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Important Notes about Conditions in African states
Notes about Conditions in African states
| Hospitals and Personnel
& Important Notes about Conditions in African states |
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Per
capita Health Expenditures
Notes about Conditions in African states |
Per Capita Health Care Expenditures in Select States - abstracted from WHO tables
Country Total Health expenditure per capita per year (in international dollars) Public expenditure per capita per year for health (in international dollars) % of public spending of total health expenditures Developed Countries Australia 823 473 57% Belgium 1,738 1,446 83% Canada 1,836 1,322 72% Czech Republic 640 591 92% France 2,125 1,634 77% Germany 2,365 1,832 77% Japan 1,759 1,410 80% USA 3,724 1,643 44% African states Botswana 219 133 61% Central African Republic 34 23 68% Congo 101 37 37% Dem R Congo (Zaire) 22 1 4.5% Kenya 58 37 64% Madagascar 18 10 56% Rwanda 35 18 51% South Africa 396 184 46% Uganda 44 17 39% Tanzania 36 22 61% Zimbabwe 130 62 48%
Check out the listing of WHO Medical Personnel: listing of doctors, dentists, and nurses/midwives by country, over world. [African countries are in BOLD, with Africa-south-of-Sahara in Red-Bold. ] WHO has no data for some countries, like Botswana.
- The data is puzzling: the World Bank (below) has information on medical personnel in Botswana--how did they get it? International agencies publish whatever member states tell them--and have been known to "make a guess" when a country does not submit any figures. In the Teaching Hospital in Zambia, the chief said the World Bank figures of 694 doctors in the country was wrong--it was about 200.
- Lesson: be very cautious about statistics from Africa
- There are no birth or death records kept in most countries
- “Verbal autopsies” are widely used because death certificates are rarely issued.
- Post mortems are seldom performed in Africa to determine
the actual cause of death- "In December, I interviewed Alan Whiteside of the University of Natal, a top AIDS
researcher in South Africa and asked for details of the alleged 100,000 AIDS deaths in South Africa in the last year. He laughed aloud. “We don't keep any of those statistics in this country,” he said. “They don't exist.” [Globe and Mail, 3/14/2000]- There are few methods to collect data on illnesses or death. The most accurate data may come from special surveys made by teams of western doctors in a limited area as they study some unusual disease.
Map of Africa, to assist in locating countries (from your friendly Central Intelligence Agency)
in Select Countries
Country Hospital beds per thousand people Physicians per Thousand France 8.7 beds 2.9 US 4.0 beds 2.6 Bangladesh 0.3 beds 0.2 India 0.8 0.4 Botswana 1.6 beds 0.2 Congo 3.4 0.3 Congo (Zaire) 1.4 0.1 Kenya 1.6 0.05 Rwanda 1.7 0.05 South Africa ? 0.6 Tanzania 0.9 0.05 Uganda 0.9 0.05
From World Bank Development Indicators 2000: Health Expenditures Service and Use
Notes about Conditions in African states
In Third World states, especially Africa-south-of-Sahara, most hospitals and clinics are in cities and towns. Most of the population live in rural areas, where the facilities are few and far between.
- In Congo (Zaire) for example, when Ebola broke out in Yambuku, the entire area with its 60,000 people was served by a Belgian Catholic missionary unit with 17 "nurses" who had had 3 months of training (and not in a certified nursing school).
- States usually provide modern hospitals in the capital city. South Africa, which has more health facilities than any other African state, may have very fine facilities in cities for whites, but very few facilities/services for Blacks. Check these sites out:
- Medi-clinic network
- Surf site of private medical facilities, note location of clinics/hospitals in terms of map (urban); check doctor listing--do you find any who specialize in sexually transmitted diseases, HIV-AIDS? Pursue listing of physicians in internal medicine or pediatrics in one province, click on web pages of individual doctors--how many say they treat HIV-AIDS? Who are the customary clients of these facilities? Wealthy, poor, Black/Asian or white?
- Children's Hospital Trust - Take "the tour with Lolo" and go to the "RX Hospital" Site; then click on other parts as you have time. Do they offer treatment of pediatric HIV/AIDS? This is a quote from the site, (Their spelling) simply to show how few facilities exist in all of Africa:
The Red Cross Children's Hospital is the only freely available, dedicated
paediatric hospital in southern Africa, and indeed, in Africa south of Cairo.
