GlobalHealthAfrica

Archive for the ‘Health Policies’ Category

Responding to the Needs of the Vulnerable: The State of Mental Health Care in Africa

In Community Health, Health Policies, Mental Health on May 18, 2014 at 12:28 am

In Africa, the problem of mental health and substance use disorders is particularly pronounced. GHA contributor, Diana Kingsbury, calls for governments and donors to increase their focus on mental health issues.

Among the many public health challenges that impact countries worldwide, mental health and substance use disorders continue to rank among the most persistent. These disorders are the leading cause of death and disability worldwide and account for about 23% of all years of life lost globally, according to the World Health Organization (WHO). For low- and middle-income countries, adequately addressing mental health needs is particularly challenging. Statistics show that 75-85% of individuals living with severe mental disorders in low-and middle-income countries are not receiving necessary treatment, compared to 35-50% in high-income countries.

Picketing in Cape Town, South Africa. Image by Halden Krog

Picketing in Cape Town, South Africa. Image by Halden Krog

In Africa, this problem is particularly pronounced. While the overall prevalence of mental health and substance use disorders across the continent is largely unreported, the lack of adequate services has been identified and is growing in relevance in the global health arena. The mental health care crisis within Africa is the result of several inter-related factors including a significantly understaffed mental health care workforce. For example, in the Niger Delta region of Nigeria, there is only one neuro-psychiatric hospital for the region’s four million inhabitants.

In Uganda, a nation of 33 million, there are only 33 psychiatrists. In Kenya, there are only 83 psychiatrists for a population of 40 million. In Ghana, there is only one psychiatrist available for 1.5 million people.

Across Africa, the burden of inadequate access to mental health care has resulted in lack of treatment, follow-up, and often inhumane treatment of the mentally ill. The additional burden of stigmatization often leaves individuals with mental disorders without any source of social support. Coupled with the significant social stresses that challenge the continent, such as poverty, food insecurity, conflict, and infectious disease, the risk of developing a mental disorder also increases. Very few prevention programs are currently in place to assist those at-risk in confronting these stresses. The limited availability of an appropriate mental health care system is a significant public health problem that needs to be addressed.

From a governmental perspective, there is limited infrastructure available to provide appropriate mental health care for those in need. It has been reported that 70% of African nations spend less than 1% of their health budgets on mental health and the majority of available funds are put toward psychiatric institutions and not community-based programs. Additionally, only 50% of African nations have a mental health policy, and if they do have a law, it is usually archaic and obsolete. In light of recent events in South Sudan and the disappearance of over 260 school girls in Nigeria, it is clear that in order to heal psychological wounds caused by violent conflict and social unrest, a commitment to building a mental health care system that can readily respond to the needs of the people should be of paramount importance.

Efforts that have been made to reverse current trends have proven successful. For example, former U.S. President Jimmy Carter’s “Carter Center” has established a mental health program in Liberia that seeks to train mental health care professionals within the country so that access to necessary mental health care services may be improved. As a result of the center’s efforts, mental health care access can be expanded to nearly 70% of the country. Organizations such as “BasicNeeds” also seek to break through stigmas associated with mental health disorders in the developing world, and create community supports that are vital to the integration and care of the mentally ill within the community. Through the work of non-governmental and philanthropic organizations, an organized effort to integrate mental health care into the primary care system, as well as an emerging focus on the mental health needs of the developing world, more attention has been brought to this issue. The relevance of adequate mental health care across the globe should not be underestimated.

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Improving Health Outcomes in Africa through Intersectoral Collaboration

In Accidents, Health Policies, Healthcare on January 20, 2014 at 5:42 pm

Global Health Africa blogger – Ifeoma Ozodiegwu – shares some of her reflections on improving health outcomes in Africa. She is currently based in Zambia.

collaboration

Here in Zambia, I have spent the past 5 months observing, reading and reflecting on how best to improve the health outcomes in Africa. I am currently obsessed with learning and highlighting best practice ideas to tackle preventable diseases.

It appears to me that part of the answer lies not in solely improving the health sector but in improving all sectors in a country. The death of a hypothetical young mother from undiagnosed HIV is strongly associated to the economic, financial and social structures prevalent within a nation. I am viewing this problem from the angle of poverty and the lack of safety nets that prevented this hypothetical lady from being educated and led her into impoverishment. At this point, she is unable to afford care and consequently, her first point of call when she is ill is the traditional medicine man, who may attribute her illness to spiritual forces.

