According to Universal Declaration of Human Rights,
“Everyone has the right to a standard of living adequate for health, including medical care and the right to security in the event of sickness or disability”
In reality the performance of this statement depends on the economic development of the country, thereby explaining differences in life expectancy rates and mortality. For example, life expectancy at birth in developing countries is equal to 59 years, while in developed countries it reaches 78. Low indicators are explained by insufficient health expenditures, which could be below the standard, set by World Health Organization, namely 34-40$ per capita per year, necessary to allow basic health services, such as essential preclusion and treatment for HIV/AIDS, tuberculosis, malaria, maternity services and childhood illnesses.
Talking about low-income countries, I would like to pay attention to sub-Saharan Africa (SSA), where the high burden of disease (24%) is opposed to its lower share of the worlds’ population (around 11%). Despite the high rate of disease, only 1.3% of the world’s medical care workers live in sub-Saharan Africa. In general, health indicators in Africa are not only behind the rest of the world, but also behind the poor countries of South-East and South Asia. Over the past 2 decades maternal mortality decreased by 27%, while in South-East Asia the decrease equaled to 58%. High rate of mortality in Africa is explained by the high rate of communicable diseases, maternal and nutritional deficiencies, non-communicable disease dangers (i.e. cancers, cardiovascular diseases).
Researches distinguish a number of possible reasons for low medical provision in SSA:
– Problem of funding and management. If to cite The Economist, healthcare in Africa is described as a “patchwork of meagre public spending, heavy reliance of foreign donors and a large dependence on out-of-pocket contributions and user fees that place the greatest burden on the poorest members of society”. Usually there are 3 main sources for healthcare expenditures in SSA countries: government, out-of-pocket medical spending, and donor assistance. Almost half of the costs are paid by inhabitants at the time they seek medical care, though it may dive them into the poverty. One third of the health costs are paid by the state. External grants can cover significant part of the costs, but usually resources are allocated to pilot programs rather than to staff costs, drugs or supplies. The problem of donors’ aid is its inefficient further application. For example, a public hospital in Kiambu district lacked some reagents and valid tests for HIV/AID treatment. Even though the funds were sufficient, it was impossible for the hospital to buy necessary inputs directly. Another problem of the hospital was insufficient amount of gloves, which were necessary to make tests in the laboratories, due to the complex procedure of their ordering. Due to the ineffective management these problems stayed unsolved, even though the financial aid was provided.
– Corruption inside public institutions. Corruption Perception Index in 91% African countries is below 50, with a scale from 0 to 100, where 0 means highly corrupted and 100 denotes absence of corruption. The problem starts at the governmental level, when health ministers and other officials despoil the funds and spend them on their needs. They spend the funds which could be allocated for equipment and basic medication in existing hospitals. Corruption also takes place within the hospitals and during conveyance from ministers to the hospitals. Such problems at the hospitals’ level as shortages of inventory systems, bookkeeping and the loss of price lists are named.
– Concentration on specific diseases and neglecting all the rest. The problem of developing countries is insufficient data on ability of facilities in SSA to treat epidemic of non-communicable diseases (NCD), such as hypertension, diabetes, cancer, heart diseases and kidney diseases. The study carried out in western Tanzania, reported that most health institutions did not provide treatment for NCD, while the abundance of hypertension in the region was 22%, and for diabetes it was 1,6%.
– Shortage of qualified medical personnel in sub-Saharan region and their migration to more developed continents. Only 1.3% of the world’s medical stuff is occupied in Africa. The assumed shortage of workers equals to 817,992. Most doctors from Africa have a tendency to migrate to English-speaking countries like UK, USA, Canada, Australia and New Zealand.
– Lack of infrastructure and facilities at the hospitals. Examination of the laboratories in Uganda exposed that only 0.3% of the laboratories meet international requirements. In terms of all countries of the region, in 37 countries out of 49 medical laboratories fail to fulfill the requirements.
Based on the existing research, some solutions could be provided to improve healthcare system in SSA.
First, direct payment schemes should be substituted by pooled expenditures, as they may protect ethnical minority from glissade into poverty. Ghana’s government has launched three insurance schemes in 2004 and almost 91% of the population is covered by them. Since then child and maternal mortality rates have significantly reduced.
The problem of corruption requires a complex approach on different institutional levels. First of all, external donors and organizations may influence the government and insist on providing development assistance in order to get access to rewards systems in the region, punishment, monitoring and control. As we see, their part should not be limited only to funds provision, but requires extension to civic education of communities, provision of basic information, and assessment of programs’ results based on the medical outcomes.
The problem of neglecting NCD should be solved on the universities level, where the knowledge should be provided on all types of diseases. Besides, mentorship opportunities, provided by foreign guest researches could increase the rate of interest and commitment. Poor infrastructure is another reason why some diseases could not be diagnosed in time and treated appropriately.
As the most “burning” problems for the healthcare system are discussed, and their possible solutions are highlighted in the literature, the main task now is to start implementing them. The question which stays unclear: how long will it take to implement the measures, so people stop dying due to malpractice, lack of equipment, corruption and lack of money to pay for the treatment?
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