History discussion paper health
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health.rarhealth/Activities Checklist - 17.SU.HIS.2215.pdf
201774 Activities Checklist
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To meet the learning objectives for this topic, you will complete these activities. Print this page and use it as a checklist.
Review the Introduction and Objectives page. Complete all activities on the Learning Activities page. Read the lesson, General WellBeing of Africa. Read the lesson, Governance and Insurance. Read the lesson, The Future is Looking Bright. Read the Spotlight: South Africa page. Participate in Discussion: Health. Take Quiz #2 on Empires and Colonalization. Post any questions about the course or assignments in the Help! Discussion.
health/General Well-Being of Continent - 17.SU.HIS.2215.pdf
201774 Lesson 01
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According to Alex Chika Ezeh, Executive Director of the African Population & Health Research Center in Nairobi, Kenya, the top three health concerns for the continent of Africa are 1) growing inequities in access to health services and health outcomes, 2) the shifting burden of disease from infectious to noncommunicable diseases (heart disease, diabetes, cancer, etc.), and 3) a greater push for country ownership of health programming and funding.
In an interview with Skoll World Forum, he went on to say, "There are many dimensions to the health inequities across Africa, but the most pervasive are typically among groups defined by their economic status, geography, age, and gender. People living in remote and marginalized rural areas and urban slums, older individuals, and young children often bear a disproportionate share of the disease burden while simultaneously having limited access to care. Apart from sexual and reproductive health services, there are few interventions aimed at improving adolescent health, which is a precursor to adult health. Addressing the social and structural determinants of these inequities remains a challenge for global health programming."
Africans live, on average, 14 years less than the average world citizen, and 21 years less than the average European. The maternal mortality and the mortality rate for children younger than five years are more than double the world average. There are only 2.3 doctors per 1,000 people in Africa, less than 1/10 of the figure in Europe and less than half the figure in SouthEast Asia.
It is important to consider the reasons why this is so. By far the most important reason is the way in which health care in Africa is funded. As The Economist puts it, health care funding in Africa is a "patchwork of meager public spending,heavy reliance on foreign donors and a large dependence on out ofpocket contributions and user fees that place the greatest burden on the poorest members of society." African governments’ budgets are insufficient to address the issues, and are often further reduced by corruption. The aid that does come from external sources is usually mistargeted, focusing overwhelmingly on high profile causes like HIV/AIDS or malaria, and neglecting other health issues, like child and maternal health, nutrition and the spending necessary to build up health systems. Other reasons are an inadequate domestic pharmaceutical industry, and the low number of trained doctors (exacerbated by a brain drain of doctors who do qualify, then choose to pursue their careers abroad).
health/Governance & Insurance - 17.SU.HIS.2215.pdf
201774 Lesson 01
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Governments which are successfully addressing their populations’ medical needs are combining direct expenditure with other financing models. In some nations, government chooses to finance the administrative side of health care, leaving specific projects such as control of epidemic diseases to external donors. When funding health care, governments increasingly prefer to pay into health insurance, instead of paying directly for medical services, as in the past. The future of health care in Africa lies in health insurance and private medical companies, although government and external funding will be important for the foreseeable future.
Direct payment at point of use is the leastoptimal way of financing health care, as in poor countries in particular,dramatic and expensive ailments can push the poor into bankruptcy, or else high costs can dissuade people from seeking desperately needed medical care. So, according to the World Health Organization, two years after Burundi introduced user fees for health care in 2002, four out of five patients in that country were either in debt or had sold assets to pay for health care. It is routine for more than 2% of the population of low income countries to suffer ‘financial catastrophe’– defined as having to spend over 40% of income after food – because of health care costs. In the estimation of the WHO, reliance on direct payments has to fall to at most 20% of total health expenditures to bring the incidence of financial catastrophe down to negligible levels.
For an unchanged level of government and external funding, improving Africa’s health care expenditure profile will thus mean shifting private expenditure from direct payment to prepaid, pooled expenditure. Analysts see this shift as the most important shift in Africa’s health care environment. So the countries most often held up as examples of successful health policy are those in which health insurance covers the greatest part of the population, or where the proportion is growing fast. Two countries often cited in this context are Rwanda and Ghana. In Rwanda 91% of the population belongs to one of three health insurance plans, thanks to a government program to match member contributions onetoone (with some donor support). The improvements in child and maternal mortality have been impressive. In Ghana the National Health Insurance Scheme (NHIS) was formally launched in December 2004 and since then it has been mandatory for all residents to be members of a district mutual health scheme, a private commercial insurance scheme, or a private mutual health scheme. Coverage of the Ghanaian population is now close to 70% and the plan's beneficial effects on health have been evident: infant mortality has dropped 19% since 2000, and the number of infant deaths from malaria has dropped by almost a third since the plan's inception.
health/Introduction and Objectives - 17.SU.HIS.2215.pdf
201774 Introduction and Objectives 17.SU.HIS.2215.500 SURVEY OF AFRICAN HISTORY
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Introduction
Africa is not a healthy continent. On all indicators of health, Africa lags behind the rest of the world, and behind poor countries of SouthEast and South Asia that were behind Africa when measured on these metrics a few decades ago. Much of this gap, which has widened since the 1980s is a consequence of the Human Immunodeficiency Virus / Acquired Immune Deficiency Syndrome (HIV/AIDS) epidemic which has hit Africa harder than any region on Earth, but much of it can be blamed on other factors.