Health outcomes have deeper roots than an individual’s decision or the state of a health sector. In the words of Dr. Margaret Chan, the WHO Secretary General, “……the threats to health are more numerous, the causes more ominous and the burden more onerous”. Echoing the same sentiment in their treatise on the evolution of health in all policies, IIona Kickbusch and Kevin Buckett write about “wicked problems” in the context of health systems. They define these problems as “difficult to define, may be socially complex, are often multicausal with many inter-dependencies, have no clear solution and are not the responsibility of any one organization or government department”

Consequently, to address the present day health challenges calls for a broader and more collaborative approach by stakeholders – African Governments, donors, health ministries, international and local NGOs. Governments in the region need to create the enabling environment for multi-sectoral collaboration to thrive. Policy-makers can see the results of such collaboration from the Singaporean experience as documented by William Haseltine in his book – Affordable Excellence.  In the book, Haseltine writes about an “unusual degree of unity” that existed within the country’s ministries as far back as the 1980s. This unified front created room for discussion and collaboration on multi-sectoral issues and development of policies that “reaches across ministries”.  In its 2000 World Health Report, the World Health Organization ranked Singapore as sixth on its overall health system performance ahead of several developed countries.

Involving other sectors to work in public health has the potential to bring about exponential improvements in the health of citizens in African countries. For example, collaborations between ministries of transportation and health could be the first step in addressing the high mortality rate from accidents in Africa. See more about accident statistics in Africa.

Such alliances could result in improved availability and response time of emergency care at frequent accident sites. In addition, research collaboration between both ministries can help determine accident risk factors and develop programs to address them. Indeed, one of the proverbs we are fond of in Africa goes: “If you want to go fast, go alone. If you want to go far, go together”.

References

http://www.brookings.edu/~/media/press/books/2013/affordableexcellence/affordableexcellencepdf.pdf

http://www.fic.nih.gov/News/GlobalHealthMatters/november-december-2013/Documents/2013-12.htm

http://www.who.int/sdhconference/resources/implementinghiapadel-sahealth-100622.pdf

http://www.who.int/whr/2000/en/whr00_en.pdf

Quality of Life for Elders: Lessons from South Africa and Bolivia

In Elderly, Health Policies, Healthcare on November 10, 2013 at 5:45 am

Last month, the Global AgeWatch Index issued a report on the quality of life of older people in 91 nations. The report included several factors such as income security, health and well-being, employment and education. African nations did not fare well. South Africa was the highest ranked African nation at number 65 while Ghana, Morocco, Nigeria, Malawi, Rwanda and Tanzania came in at numbers 69, 81, 85, 86, 87 and 90 respectively. Other African nations were not included in the report because there was not sufficient data. With South Africa leading the pack in elderly well-being, it helps to decipher the various ways it deals with its senior citizens.
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In addition to having the largest and most developed economy in Africa, the old age pension reaches 72% of the older population in South Africa. South Africa’s pension system is the second most distributed of the African countries that are in the Index. Namibia is the first at a whopping 167.3% although there was not enough data in other areas to include the nation in the report. While South Africa performed moderately well in income security, they ranked low in elderly’s health status. There are only eight registered geriatric doctors to serve an older population of 4 million. Since 1994, dramatic changes have taken place in the structure of health services. The government prioritized maternal and child healthcare because of the HIV/AIDS pandemic in the 90’s.

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Although South Africa was ranked at number 65, Bolivia, one of the poorest countries on the list was ranked at number 46. This shows that higher-income does not always correlate with better quality of life. In fact, some lower-income countries that invested in aging saw positive impacts. Bolivia, for instance, implemented a national plan on aging and free health care for older people, which vastly improved quality of life. The rankings illustrate that limited resources need not be a barrier to countries providing for their older citizens, that a history of progressive social welfare policies makes a difference, and that it is never too soon to prepare for population aging. This is important for other African nations because the elderly are a significant boon. As African nations, we can do better by learning from each other as well as other non-African nations. Our collective goal is to improve the elderly’s quality of life for present and future generations.

West African Healthcare: Problems and Solutions 2

In Health Policies on June 11, 2013 at 10:33 pm

In Part 1, Guest Blogger Udo Obiechefu discussed three major obstacles that West African nations face in their effort to provide accessible quality care for their citizens. In Part 2, Udo explores three solutions that could possibly gain traction as viable options to increase access to care.  

