This article focuses on a number of countries in Africa that have made improvements in their health outcomes and that are on their way to meeting their health Millennium Development Goal (MDG) targets, including Tanzania, Kenya and Rwanda. Infant mortality fell by over 40% in Tanzania, from 99 deaths per 1,000 live births in 1999 to 58 in 2007-08, which suggests that the country can reach its Millennium Development Goal (MDG) target by 2015. Under-five mortality has also declined, from 146 deaths per 1,000 live births to 91. After a period of stagnation during which infant and child mortality rates deteriorated and life expectancy dropped, Kenya has recently made very significant progress, reversing its negative health trends between 2003 and 2007. The 2008 Kenya Demographic and Health Survey (DHS) reveals remarkable declines in infant and under-five mortality rates in this period (from 77 to 52, and from 115 to 74, per 1000 live births, respectively). After the 1994 conflict, which took a great toll on the health sector, Rwanda entered the 21st century with one of the weakest health systems in the world. Yet today it shows some very strong health results. Assisted childbirths rose from 39% in 2005 to 52 percent in 2008; while under-5 mortality fell by a third, from 152 deaths per 1,000 live births in 2005 to 103 in 2008. And the use of modern contraception has increased from 10% to 27% in just three years.
Equity in Health
Shortly before his death, Mahatma Gandhi offered a useful reflection that helps to cut through some of the complexity surrounding debates about equity. “Recall the face of the poorest and the weakest person you may have seen and ask yourself if the step you contemplate is going to be any use to them.” It’s a simple but compelling guide for policy makers concerned with combating extreme inequality. Something of the same spirit underpins the report of the High Level Panel established by the UN Secretary General to make recommendations for the post-2015 development agenda. Going beyond the identification of universal goals, the report calls for “a focus on the poorest and most marginalised” and a commitment to “leave no one behind". This approach is argued to be in-keeping with other work on the post-2015 agenda, including the Global Sustainable Development Report. Far more than the Millennium Development Goals (MDGs)—which were largely neutral on the issue of inequality—the High Level Panel report includes a wide-ranging social justice agenda. If adopted by governments and backed by national policy commitments and a new global partnership, the Panel’s agenda could, the author argues, put exclusion, inequality, and marginalisation at the centre of the post-2015 development framework.
Despite widespread implementation of effective multidrug therapy, leprosy has not been eliminated. The authors of this paper report that a third of newly diagnosed patients have nerve damage and might develop disabilities, although the proportion varies according to several factors, including level of self-care. Women who develop leprosy continue to be especially disadvantaged, with rates of late diagnosis and disability remaining high in this subgroup. Leprosy was not a specified disease in the Millennium Development Goals, but improvements in the other areas they cover, such as education and levels of poverty, will help leprosy patients and services, the authors argue. Recommendations for research on diagnosis, treatment, and prevention include further use of molecular analysis of theMycobacterium leprae genome, implementation of BCG vaccination and administration of chemoprophylaxis to household contacts. The authors also suggest development of tools for early diagnosis and detection of infection and nerve damage, and formulation of strategies to manage the chronic complications of leprosy, such as immune-mediated reactions and neuropathy.
In June 2010, the Lesotho health department, in partnership with the World Health Organisation and the United Nations (UN) Children's Fund, launched a programme targeting the four worst-performing Millennium Development Goals (MDGs), namely those relating to the eradication of poverty and hunger, to reducing child and maternal mortality and to combating HIV. The programme has been implemented in the four worst-performing of Lesotho's 10 districts. Interventions are focused on helping mothers, and the programme also tries to address the lack of coordination and wasted resources that have plagued aid delivery in the past. The health department aims to identify pregnant, breast-feeding and HIV-positive mothers and their infants who are in need of food rations from the World Food Programme. They will be supplied with seeds, tools and advice on how to grow vegetables and raise chickens, in the hope of making them less reliant on food assistance, and will later receive training on how to start small businesses. By 2012, the programme should have yielded enough results and best practices for government to decide whether to take over and replicate it in other districts. The UN resident coordinator in Lesotho has called for funding for the programme to become part of the national budget, otherwise it runs the risk of failing.
