Intended for healthcare professionals

Education And Debate

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

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7519.755 (Published 29 September 2005) Cite this as: BMJ 2005;331:755
  1. D M Sanders, director (dsanders@uwc.ac.za)1,
  2. C Todd, general practitioner3,
  3. M Chopra, director of health systems research2
  1. 1 School of Public Health, University of the Western Cape, Bellville, 7535, South Africa
  2. 2 Health Systems Research Unit, Medical Research Council, Tygerberg, South Africa
  3. 3 Wendover Health Centre, Wendover, Aylesbury, Buckinghamshire HP22 6LD
  1. Correspondence to: D M Sanders

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

    Introduction

    At current rates of progress, sub-Saharan Africa will not achieve any of the millennium development goals.1 In health, the situation is especially bleak, with little or no substantive progress since 1990. All key health indicators are at much worse levels than those in any other of the world's developing regions (with the exception of malnutrition in children under 5 in South Asia, but there the situation is improving).2 3 In this article, we critically examine the main approaches currently supported by the international community for accelerating progress towards the health related goals—increased aid, reform of the health sector, and global health initiatives—and outline an alternative approach for improving the health of African people.

    Why is the health of people in Africa so poor?

    At the heart of the poor state of health in Africa lies a failure to tackle extreme poverty. Today, 46% of the population live on less than $1 (£0.55; €0.82) a day, a greater proportion than 15 years ago.1 The failure to tackle poverty is due to several inter-related factors, mainly economic stagnation and the related debt crisis. Support from the International Monetary Fund and World Bank for countries with crippling debt has been contingent on governments adopting painful structural adjustment programmes. These have required countries to put strict ceilings on government spending in the social sectors, limit public sector recruitment, and liberalise trade.

    National institutions in many African countries are often weak, leaving governments open to corruption, and conflict has affected several African countries with devastating consequences for health. HIV and AIDS have undoubtedly contributed. On average, 1 in every 14 adults in Africa is infected with HIV, a rate much higher than in any other part of the world. The resulting pressures on …

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