The International Federation of Red Cross and Red Crescent Societies (IFRC) has launched a US$ 8 million initiative to help build the disaster resilience of 600,000 people living along the Zambezi river in seven southern African countries. The Zambezi River Basin Initiative (ZRBI) is a response to ‘a dramatic increase in the numbers of floods along the river basin’, according to Farid Abdulkadir, IFRC disaster management coordinator for the southern Africa region. The focus of the ZRBI is on disaster preparedness rather than post emergency relief operations, as in the past. It is a joint programme between the Angolan, Botswana, Malawi, Mozambique, Namibia, Zambia and Zimbabwe Red Cross Societies, combining risk reduction efforts with food security, health, HIV prevention and capacity building activities. The US Agency for International Development (USAID) has already committed US$1 million to the project.
Equity in Health
Zimbabwe and Botswana have reported their first suspected cases of swine flu as the H1N1 virus begins to establish a foothold in southern Africa. Neighbouring South Africa has reported 54 laboratory confirmed cases of swine flu so far, 32 of which have been linked to a squash tournament at a university in Johannesburg. No deaths have been reported in the region as yet. Dr Lucille Blumberg, head of epidemiology at South Africa's National Institute for Communicable Diseases, said that most cases of the illness were ‘mild’, and that it was too early to tell whether people living with HIV and AIDS (PLWHAs) would be affected to a greater degree by the flu. Most PLWHAs are in southern Africa, where most countries also have severely stretched health services, and the effects of the virus on their populations remain uncertain. Blumberg said in other parts of the world swine flu had killed healthy people, as well as those suffering from underlying illnesses.
This study set out to assess the effect of educational attainment and other factors on the risk of HIV in pregnant South African women. Repeated cross-sectional surveys were used. Pregnant women, who were attending public antenatal clinics were tested for HIV annually between 2000 and 2005, provided demographic information. Among women aged 15-24 years, HIV risk in those who had completed secondary education was significantly lower than in those who had only primary education – it increased by 8% per annum in those with no secondary education but did not increase those with secondary education. Together with other evidence, this study suggests that higher educational attainment did not protect against HIV in the early stages of the South African HIV/AIDS epidemic. But in recent years, the risk of HIV infection in young South African women with completed secondary education has reduced significantly relative to that in young women with primary education, suggesting that HIV prevention strategies may have been more effective in more educated women.
This paper documents the impact of the AIDS crisis on non-AIDS related health services in 14 sub-Saharan African countries. The authors, using multiple waves of Demographic and Health Surveys (DHS) for each country, examined antenatal care, birth deliveries, and rates of immunisation for children born between 1988 and 2005. They found deterioration in nearly all of the above dimensions of health care over this period. Using data collected on HIV prevalence in the most recent DHS survey for each country, they noted that erosion of health services is highly correlated with increases in AIDS prevalence. Consequently, regions of countries that have light AIDS burdens have witnessed small or no declines in health care, using the measures noted above, while those regions currently shouldering the heaviest burdens have seen the largest erosion in treatment for pregnant women and children. Finally, the authors estimate that the beginning of the divergence in health services between high- and low-HIV regions took place in the mid-1990s.
There is overall consensus that recent decades have seen an increase in inequities in general and in health in particular. Some less-developed countries are showing deteriorating health outcome averages (in some cases due to the HIV/AIDS pandemic), as a result of the widening gap between poor and rich. The epidemiological transition has been quoted as one contributing factor. What is missing is consensus around what the solutions are. There have been justified criticisms that private foundations – the big health spenders – are too technocratic and disease-specific to make an impact. The way forward is argued to need more comprehensive government leadership, acting beyond the health sector, through comprehensive approaches and processes that deal with diseases in an equitable and effective way.
Several misunderstandings have arisen about the Millennium Development Goals (MDGs). The biggest is that every country must achieve the same numerical targets (for example, halve poverty by 2015), which is incorrect because global performance is an average of all countries’ performance, so some countries will perform above and below average in order to achieve them. A one-size-fits-all approach will not work, as different countries have followed different approaches and strategies for achieving social and economic progress, with varying costs. Unless disparities within countries are addressed, the MDGs will not be met by 2015. To formulate a homegrown MDG-based national development strategy to address inequality and to achieve the MDGs, the author proposes four practical steps: tailor the global targets to make them context-sensitive, set intermediate targets for political accountability, translate targets into specific programmes and policies, and cost programmatic and policy interventions.
Effects of climate change on health will affect most populations in the next decades and put the lives and wellbeing of billions of people at increased risk. During this century, earth's average surface temperature rises are likely to exceed the safe threshold of 2°C above preindustrial average temperature. Rises will be greater at higher latitudes, with medium-risk scenarios predicting 2–3°C rises by 2090 and 4–5°C rises in northern Canada, Greenland, and Siberia. This report outlines the major threats – both direct and indirect – to global health from climate change through changing patterns of disease, water and food insecurity, vulnerable shelter and human settlements, extreme climatic events, and population growth and migration.
Deaths of children aged under five years old have dropped by 27% globally since 1990, according to the latest World Health Organization (WHO) estimates. But, in WHO’s first progress report on the health-related Millennium Development Goals, released in the World Health Statistics 2009, other results are mixed. Areas where there has been little or no movement are notably maternal and newborn health. In many African countries – and in low-income countries generally – progress has been insufficient to reach the Millennium Development Goal target that aims for a two-thirds reduction in child mortality by the year 2015. ‘While data is patchy and incomplete, it appears that the regions with the least progress are those where levels of maternal mortality are the highest. The challenges ahead are those presented by weak health systems, those associated with noncommunicable chronic conditions and emerging health threats such as pandemics and climate change,’ said WHO.
Recent claims have been made that system-wide approaches, and primary health care for all, are universally agreed-upon goals. So why haven’t these goals been fulfilled? Certainly much of the problem has been lack of real commitment to a comprehensive approach to reducing health risks and improving primary care. The prevailing neoliberal economic model of development, the so-called 'Washington Consensus', which -emphasised liberalisation, privatisation and fiscal austerity, displaced ‘Primary Health Care for All’ with ‘Primary Health Care for Some’.
The current economic downturn will diminish wealth and health, but the impact will be greatest in the developing world. The world can be grateful that health officials are recommitting themselves to primary health care, the surest route to greater equity in access to health care. Much of the blame for the essentially unfair way our world works rests at the policy level. Time and time again, health is a peripheral issue when the policies that shape this world are set. When health policies clash with prospects for economic gain, economic interests trump health concerns. Time and time again, health bears the brunt of short-sighted, narrowly focused policies made in other sectors. Equity in health matters. It matters in life-and-death ways. The HIV/AIDS epidemic taught us this, in a most visible and measurable way. We see just how much equity matters when crises arise.