Here in the United States, we have experienced significant growth in the discussion and opinions regarding healthcare. These discussions include concerns about the availability of affordable healthcare for all and how it should be paid for. During the early part of the Democratic Presidential debates, we saw that healthcare was one of the most important topics for the candidates and the voting public. The topic did tend to cause a lot of divisiveness in America but in general, the message from all of the Democratic candidates was in line with the thought that it is a major responsibility of government to be sure that all Americans had access to healthcare and that they can afford to have it.
We can see that the government that is in charge plays a big impact in the healthcare system. We also hear that some groups of people do not have equal access to the healthcare they need. As society has seen vast globalization in the past few decades due to improved technology and travel there has been a growth in what we know about people throughout the world.
As we look at the global society we see that many countries appear to be managing the healthcare business better than the United States. But, there are numerous examples of countries in which the healthcare and the resulting health of the population are full of inequities.
This research paper aims to look at health and healthcare in Africa. Not all countries in the continent of Africa are equal in their healthcare.
One objective is to learn some of the reasons for the discrepancy between countries and even within countries. Another objective of the research will be to look at the current status of healthcare and any inequalities within Africa and compare that to historical data to determine if there have been any improvements. Inequalities in health are any that are considered to be unjust and more importantly, avoidable (Yourkavitch et al, 2018). And finally, what challenges is Africa facing to see improvement and how important is it to other continents and countries that improvements are achieved in Africa.
The continent of Africa is rich in resources that are provided to the rest of the world but the people living there continue to be among the poorest in the world (Ramirez, 2005). This poverty contributes to poor health in many ways. A child born into a poor family and community has historically found it almost impossible to escape from it. These children live in areas that do not have safe water to drink, sanitation services, or hygiene services (“Sixty-seventh session”, 2017). They grow up with soil and air pollution, improper waste, and chemical disposition, and when they work it is in unsafe workplaces (“Sixty-seventh session”, 2017). All of these factors contribute to health inequalities and ultimately relate to healthcare inequalities. A discussion of the health challenges will help understand the significant undertaking that it will be to provide equal healthcare to all citizens of the continent of Africa. The sub-Saharan Africa region endures some of the greatest health inequalities in the world with high levels of malnutrition and infectious diseases as well as half of the maternal and child deaths globally (Rispel et al, 2009). The impact of air pollution is worse for the poor in this region (Drabo, 2013). There are a few reasons for this disparity. The poor live in more polluted areas, work in dirty environments, and do not have housing that blocks out air pollution (Drabo, 2013). Adding insult to the environments in which they live and work is the fact that in many cases the poor are not educated on the importance of good hygiene and cannot financially afford to wear clean clothing (Drabo, 2013). Even within the very poor sub-Saharan region, there are large variances in the levels of income, especially in Botswana and South Africa (Rispel et al, 2009). For years the black population was oppressed in South Africa through racial segregation which ended in the 1990s (Rispel et al, 2009). South Africa to its credit has had a successful policy to provide free healthcare to those in the poverty category which has corresponded to more preventive healthcare, family planning, and prenatal care (Rispel et al, 2009).
The natural first place to start in a discussion of health challenges is the period from before birth to five years old. The worldwide mortality rate for children in this category was reduced by 27% between the years 1990 and 2008 (Hosseinpoor et al, 2011). Between 1990 and 2012 the sub-Saharan Africa rate for these children declined by 45 percent, a rate better than the worldwide decline (Yourkavitch et al, 2018). However, the six countries in Africa that make up sub-Saharan Africa had more than half of the 8.8 million global deaths that occurred in the year 2008 (Hosseinpoor et al, 2011). Additionally, in 2008 the sub-Saharan region had 900 maternal deaths for every 100,000 births which are a rate more than twice as high as the next highest country in the world (Hosseinpoor et al, 2011). Maternal deaths are a significant indicator of health inequality. Ninety-nine percent of all maternal deaths occur in developing countries (“10 facts”, 2017). A woman in the African country of Chad has a lifetime chance of 1 in 16 of death during childbirth compared to less than 1 in 10,000 in Sweden (“10 facts”, 2017). Many of the child deaths could have been easily prevented with a better healthcare system (Hosseinpoor et al, 2011). The leading cause of death for children under 5 is measles and they are preventable with immunization (Yourkavitch et al, 2018). In Nigeria, only 42 percent have received the measles vaccination (Yourkavitch et al, 2018). Another disease that threatens the African continent is yellow fever. Sadly, there exists a vaccine that provides immunity for life but there are millions that have not received the vaccination (“Sixty-seventh session”, 2017). The World Health Organization has made the yellow fever immunization in Africa a high priority but as Table 1 illustrates it will take several years for that to be completed due to the over 450 million that are not immunized (“Sixty-seventh session”, 2017). There have been issues in the past with immunization programs running out of supply but as of 2012, the annual production had been increased to 83 million doses (“Sixty-seventh session”, 2017).
