen interest your publications on Brain Drain Syndrome and its effects on the economy of the Sub Saharan African countries. A National Health Conference is coming up on HRH championed by National Association of Resident Doctors (NARD) of Nigeria. Venue: NICON HILTON Abuja Nigeria Date : 16-18 November 2005 Goal: Creating enabling environment for the health workers in Nigeria to reduce Brain Drain and encourage return of health experts in Diaspora for sustainable Health Sector performance to achieve Millennium Development Goals. Theme: Human Resources Development for Health: Facing the Challenge of Millennium Development Goals. Topics :
We invite your organization to participate fully in this epoch making conference, which we hope, will bring a turning around of the Nigerian Health system. We shall greatly treasure your inputs Yours truly, Dr Nnamdi Ojimadu
Competing interests: Your concern for the state the health sector and its crisis is geniuine and time . a conerence to address the health crisis in Nigeria is coming up soon in Abuja. 16-18 Nov 2005 |
|||
|
|
|||
|
J Gordon Avery, Associate Professor MUA PO Box 701 Charlestown. St Kitts/Nevis, None
Send response to journal:
|
Editor BMJ ‘Each time a man stands up for an ideal………he sends a tiny ripple of hope………those ripples build a current which can sweep down the mightiest walls of oppression and resistance’ Robert F Kennedy. University of Capetown 1966. In response to your recent series on Africa (1 October 2005) some comparisons with the Afro-Caribbean descendents of that continent may be pertinent . The small island territories of the Caribbean are reasonably well governed. They have sound economies, good education and health services and reasonable law and order. They have a strong faith based ethic and good extended family networks. Their GDP ranges from $US 5-10,000 per person per annum and real poverty is unusual. They have low infant mortality and high life expectancy in spite of increasing chronic non - communicable diseases. They have near 100% vaccination coverage in childhood and very good control of all communicable diseases except for HIV/AIDS. Overall their health is considerably better than that of their cousins in Africa. If there is to be any realistic prospect of achieving the Millenium Development Goals (MDG’s) in Africa then there is a pressing need to sort out some of the basic problems of governance and democracy. Much of this can be resolved from within in the African way. The west does have talents and skills which, working closely with African counterparts, can be put to good use to solve some of the problems. But above all at the heart of the state of poor health in Africa lies a failure to tackle extreme poverty (1). Ways to tackle the poverty problem have been spelt out by numerous commentators on many occasions. They have been well summarized by Jeffrey Sachs (Special Advisor to the UN) in his important work on ‘the End of Poverty’ (2). Taking this into account and focusing on ‘Health in Africa’ the following issues need attention :- 1. Getting world leaders to draw up a (Marshall Aid type) Plan of Action to defeat poverty. Set this out to individually address in detail how best to reach each one of the (currently unattainable) Millenium Development Goals. 2. Strengthening the United Nations and Non-Governmental Organisations by giving them full recognition and financial support.Give them greater authority to resolve conflict, disasters and famine by diplomatic, peaceful and non violent interventions. Look seriously into sources and legitimacy of arms supplies. Place strict embargoes where armed conflict continues. 3. Strengthening the role of the World Bank and associate organisations to be champions of economic justice and enlightened globalization. 4. Getting Political commitment and good governance at the highest level to place health as a top priority. Make serious efforts to introduce real democracy and respect for human rights. Sort out problems of nepotism, misappropriation of funds, corruption, crime,violence and conflict . 5. Improving the Basic Infrastructure of education, health services, law and order. 6. Giving Priority to Primary Education in order to strengthen the voices of advocacy and empowerment from the poor people to get them out of the poverty trap. 7. Promoting Sustainable Development especially in agricultural self sufficiency whilst also investing in the sustainability of the world’s ecosystems. Ensuring that development aid goes into physical projects and not just to purchase of goods, consultancies and services from the donor countries. 