THE SOLUTIONS

Involving the Private Sector: It can be done!

The availability of private health insurance in West Africa is quite limited. Many health insurance plans are only available and marketed to the wealthy and/or expatriate communities. As mentioned in part one, it is apparent that West Africans are willing and able to pay for reasonably priced prepaid services. There is great potential to improve healthcare access and delivery through the availability of well-priced, quality health insurance. CorporateTraining What would make the idea of purchasing health coverage more palatable for citizens of West African nations are more reliable health services. Even if given reasonable choices for coverage, there still has to be confidence in the system to provide the care required. The system can be improved if more is done with the resources available. Some of these resources include the user fees that consumers must pay out of pocket and international aid. The idea of providing private health insurance to low income Africans is already being put to practice. The Health Insurance Fund (HIF) is a foundation devoted to achieving this goal. Through the foundation, donor funds and international monetary aid are linked to health maintenance organizations and insurance companies. These organizations are responsible for the execution of the insurance plans. The mission of the Health Insurance Fund is to protect the wealth of low income African families by utilizing private insurance as a means to access quality care. The resources of the HIF are used to upgrade the medical and administrative services of the contracted insurers and providers. The first HIF program was initiated in Nigeria utilizing Hygeia, which is the largest healthcare service group in the country. At this point in time the HIF has over 120,000 enrollees.  

Community Based Prepayment: Community Solutions for a Continental Problem 

Community based initiatives have the potential to be very effective tools for change. A community based concept that has gained traction in recent years within some ECOWAS nations are Community Based Health Insurance schemes (CBHI). These plans are more accessible than the formal private sector insurance plans currently available to West Africans. Prepayment plans are funded by annual or regular payments. They require reduced fees at the time health services are rendered. Most CBHI schemes involve either hospitalization services or primary care visits. Johannes P. Jutting, in an article analyzing community plans in the Thies region of Western Senegal, came to the conclusion that CBHI plans have the capability of having a strong impact;

“It was shown that in an area where most people are deprived of access to health care of good quality, the introduction of CBHI schemes can make a substantial difference” (Jutting 2003) Community Community based plans are a common sense approach that provides consumers with more realistic financial options. The availability of flexible payments insures a consumer’s ability to make payments that make sense given their financial circumstances. Community based plans also offer the capacity for providers to create community specific options. A group of plans available in Sikasso, Mali may not be the same as plans available in Taoudenni, Mali. The customizations that are made to payment plans in different communities can be based on demographics, disease prevalence and average income of those living in the geographic area. This flexibility allows for high degrees of adaptation between marketplaces. The success of community based initiatives are not a guarantee. Although it has the potential to provide access to care for large majorities of lower income populations, it still is a concept that struggles to include extreme cases of poverty. There is still much research to be done, but the future is promising. Systems that identify community needs and embrace an approach specific to the region have the potential to produce a more sustainable marketplace for middle and working class West Africans to purchase reliable health coverage.

Natural Resources: Where Are the Revenues Going?

Over the last ten years many West African nations and Africa as a continent has seen substantial growth as the result of increased exploitation of African natural resources. From diamonds in Botswana to oil off the coast of Nigeria, Africa offers a vast array of resources that contribute to the foundation on which most of western society sits. What has become evident during this recent increase in West African economic activity is a severe lack in transparency in relation to the taxation practices that seem to be attracting foreign investors. Liberia’s President, Ellen Johnson Sirleaf, believes that African nations are suffering due to lack of appropriate taxation methods;

“Africa, like the rest of the world, is suffering tremendous losses from the illicit and unwarranted outflow of wealth through tax avoidance, shell companies, tax havens, transfer pricing and others, that in a way leads them to avoid their fair share of taxes,” natural resources What should be a vast economic windfall for West African nations and citizens seems to never have a tangible financial impact on the countries from which these resources are being acquired. The 2013 Africa Progress Report concluded that Africa is at a critical point in time where greater investment of natural resource revenue needs to be invested into West African economies. Corruption is a real problem with real economic impacts on West Africans , but a greater issue is the belief of West African governments that an increase in transparency, coupled with stronger negotiations could lead to a loss of business. These ideas must be overcome to gain maximum value and increased revenues for West African. An increased stream of income from ECOWAS nation’s reserves of natural resources could in turn provide the financial ability to improve many of the access to care issues we discussed in part one of this story.