Another significant contributing factor to the poor health and healthcare in many African communities is maternal education. The education of a mother has been shown to have an impact on the birth success and nutrition of young children. In northern Nigeria where there is a growing trend of undernourished kids, studies show that pregnancies are high in the 15-19 age category and the mothers have little or no education (Akombi et al, 2019). The women in northern Nigeria have a lower status than the southern region and other countries in Africa due to socioeconomic inequalities (Akombi et al, 2019). The healthcare system will be rewarded if the literacy of mothers is improved, especially as it relates to knowledge of what is important for their children to reduce malnutrition (Akombi et al, 2019). An example of the education of these women that impacts nutrition is the teaching of the benefits of exclusive breastfeeding for the first six months (Yourkavitch et al, 2018). This practice will be followed more as mothers learn the benefits of reduced infant mortality and morbidity (Yourkavitch et al, 2018). This of course will close the gap on the health of infants which will reduce strain on the healthcare services allowing their resources to be dedicated to other needs.
In the past thirty to forty years the healthcare system in Africa has been challenged more than most continents by the AIDS/HIV epidemic. More than 14 million citizens of Africa have died and today between 20 and 30 million residents of sub-Saharan Africa are living with the disease (Ramirez, 2005). Again, there has been a lesson on the importance of education. In the late 1980s in the country of Uganda, the new president used an inexpensive, indigenous, and effective response of educating people about the disease and how it is contracted or transferred (Ramirez, 2005). The political leadership and the marketing of the message led to Uganda achieving the most significant decline in the epidemic of any country in the world (Ramirez, 2005). If more countries in Africa and the world could have as much success reversing the impact of AIDS, healthcare resources would be freed up to deal with other issues. Because this disease traveled to other parts of the world and infected famous people the media made a big deal of it and people responded by raising money for the cure. While this was appreciated it was certainly not the biggest disease to impact Africa. Compared to the 20-30 million that are infected with AIDS, there are more than 300 million with malaria (Ramirez, 2005).
Another disease that impacts the global community is breast cancer. In recent years developed countries have reported higher incidences but lower mortality from the disease (Igene, 2008). At the same time, developing countries report fewer incidences but higher mortality rates which account for about 75% of the total global deaths from the disease (Igene, 2008). Approximately 50% of breast cancer cases are in developing countries and these countries consume only 10% of the cancer control and care expenses (Igene, 2008). In Nigeria, which had a population of over 140 million in 2008, there existed two hospitals that had equipment and medicine for radiotherapy and chemotherapy and less than 100 cancer doctors (Igene, 2008). Even within Africa, there is an inequality in healthcare for cancer patients as professionals move to areas that can pay them better (Igene, 2008). There simply have not been enough resources available to educate people to look for early detection and as a result areas like sub-Saharan Africa have become characterized by late discovery and high mortality (Igene, 2008).