8. Utilising Appropriate Technology to teach and assist people from poorer countries to tackle agricultural, transport, water supply, sanitation, housing and construction problems. 9. Raising awareness in the rich nations to change attitudes amongst the general public to recognize that we are not doing enough to help the poor nations. The 0.7% of GNP dedicated to overseas aid (achieved by very few countries) is nowhere near enough to redress the gross imbalance between the rich and the poor. If the above issues are taken seriously it will take the world and Africa a very long way towards solving their poverty problems. However this is not the whole story. If, as seems likely (3) the USA is unable or unwilling to provide the necessary inspiration and leadership then the rest of the world must do so. Ideally this should be through the United Nations. If that proves impossible then the European Union through the Commission for Africa (4) may be the only viable alternative. Furthermore, if the rich international community is really honest with itself it will fully and properly address the issues which make it one of the main contributors to poverty. It will examine and remedy the vested interests which sustain low wages, environmental degradation, unfair trading practices, provision of arms and exploitation of resources that keep so many people in the poverty trap(5). It will look at how much aid is really getting to the people who need it and how much is merely being used to pay for expensive consultancies and purchase of costly and sometimes inappropriate products from the donor countries. In addition to the main measures put forward above to end poverty there is a also a pressing need for international public health to put its act together. Such an approach has been proposed in a ‘Global Partnership for Health’ by Professor Barry Bloom of the Harvard School of Public Health’ (6). This means much more than just the Global Fund to fight AIDS, Tuberculosis and Malaria led by Dr Richard Feachem and the WHO initiative on Bird ‘Flu led by Dr David Nabarro. It requires the best possible usage of the intellectual capital and influence of heads of governments, research scientists, key health staff and non- governmental/voluntary/philanthropic organizations. In particular it needs much closer co-operation between the well endowed prestiege academic institutions of the west and the relatively impoverished universities in the poorer countries (7). The effort needs to be focused on the real health needs of the people and not on high powered esoteric projects. It needs to ensure best use of Evidence Based Medicine (EBM) practice (8) especially in the use of viable vaccines and medicines for treatment of infectious diseases at a level that countries can afford. Above all it needs a firm commitment from commerce and industry to use their enormous skills and wealth to help public health practitioners put social welfare and health at least on a par with profit. All this might then allow the right conditions to exist to encourage the people of Africa to develop and flourish and achieve their basic human right of good health(8). As Sachs has said so succinctly ‘Let the future say of our generation that we set forth mighty currents of hope and that we worked together to heal the world’ Competing Interests. The author is head of a small research unit dedicated to health improvement in the Leeward Islands of the West Indies. He therefore has an interest in attracting foreign and regional funds for this purpose. References. 1. Sanders DM Todd C Chopra M. Confronting Africa’s Health crisis; more of the same will not be enough. BMJ 2005;331:755-758. 2. Sachs, Jeffrey. The End of Poverty. New York. Penguin. Press. 2005. 3. Ferguson, Niall. Collossus. The rise and fall of the American Empire. New York. Penguin Books. 2005. 4. Commission for Africa. Our common interest. London. Commission for Africa. 2005. 5. Malweyi I Africa does not need aid but the opportunity for fair trade. BMJ 2005;331:784. 6. Bloom, Barry. Public Health in Transition. Scientific American. Special Isssue on Crossroads for Planet Earth. September 2005. pp 70-77 7 Dare L, Buch D. The future of health care in Africa. BMJ 2005;331:1-2. 8. Straus Sharon E, Richardson W Scott, Glasziou Paul, Haynes R Brian. Evidence –Based Medicine. Edinburgh. Elsevier Churchill Livingstone. 2005. 9. Labonte R, Shrecker T, Sen Gupta A. A global health equity agenda for the G8 summit. BMJ 2005:330:533-6 Dr Gordon Avery. Director/Associate Professor. Leeward Islands Health Research Unit. Medical University of the Americas. PO Box 701, Charlestown, Nevis, St Kitts/Nevis. Competing interests: An interest in obtaining funds for my research unit. |
|||