Conclusion

The struggles surrounding health care on the African continent have been well documented. West Africa is no different. For there to be sustainable change within the region the paradigm must be shifted. West African nations must rely more on the ingenuity and resourcefulness of the populations they are seeking to help. Community based solutions offer promising results that involve an approach specific to the region.  ECOWAS nations also must look to maximize their potential by increasing transparency and implementing better business practices. Better utilization of already existing sources of revenue will lead to a greater financial freedom. This increase in financial maturity can provide West African governments with the confidence to take many problems in their healthcare delivery systems head on. Improving the access and delivery of care in West Africa is a daunting task. Lack of funding, a small workforce, poor organization, and a dearth of viable private sector solutions has left many nations in dire situations. Although the current environment is not ideal, the future is not completely bleak. With proper investment of aid, a change in approach and an aggressive and forward thinking collection of decision makers West Africa has the opportunity to improve the access and delivery of health services for millions in the years to come. References

An African Public Health Story 2: Let’s Talk of Funding

In Health Policies, Healthcare, Malaria on May 29, 2013 at 12:13 am

joseph-kasonde-health-zambia-reports

This write-up is a continuation of our discourse on the Zambian Malaria Initiative. Click here to read Part 1 of the blog post. This initiative was introduced by the Zambian National Government and a host of international partners to eradicate malaria from Zambia.

After reading Part 1 of the write-up and perhaps other write-ups on this topic, I hope the reader will ask the same questions I asked. “How can this effort be sustained? Will funding costs allow it to be replicated successfully in other malaria-endemic African countries?”. In 2006 and 2008, the Zambian malaria eradication project costs approximately $35 million and $40 million respectively. This implies huge financial implications for all funding parties. Hence, any event that prevents Zambia’s international partners from future funding of the project means that all past gains will be relinquished.

Read an earlier blog post titled Health Inequalities-Wealth is Health that discusses the impact of resources on the health of nations.

Perhaps a better question to ask is: How can public health interventions, especially in resource-poor settings become more efficient? What new and innovative techniques are been applied to reduce costs, in malaria and other disease intervention programs in Africa? Please comment and share what you know or what you are doing.

West African Healthcare: Problems and Solutions

In Health Policies, Healthcare on May 11, 2013 at 5:43 pm

In this post, Guest Blogger Udo Obiechefu attempts to start a conversation on some of the issues impacting access and availability of care in West Africa. In his next post, Udo will explore avenues for solving these issues. Enjoy!udo picture

The issues related to health care delivery and access in West Africa is plentiful. Lack of adequate funding, a small workforce, poor organization, and a dearth of viable private sector solutions are just a few of the many dilemmas preventing countless West Africans from attaining sustainable access to quality care. Discussions addressing these issues are numerous and ongoing. I will attempt to contribute the discussion by starting a conversation revolving around three major dilemmas facing West African healthcare. In part two we will discuss possible solutions.

Part 1: The Problems

The Private Sector: Is Private Health Insurance Realistic?

A problem that is evident within the realm of West African healthcare is the lack of an adequate, cost appropriate private sector market. Much of this is due to the fear of high costs and conjecture surrounding the profit motives of potential investors. Although these suspicions may be warranted due to the insurance industries checkered history in other parts of the world, it is important to acknowledge the lack of strong private sector options as another problem plaguing healthcare access in West Africa.  Because of the high out of pocket expenses encumbered by those seeking medical services, healthcare providers have difficulty predicting the flow of revenue. This lack of predictability has lead to the inability of providers to improve the quality of services. As a result of this and many other factors the private sector has remained underutilized.

The reality is that West Africans have proven capable of and willing to prepay for services. This is evident in the success of prepaid cellular cards. Of course, the healthcare market has many complexities and comparisons with the mobile telecommunications market can be a stretch, but what is evident is the basic premise of prepayment is not a foreign idea. The problem resides in the fact that consistent access to quality medical care can be difficult to come by. Questions must be asked about how private insurance can better provide realistic options for citizens of West Africa. What options are available for middle income West Africans? Can the private sector play a role for those living in poverty? More work has to be done in researching all possible avenues for improving the health of West Africans. At this point in time the lack of a competitive private health insurance market has to be viewed as a deficiency.