Other studies have found that inequalities in healthcare, especially in developing countries can be a result of the distance patients need to travel for health services. In South Africa for example, even if the services are provided at no charge, some poor families cannot afford the travel costs, or the time needed to travel to services (McLaren et al, 2014). In South Africa, this also represents an unequal availability of healthcare by race since Caucasians are far more likely to live in urban areas, close to healthcare facilities and blacks are more likely to live in rural areas (McLaren et al, 2014). Other countries within Africa have a similar situation in regards to distance. In Nigeria for example a large number of the extremely poor live in rural areas far from health services (Hosseinpoor et al, 2011). Studies that show improvements in a country during a period may not always tell the story of the lack of change for the rural and poor populations (Drabo, 2013). One example is related to the Millennium Development Goal (MGD) of having safe drinking water for at least 74% of the population (“Sixty-seventh session”, 2017). While the goal was missed, there was progress from 48% to 68% over the targeted area (“Sixty-seventh session”, 2017). However, the details show that while the urban communities achieved 87%, only 56% of the rural community was able to attain safe drinking water (“Sixty-seventh session”, 2017). The MGDs related to sanitation improvements and air pollution were not as successful as the safe water goal, so there remains much work to do (“Sixty-seventh session”, 2017).
For years some areas in Africa have struggled with conflicts between governments and military regimes (Ramirez, 2005). In many of these cases, the driving force was a lack of education or wrong education that supported decision-making (Ramirez, 2005). The impact on the health services in the countries has been significant and caused inequality among countries and within countries (Ramirez, 2005). In much of Africa, the conflict has been decreasing in the past couple of decades, but in other areas, there is still corruption and some civil wars (Ramirez, 2005). The damage economically and socially of any conflict makes progress on healthcare an unlikely event.
Despite the history of poor health and healthcare inequality in Africa, there seems to be some legitimate momentum to change. In 2000, the United Nations established eight Millennium Development Goals (MDGs) for the elimination of poverty in the world (Hosseinpoor et al, 2011). In addition to two of the goals relating to child and maternal health, there is a goal of universal access to reproductive health services (Hosseinpoor et al, 2011). The African region is falling behind its goals (Hosseinpoor et al, 2011). The World Health Organization (WHO) calls health equity the absence of avoidable differences between groups of people (Stolk et al, 2016). Their Commission of Social Determinants of health states: “Where systematic differences in health are judged to be avoidable by reasonable action they are, quite simply, unfair. It is this that we label health inequity. Putting right these inequities – the huge and remediable differences in health between and within countries – is a matter of social justice” (Stolk et al, 2016, p.2).
There has been a recurring theme that malnutrition and poor education play a big part in the inequality of health of the poverty class in Africa. A man named Magnus MacFarlane-Barrow started Mary’s Meals with a vision to provide a meal in a place of education in the poorest regions of the world. In 2002 when he started, his group was feeding 200 kids each school day (Mary’s Meals, n.d.). Today this organization is feeding 1,667,067 per school day (Mary’s Meals, n.d.). Eleven of the nineteen locations they serve are in Africa (Mary’s Meals, n.d.). The kids are coming to school with the promise of a meal, in many cases their only meal of the day. Community members are required to prepare and serve the meal. The success of this program in feeding the children, getting them an education they would not have otherwise received, and providing a sense of pride in the community is a blueprint for others to help with social justice.
The World Health Organization established 17 Sustainable Development Goals (SDGs) in 2015 to end poverty and sustainable development by the year 2030 (“Sixty-seventh session”, 2017). One recurring theme in all of the goals is human health and well-being (“Sixty-seventh session”, 2017). Included in the goals are topics of the environmental impact on health and the importance of prevention in the health world, not just treatment (“Sixty-seventh session”, 2017). To make significant strides in vaccinations or treatment for the diseases of developing countries, particularly in Africa, there needs to be an effort to get pharmaceutical companies involved. While the developing countries are home to about 90% of the disease burden on the planet only about 3% of the research and development budget is dedicated to these diseases because this work would not be as profitable (Ramirez, 2005). Getting medical facilities located near the rural poor of Africa is likely not an option any time soon but there have been successes taking mobile units to the people for vaccinations and education topics related to responsible family planning (Hosseinpoor et al, 2011). Some ideas in South Africa to reduce the travel time for the poor to healthcare services are to situate services close to the places these people work if it is not feasible to locate where they live and to decentralize services (McLaren et al, 2014). The rest of the world needs to see the importance of supporting the developing countries as they push for improved and more equitable healthcare. Improving the healthcare services, education, and nutrition of people in developing countries will cost a lot of money but ultimately investing in this will save money and more importantly lives. As the current COVID-19 pandemic has shown all of us, the global community is getting closer all the time and what happens in other countries can happen elsewhere.