One hundred and seventeen African health, social development, gender-based, youth and human rights organisations, as well as trade unions, have signed and submitted a letter to the 15th African Union Summit of Heads of State, which took place from 19-27 July 2010 in Uganda. The letter was featured in the July EQUINET newsletter since which time the large number of civil society organisations have signed on. The letter sent to the chairman of the African Union urged governments to uphold, improve and urgently implement African and global health and social development financing commitments, including the Abuja Commitment to allocate 15% of national budgets to health.
According to this report, substantial progress has been made towards achieving Millennium Development Goal (MDG) 4, namely to reduce global child mortality by two-thirds by 2015. The number of under-five deaths worldwide has declined from nearly 12 million in 1990 to 6.9 million in 2011. Since 1990 the global under-five mortality rate has dropped 41% and the annual rate of reduction in under-five mortality has accelerated from 1.8% a year over 1990–2000 to 3.2% over 2000–2011, but it remains insufficient to reach MDG 4. Globally, more than a third of under-five deaths are attributable to undernutrition. The highest rates of child mortality are still in sub-Saharan Africa, where 1 in 9 children dies before age five and Southern Asia (1 in 16). As under-five mortality rates have fallen more sharply elsewhere, the disparity between these two regions and the rest of the world has grown. By 2050, 1 in 3 children will be born in sub-Saharan Africa, and almost 1 in 3 will live there, so the global number of under-five deaths may stagnate or even increase without more progress in the region.
Many low - and middle-income countries are experiencing an epidemiological transition from communicable to non-communicable diseases, imposing both economic and health burdens on their societies. While the prevalence of such diseases varies with socioeconomic status, the inequalities can be exacerbated by lifestyles. This paper explored the contribution of smoking and alcohol consumption to health inequalities, incorporating measures of health directly associated with these lifestyle practices from National Income Dynamic Study panel data for South Africa. The authors found significant smoking-related and income-related inequalities in both self-reported and lifestyle-related ill-health. The results suggest that smoking and alcohol use contribute positively to income-related inequality in health. Smoking participation accounts for up to 7.35% of all measured inequality in health and 3.11% of the inequality in self-reported health. The estimates are generally higher for all measured inequality in health (up to 14.67%) when smoking duration is considered. Alcohol consumption accounts for 27.83% of all measured inequality in health and 3.63% of the inequality in self-reported health. This study provides evidence that inequalities in both self-reported and lifestyle-related ill-health are highly prevalent within smokers and poor people. The authors suggest that policies aimed at reducing tobacco consumption and harmful alcohol will improve health and reduce health inequalities.
In this study, researchers assessed whether the global target of halving tuberculosis (TB) mortality between 1990 and 2015 can be achieved and estimated the number of lives saved globally by the DOTS/Stop TB Strategy of the World Health Organisation (WHO). Mortality from TB since 1990 was estimated for 213 countries using established methods endorsed by WHO. The researchers found that TB mortality among HIV-negative (HIV−) people fell by 36% between 1990 and 2009 and they predict it could be halved by 2015. The overall decline (when including HIV-positive people, who comprise 12% of all TB cases) was 19%. Between 1995 and 2009, 49 million TB patients were treated under the DOTS/Stop TB Strategy, saving 4.6–6.3 million lives, with a further 1 million lives that could be saved annually by 2015. The researchers conclude that their findings indicate that the global target of halving TB deaths by 2015 relative to 1990 is possible. Intensified efforts to reduce deaths among HIV+ TB cases are still needed, especially in sub-Saharan Africa.
The United Nations says Senegal leads Africa in combating AIDS on the continent and is one of only three nations worldwide to successfully contain the pandemic. AllAfrica.com's Ofeibea Quist-Arcton, focuses on Senegal with a series of special reports on the country's battle against HIV/AIDS.
A pilot study was conducted in one district of Zambia, in which maternal deaths occurring over a period of twelve months were identified and investigated. Data was collected through in-depth interviews with family, focus group discussions and hospital records. A total of 56 maternal deaths were investigated. Poor communication, existing risk factors, a lack of resources and case management issues were the broad categories under which contributing factors were assigned. Potential high impact actions were related to management of AIDS and pregnancy, human resources, referral mechanisms, birth planning at household level and availability of safe blood. In resource-constrained settings, authors note that the Investigate Maternal Deaths and Act (IMDA) approach promotes the use of existing systems to reduce maternal mortality, thereby strengthening the capacity of local health officers to use data to determine, plan and implement relevant interventions that address local factors contributing to maternal deaths. Monitoring actions taken against the defined recommendations within the routine performance assessment should help ensure sustainability.