Staffing: Understaffed, Overworked and Unemployed                                                                

The World Health Organization recommends, as a minimum standard, one physician for every 5,000 inhabitants of a geographic area. Many West African nations fall far short of this criteria. Burkina Faso, Benin, Senegal, Sierra Leon, Niger and Mali all average less than ten physicians per 100,000 inhabitants. This staffing crisis is also present in nursing and hospital administration. Despite the fact that Africa, as a continent, accounts for over 40% of the worlds communicable diseases, it comprises less than five percent of the global health workforce. Unfortunately West African nations are not producing healthcare workers at the rate of demand. Also troubling is the fact that many of the healthcare workers who are available are located in larger cities which leaves those in rural areas an additional burden.

Notwithstanding the issue of shortage, there is also the issue of funding. There are many nurses and midwives who are underemployed or unemployed in West Africa. This is due to nations lacking the financial ability to meet even modest salary demands. This has caused many capable medical professionals to leave the region in hope of finding more opportunity elsewhere. West Africa is being devastated by a “brain drain”. Due to economic, social, and personal reasons well educated, qualified and motivated healthcare professionals in West Africa are seeking opportunities in the west. Europe and North America are reaping the rewards of West African educated healthcare professionals. These issues have lead to an over reliance of many *ECOWAS governments on skeleton staffing or temporary foreign health workers. This dependency has produced a system where instead of making systemic changes to the current healthcare structure that would aid in the production and maintenance of a larger workforce, there is a culture of anticipation and need for the next available foreign assistance to provide relief to a poorly functioning arrangement.

Healthcare Financing: “…..Or lack thereof”

Donor funding accounts for 25% of healthcare financing in one third of African nations. This statistic also holds true for numerous ECOWAS nations. Many foreign funding sources that contribute large amounts of aid to West African countries operate cyclically and can at times cut funding without the host country being prepared to absorb the financial impact. Even more concerning is the high percentage of funding that comes from out of pocket expenses. Sixty percent of health expenses are paid for out of pocket in Africa. These expenses can come in the form of user fees at public facilities, direct payments to private providers and even cash payments to traditional healers.

Numerous West African nations struggle with developing revenue streams to finance their healthcare systems. User fees are currently a source of revenue for West African governments. Although many primary care services are exempt from fees (immunizations, family planning, treatment of communicable disease), it still has proven a burden to care for many poor families. User fees have shown to be largely unpopular and many ECOWAS nations are currently exploring their abolishment. With the abolishment of fees comes the need to find a suitable source of additional revenue which can be quite difficult for low income nations.

References 

Check Back for Part 2……

An African Public Health Story-The Zambia Malaria Initiative Part 1

In Health Policies, Malaria, News on March 10, 2013 at 6:39 pm

The Zambian National Malaria Control Programme appears to be a growing success.  Estimates from the Zambian Demographic Health Surveys indicate a 29% reduction in under-5 mortality for the period, 2001-2007. Even more, a research paper in the American Journal of Tropical Medicine and Hygiene highlights the improvements in household and individual adoption of malaria prevention tools such as insecticide treatment nets (ITN) and Intermittent preventive treatment in pregnancy (IPTp). By 2008, 60% of households in Zambia had at least one ITN and over 60% of pregnant women had received 2 or more doses of IPTp. However, an increase in malaria cases was reported in 2010.

Having read bits and pieces of Zambia’s efforts in combating malaria in the news media, I set out to understand and share, from public health literature, some of the factors that were responsible for their public health gains. In part 2, I will examine the implications of these factors, which I call the building blocks, and the challenges that lie ahead for Zambia and other African nations.

The Building Blocks

National Commitment

After the launch of the Roll Back Malaria Partnership in 1998, the Zambia Government put in place structures that demonstrated a commitment to the elimination of malaria. These included the establishment of a ministerial task force to coordinate the development of the 2000-2005 National Malaria Strategic Plan (NMSP) and the founding of the National Malaria Control Centre (NMCC) in 2002. The National Government also went ahead to eliminate taxation on ITNs and on corresponding insecticides while adopting artemesinin- based combination therapy (ACT) as its front-line anti-malaria therapy recommendation.

