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
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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 :
Reappraising Human Resources Development in the health sector.
Repositioning the health Worker to achieving the Millennium Development
Goals.
Effective Leadership Training: Key to sustainable Health Sector
performance
Corruption and Health System auditing
Confronting the menace of incessant strike and
Brain Drain syndrome in the Health sector
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
Chairman Organizing Committee
C/o Family Medicine Department,
Jos University Teaching Hospital,
E-mail: neojimadu@yahoo.com
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
Competing interests: No competing interests
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.
Competing interests: No competing interests
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
Competing interests: No competing interests
Health in Africa – needs an end to extreme poverty.
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.
Competing interests: No competing interests