Working together for health
Olga Makoni and Everson Munyunyu

It is ironic to be talking of working together for health in Southern Africa - a region faced with chronic shortages of health workers as a result of massive brain drain, inadequate drugs, inadequate and chronic shortage of infrastructure and equipment. The fundamental question is who will be working with whom given the skeletal health personnel in the region? How can health provision be a reality in situations of collapsing health delivery systems, absence of drugs and medical equipment? Working together for health was this year’s theme for World Health Day, commemorated on the 7th of April.

It is sad and disheartening that little was said in Southern Africa for World Health Day. The media carried only limited coverage. How then can we expect to address the health crisis in Africa when we are reluctant to talk about it ourselves and most of us are unaware even of the existence of World Health Day? Whom do we expect to address the problems of Africa when we cannot take an active role in lobbying for help? Is it possible to have adequate healthcare workers when the Western world is poaching the few workers that we have?

This year’s theme was focusing on the human resources for health; nurses, physicians, doctors, and surgeons among others. The Americas were celebrating their over 7 million health workers who were honoured as “Everyday heroes” in ceremonies throughout the region. What a stark contrast to the global South where there was nothing to celebrate. Although we harbour about half of the world’s population of people living with HIV and AIDS, there are only an estimated 750 000 health workers in a region that is home to about 682 million people . The whole African continent has a shortage of about 900 000 workers which means it needs an increase of about 139% to have an adequate number of healthcare workers. For now the realities are harsh; Malawi has 25,6 nurses per 100 000 people, Mozambique has 20,5 and Zimbabwe 54,2, while South Africa currently compares better, with a ratio of 388 nurses per 100 000 people. These figures call for no celebration at all when compared to the 7,5 million healthcare workers in the Americas, many of whom many are the result of costly training programmes paid for by developing countries.

In southern Africa the majority of the population is far below the poverty datum line, a circumstance which puts the cost of health services beyond their reach and has resulted in this tragic comment from the 2005 World Health Report: more than 100 million individuals in the world each year are pushed into poverty as a result of spending money on health. In a recent article published in the Zimbabwe Herald, a woman was evicted from her home after failing to pay rent. She had failed to pay the rent because she had used the money to send her daughter to hospital. Hence she sank deeper into poverty. In Malawi about 80% of the population is rural based, where everything from diagnostic procedures to treatment regimens is unavailable to most people. The situation is similar in Zimbabwe, where the country is faced with problems ranging from the unavailability of life saving medication in most public hospitals, to shortages of the most basic necessities, like contraceptive pills and even sanitary pads. Where these items are available, it is usually from private institutions where the cost puts them beyond the reach of the average person.

The poverty crisis linked to HIV and AIDS in Africa must be addressed because poverty has fuelled promiscuity, especially among girls and women, contributing to the rapid spread of HIV and AIDS. Treatment of people living with HIV and AIDS becomes relatively cost effective when compared with the cost of progression to AIDS, which includes the expense of opportunistic infections like TB, diarrhea, pneumonia, rashes, cancers and meningitis. These diseases translate to a much greater burden on the health delivery system, not to mention the human misery and suffering they cause. Treatment for HIV and AIDS treatment must be made available and affordable to avoid these terrible costs. Equally if treatment is available, this should help combat the stigma attached to HIV and AIDS.

When the theme Working together for health was selected for the World Health Day commemorations it seems they were thinking only of the developed world, where everything is in place to ensure working together for health. Do they ever ask the health professionals poached from the developing world why they left? For many it was not a matter of seeking more money, but a matter of being unable to tolerate watching patients die that ought to live. In the rich countries of the North, there is an over subscription of state of the art medical equipment, preventative health care and drugs. Like some grotesque parody, the people of the North worry about obesity, while those of the South struggle to get enough to eat. For the majority of the Third World, this year’s theme lacks relevance, but especially for Southern Africa, where there is no one to work together with. WHO’s recommendation that the developed nations stop poaching health personnel from poorer regions rings false, for the countries of the North train fewer nurses and doctors than they need, knowing full well that they will ‘import’ these skills at the expense of the South.

Recommending that developing nations should increase their health budgets is both impractical and unrealistic because most of them are scrimping resources from one sector to give to another already. Their failure to improve working conditions and remuneration of health personnel is due to lack of resources. The theme, pretty as it sounds, does not address the problems of the global South and especially of southern Africa.

As most stakeholders in HIV and AIDS are working towards ensuring “universal access to treatment for all those who need it by 2010” it is time to take stock of the many gaps in the health delivery system and ensure that they are appropriately addressed. Universal access to HIV and AIDS treatment needs to be tackled as a holistic package, which includes the provision of affordable drugs and adequate health facilities and support systems. There is also need for reinvestment in the public health service networks and the removal of user fees, which deny the poor access to even the most basic health care. As we commemorate World Health Day, we call for a reassessment of the increasing global inequality and a genuine commitment on behalf of the rich countries that they recognise the role they play in the state of our health. No one else is going to speak our truth.

* Olga Makoni and Everson Munyunyu are from the SAfAIDS' media unit.
www.safaids.org.zw