By 2005, the National Malaria Control Centre set out to reduce malaria incidence and under-5 mortality in five years by 75% and 20% respectively. These goals were set to be achieved through a combination of prevention strategies that included insecticide treated nets (ITN), indoor residual spraying (IRS) and prompt malaria diagnosis and treatment with Rapid Diagnostic Kits and artemesinin-based combination therapy (ACT). Coverage targets outlined in the 2006-2011 NMSP included: greater than 80% of households with an average of 3 ITNS/HH, greater than 80% of pregnant women receiving greater than or 2 doses of IPTp, greater than 80% of pregnant women sleeping under ITN or in a house with IRS, greater than 80% of children under 5 years sleeping under ITN or in a house with IRS and greater than 80% of sick persons treated with effective anti-malarial within 24 hours of onset.

To further along their goals to eliminate malaria, The Zambia Government also increased allocations for the malaria control initiatives. By 2008, budget allocations for malaria from the Zambia Government had come to $25.4 million.

These actions by the Government of Zambia provided evidence of its dedication to eliminating malaria and improving the health outcomes of Zambians.

 International community support

Zambia’s efforts to build the infrastructure for national scale malaria control program attracted substantial donor support. Donors included the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), the U.S Agency for International Development (USAID), the Bill and Melinda Gates Foundation through the Malaria Control and Evaluation Partnership in Africa (MACEPA), the World Bank, the U.S President Malaria Initiative (PMI), and the World Health Organization. Donations from these international organizations combined with domestic funds from the Zambian Government ensured that crucial aspects of the malaria control program were funded.

However, support for malaria control initiative in Zambia was also the result of a desire by the international community to have a successful model of a national scale malaria control initiative which can be replicated by other countries within the region.

Staying the course

 From 2002, Zambia began a nation-wide roll out of insecticide treated nets (ITNs), indoor residual spraying (IRS) and Rapid diagnostic Tests (RDTs) kits. In the following years, efforts were made to expand the distribution of these key aspects of the malaria control program to ensure adequate population coverage. However, the inconsistent nature of donor funding impacted the distribution of bed nets for years 2004 and 2008.

Rollout of ITNs, IRS and RDTs at the National Level

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Source: National Bureau of Economic Research

To ensure access to treatment for diagnosed malaria cases, ACTs were made free to all those seeking care within the public health sector.

 Data-Informed Decision-Making

Using the National Health Management Information Systems as well as sentinel surveys like the Zambian Demographic and Health Survey (ZDHS) and the Malaria Indicators Surveys, the Zambian Government and its International partners were able to monitor the progress of the nation-wide malaria control efforts.

Some data points captured by these data tracking tools include under-five child malaria mortality, yearly malaria in-patients from all facilities, and distribution, ownership and use of ITNs.

Climatic Advantages

Zambia has 3 distinct seasons within its tropical climate-a hot, rainy season (November-April), a cool dry winter (May-August), and a hot, dry season (September-October). These seasonal variations influenced the transmission of malaria by Plasmodium infected mosquitoes. Mosquitoes were abundant from September to April but markedly reduced during the cold winters from May to August. As a result, efforts to reduce population malaria parasitemia during those winter months may induce reduced transmission during the other months.

To be continued

Sources

http://www.ncbi.nlm.nih.gov/pubmed/18606763

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2929038/

http://www.nber.org/papers/w16069

http://www.pmi.gov/countries/mops/fy13/zambia_mop_fy13.pdf

http://www.hindawi.com/isrn/pm/2013/495037/

http://www.malariajournal.com/content/12/1/10

Introducing Post Abortion Stress Syndrome (PASS)

In Health Policies, Mental Health on February 16, 2013 at 3:36 am

depressed

The topic of Post Abortion Stress Syndrome (PASS) brings up great controversy among pro-life and pro-choice groups everywhere. In fact, there is much debate about the existence of this problem because some fear that pro-life groups invented PASS in an attempt to hinder further abortions. However, other groups of people recognize PASS as a problem. This article is not about the controversy, but a highlight on PASS especially since it is present in Southern Africa (Boulind & Edward, 2008).

The term Post Abortion Stress Syndrome is not known by a lot of people and there is little research from the African continent. Post-Abortion Stress Syndrome, abbreviated as PAS or PASS is a form of trauma that can occur in women after an abortion (Speckhard & Rue, 1992). It has also been called post traumatic abortion syndrome. According to a South African study published in the journal BMC Psychiatry, women who have experienced abortion have high levels of post-traumatic stress disorder (PTSD), which follow findings from earlier studies linking abortion and PTSD (Suliman et al. 2007). Moreover, the study states that high rates of PTSD characterize women who have undergone voluntary pregnancy termination. Believing that PASS exists means that health professionals should provide supportive and constructive counseling around the trauma symptoms African women experience. What are your thoughts on PASS?