Widespread and rapacious corruption has meant that large slices of health budgets have gone missing. Infrastructure problems have made it difficult to provide services to many people in more remote areas. Poverty has slowed the emergence of private healthcare initiatives outside of a few cities. Conflict has directly affected Africans’ health through high numbers of death and injuries, and indirectly by hampering healthcare delivery. All these problems, as well as Africa’s sheer size and its position on the globe have made Africans unhealthier and worse looked after medically, than the inhabitants of any other continent on earth.
Objectives
After completing the learning activities for this topic, you will be able to:
Relate the issue of health to governance in African countries. Understand the major health concerns across the continent. Articulate possible solutions to the health crisis in Africa.
health/Learning Activities - 17.SU.HIS.2215.pdf
201774 Learning Activities 17.SU.HIS.2215.500 SURVEY OF AFRICAN HISTORY
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View This
This 1 1/2 minute video from TED Global proposes new ways to look at African Healthcare.
African Healthcare Brainstorm
Explore Resources
Explore this webpage
Our Africa: Health
Most of the week's online lectures came from the report, The State of Healthcare In Africa.
Click here for the full report.
health/question.docx
Please answer the following question. Your answer should be thorough and demonstrate your understanding of the material.
Should international drug companies provide pharmaceuticals to Africa free of charge?
Make sure you support your answer with evidence from the readings.
health/Spotlight_ South Africa - 17.SU.HIS.2215.pdf
201774 Spotlight: South Africa 17.SU.HIS.2215.500 SURVEY OF AFRICAN HISTORY
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The South African Truth and Reconciliation Commission (TRC) was setup by the Government of National Unity to help deal with what happened under apartheid. It is the example for the world in how to lessen/resolve national issues. The conflict during this period resulted in violence and human rights abuses from all sides. None escaped abuses during this tumultuous people of South African history.
The TRC was based on the Promotion of National Unity and Reconciliation Act of 1995 which stated, a commission is a necessary exercise to enable South Africans to come to terms with their past on a morally accepted basis and to advance the cause of reconciliation.
The TRC was a courtlike, publichearing setting in which victims gave statements regarding the human rights suffering they experienced during apartheid. Additionally, perpetrators were invited to give statements and request amnesty from both civil and criminal prosecution, most of which were granted. These public hearing were seen as a healing process for the nation. Obvious during the open, often brutally honest, testimony was that all had suffered regardless of ethnic origin. After nearly 2 years of hearings, the Commission issued its report and condemned all parties of injustice. No one group was spared the condemnation of the Commission.
More often than not the Commission is viewed as successful, at least at bringing out the truth. The process of reconciliation through the truth, and not through prosecution, was copied by other nations attempting to reconcile domestic strife. Jay and Erika Vora, produced a report entitled The Effectiveness of South Africa's Truth and Reconciliation Commission, in which they concluded that all three ethnic groups (Shosa, Afrikaners, and English) looked positively at the results of the Commission, though they noted the English saw the Commission's effectiveness more positively than the others. Additionally, it was concluded that the Commission positively impacted the nation's economy, international standing, and politics (Vora, 1998).
health/The Future is Looking Bright - 17.SU.HIS.2215.pdf
201774 Lesson 01
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Possibly the most exciting application of technology to the health care industry lies in the field of ‘telemedicine’, which usually refers to the use of telecommunications to allow health care workers in outofthe way places to remotely diagnose patients in conference with specialists. As part of the Pan African eNetwork Project, a co operation between the government of India, doctors in India are helping to remotely diagnose patients in 53 hospitals in Africa. The same project makes it possible for African students to study medicine under lecturers at seven universities in India.
Technology can also provide more orthodox solutions to bureaucratic issues that can sometimes be overlooked by actors in the health care space with a propensity to look for the dramatic fix. Carego Livewell, a Nairobibased health care company, is providing health care facilities with software to simplify their clinical and business processes and for regional and national health care organizations and governmental departments to coordinate better. Intelligently targeted health awareness campaigns can leverage the high levels of mobile phone and internet penetration in order to better communicate with the public; this is already the case with many HIV/AIDS initiatives in Southern Africa.
Advances in chemistry will save and improve lives, as researchers develop drugs specifically for Africa, or at least for low income societies. One good example is the retroviral treatment developed by an Indian pharmaceutical company. Cipla: unlike previous drug cocktails, Cipla’s fixeddose combination does not require refrigeration, which played an important part in prompting its uptake in Africa. If heat resistant insulin is ever developed, it is certain that its effect in Africa will be tremendous.
Because of the huge beneficial effect that generic drugs have had in addressing health crises in developing countries, most lower income countries were given 10 years in which to comply with the clauses in TRIPS relating to medicines. In this regard, India was allowed to produce generic medicines until 2005 and the least developed countries were given until 2016. When these deadlines are reached, there will again be some difficult debates about profits versus people.
The rise of noncommunicable conditions, as infectious and parasitic diseases, are brought under control in Africa, the continent’s mortality profile will increasingly come to resemble that of more advanced societies. Noncommunicable conditions like cancer, diabetes and heart failure will kill the most people, resulting in a complete change in the demands on health care systems. It is estimated that noncommunicable diseases, including ‘lifestyle disease’ related to suboptimal lifestyle choices, will overtake communicable and parasitic diseases as the main cause of death in Africa by 2030. It will be a challenge for health departments focused on the very basic aspects of health care – preventing child mortality and eradicating diseases that no longer exist in more advanced countries – to addressing these very modern diseases, for which, moreover, there is usually no cure, only treatment.