Its mission is to be the foremost centre of excellence for specialist
paediatric services in Africa, and to provide comprehensive health care of
the highest quality to children and adolescents in a nurturing and friendly
environment.- Wilger's Hospital
Note on South Africa Rape is so common now that one-third of the women can expect to be raped. HIV is heterosexually transmitted. Raped white women, middle class, in large cities can obtain medical treatment for HIV. Panos says that even if a hospital bed is available, patients or their families have to provide bed linen, food, and cooking facilities. Furthermore,
- Doctors may ask patients for bribes;
- Underpaid Doctors may spend limited time in government hospitals so they can earn money from wealthier patients in their private clinic.
- Doctors tell patients what to do, but not why or why it is important, or what side-effects might occur.
- Patients don't ask questions of doctors, and may stop taking medication if side effects are bad.
- (In one Thai province, some 80% of the patients stopped taking an HIV drug within two weeks--patients assumed it had the same importance as vitamins, and didn't like nasty side-effects.)
Critical supplies for clinics, especially in the hinterland, may be extremely scarce:
- Limited supply of hypodermics. The "nurses" in Yambuku and many other clinics did sterilize hypodermic needles overnight, but had to use the same needle over and over again during the day. They lacked fuel to run the generator which powered the sterilizer, more than once a day.
- Corruption and graft are common.
- McCormick noted that when a generator, or engine, or microscope broke down, either the scientist/doctor repaired it or had to order another. Six months later a message would come that the new equipment had been sent; by the time the supplies cleared customs, and were transported to the village, the generator (or other supplies) would be missing. Cases of antibiotics sent were not received in full-quantity(Garrett).
- Panos notes that black market HIV drugs, stolen from the government of Guatemala, are sold on the streets in front of the building where the drugs are given free to a limited number of people with AIDS.
- Patients who get AIDS drugs often sell them to the highest bidder in order to buy food and shelter(Panos).
- Important people, such as politicians and the wealthy, usually can get what limited drugs are available (Panos).
- Counterfeited drugs are marketed (white and black market). Capsule contents are divided into two or three capsules; pills are crushed, mixed with other powders, and pressed into a pill-form (fairly inexpensive to buy pill-maker, including one that produces a stamp similar to that of the original). Liquids are adulterated. (Panos)
- Famine, war, or disease might lead to a quarantine: supplies would give out and no new supplies could arrive. Famine and war would lead to an increase in pilfering.
- The poor or nonexistent roads, with no gas stations or repair facilities along the way, may mean that provision by air is essential. To fly, pilots often have to cannibalize parts from still older craft. Flights to a particular area may be available once a month.
Administration of Health Programs
- Large vaccination campaigns have been carried out. Advance notice of a campaign, and cooperation of law enforcement, lead to mass vaccinations in an outdoor location. Medical personnel fly or drive in, live in tents for a few days, vaccinate 70,000, then leave for the next location. No records are kept of who receives a vaccination.
- Drug distribution systems may be non-existent or incomplete
- Clinics, hospitals, pharmacies, and doctors have no reliable supply and no assurance that re-fills will be available at the proper time
- Senegal: 70 people with AIDS, living in the capital of Dakar, were chosen by national multi-disciplinary committee to receive AIDS drugs. (32,000 need the drugs.) The 70 pay on a sliding scale according to their means between $32 and $285 a month. Income and family responsibilities are two of the criteria used by the committee. It is important to choose the "right people" because side effects are exaggerated if people have little to eat or are unemployed. The experiment has been considered successful.
- Ivory Coast: 400-500 people were chosen for AIDS drugs, but this was too many for the health personnel to deal with. The program has been criticized as "too ambitious" and a failure. Problems were compounded when the drugs became unavailable.
- If prices are cut, the urban middle-class and political leaders benefit, as do black marketeers. These have preferential access. Indeed, health personnel (whether at Ministry of Health or in hospitals) may easily become black marketeers.
- Counterfeiting of drugs
For the curious and intrepid explorer:
- can you find any information anywhere on the number or location of clinics in rural or small-town Africa (try using your favorite search engine, such as Yahoo, and surf the World Health Organization, Red Cross, Red Crescent, Doctors Without Borders)? Try it country by country (Botswana, Zimbabwe, etc) or for continent.
- Want to know details of medicines and courses of treatment for HIV-AIDS, check out Project Inform; go to publications (for example) then read about different anti-viral drugs, etc. Interesting site.
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