References

1. A. C. Speckjhard and V. M. Rue, “Postabortion Syndrome: An Emerging Public Health Concern,” Journal of Social Issues 48 (1992):95-119.

2. M. Boulind and D. Edward, “The Assessment and Treatment of Post-Abortion Syndrome: A Systematic Case Study From Southern Africa,” Journal of Psychology in Africa 18 (2008): 539-548.

3. S. Suliman, T. Ericksen, P. Labuschgne, R. de Wit, D.J. Stein and S. Seedat, “Comparison of Pain, Cortisol Levels, and Psychological Distress in Women Undergoing Surgical Termination of Pregnancy under Local Anaesthesia versus Intravenous Sedation,” BMC Psychiatry 7 (2007):1-9.

Health Inequalities: Wealth is Health

In Health Policies on February 1, 2013 at 5:00 am

The slogan on the Global Health Africa website reads “Health is Wealth” but “Wealth is also Health”. By wealth I mean various resources -power, education, employment, inheritance, living conditions-which gives one individual an advantage over another. Possession of any of these resources increases one’s likelihood of a better health.  A number of researchers have written about the influence of these socio-economic factors on one’s health; most notably, Michael Marmot. Below we discuss the link between these factors and health as well as implications for organizational policy.

Exploring the link between Wealth and Health

In his article published in a 2005 edition of the Lancet, Marmot provides an apt description of the variation in health outcomes within countries, by socio-economic status. Using Indonesia, Brazil, India and Kenya as examples, under-5 childhood mortality was shown to be highest among the poorest households in all these countries. While in Bangladesh, mortality rate among men differed by educational status

poorest of poor As a result, Marmot warns that addressing surface public health issues may not be the solution. Rather, there is a need to identify the causes of causes by examining the social conditions in which individuals live and work. Still, I am not in full agreement with his suggested methods for addressing these social conditions as they comprise of policies such as cash transfer programmes, which may encourage dependency on government welfare and are largely, unsustainable.

A recent example of health inequalities between nations can be seen in the newly released Global Burden of Disease Study 2010 by the Institute for Health Metrics and Evaluation in Seattle, Washington.  Wealthy Western and Asian countries have the longest years of healthy life expectancy while some of the poorest African Nations are at the bottom of the ladder. So the question is: How can public health organizations address these health inequalities in Africa?

Changing the way we work

There is no one size fits for addressing health inequalities in Africa neither do I claim to know it all. Still, I make some suggestions.

  1. People empowerment approach rather than a people giving approach: A widely used proverb goes, “Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime”. Governmental and non-governmental public health organizations need to recognize that ill-health and premature death is often times a symptom of social conditions. Therefore, in planning public health interventions, it is pertinent to include measures that will aid individuals to acquire skills needed for self subsistence. This could include training breadwinners on business skills, providing loans for start-ups, as well as scholarships.
  2. Targeted interventions: This would ensure that the poorest of the poor have access to health information and services, education and an opportunity for their voice to be heard
  3. Working together: It is imperative that public health and non-public health organization work together  to ensure that there is a focus on community priorities rather than organizational agenda
  4. Research and Advocacy: A lot of work still needs to be done to identify best practices for addressing health inequalities in African nations. There is also a need for organizations to advocate for policies that address the needs of the poorest of the poor in African Nations.

So what do you think? How best can health inequalities in Africa be addressed?

Healthy Policies: Regulating the Nigerian Aviation Industry for Disaster Prevention

In avaiation, Health Policies, News, Uncategorized on December 16, 2012 at 1:52 pm

The recent aviation disaster in Nigeria is a call to the Nigeria Government to examine practices within its aerospace.  News reports indicate that a State governor and five other individuals were killed when a military helicopter crashed enroute Nigeria’s oil capital, Port Harcourt. This is a developing story and you can read more about it HERE.

Air incidents are increasingly becoming significant public health events in Africa’s most populous nation. This year alone, aside from the current event, there have been three reported air disasters which altogether have left close to 200 people dead or injured.

In order to prevent such disasters, the Nigerian Government has to step up to the plate to determine best practices for its aviation industry.

The video below is a record of the site of the DANA air crash that occured in the month of June, this year. Please be warned. The images in the video below are graphic and can be disturbing