“Cause(s) of Africa’s pub health challenges… 

“The principal cause(s) of Africa's public health challenges today... 

Adama Dieng
…are varied and multi-dimensional. However, it is evident that governance and leadership remain some of the most pressing challenges. This argument is made in light of the fact that there is a significant correlation between the state of public health and the ability of the state to guarantee the enjoyment and respect of social and political rights for its citizens.

Most of the public health challenges in Africa stem from the failure of states to exercise prudent leadership and effective management of available resources. It is an indisputable fact that the ongoing human rights abuses and armed conflicts in most African countries have had dire consequences on the ability of these countries to create and sustain strong institutions to guarantee access to basic rights such as health, education and justice – among others. Equally apposite is the existence in most countries of state-sanctioned corruption that has led to the embezzlement of public funds, illegal and substandard procurement of public health goods and services, as well as the flight of talent – including much-needed health care professionals – to overseas labour markets in search of better opportunities.

To be sure, ongoing conflicts have also had a negative impact on the spread of chronic diseases like HIV/AIDS and TB, while facilitating sexual and gender-based violence against women. Such diseases and violence cause immeasurable trauma to the victims for many years and, in the case of HIV/AIDS, death (as HIV/AIDS still has no cure).

What can be done to address this situation? Africa needs to create and respect institutions of governance and exercise prudent leadership to effectively manage available resources, while investing aggressively in accessible social services like health and education. States should also ensure equal participation of their citizens in the management and enjoyment of these resources. Of course, public participation cannot become a reality unless the state is committed to human rights ideals that respect the dignity and worth of each individual citizen. As experience in different countries has shown, even when conflict comes to an end, it takes decades and even generations before a state can transform itself into a strong polity underpinned by respect for human rights and good governance. Better, then, that states invest their time and resources in the prevention of conflicts through strong and accessible institutions of governance, such as an independent judiciary to adjudicate differences between citizens, and between citizens and government agencies. It is only through such institutions and such commitment to prudent leadership and respect for rights that states can meaningfully address current public health challenges and improve the social and economic welfare of their citizens.”

» Adama Dieng is the Special Adviser of the UN Secretary-General on the Prevention of Genocide, and former Registrar of the UN International Criminal Tribunal for Rwanda.

John W. McArthur
…include a complex blend of unique disease ecology, historically low public investments, and rapidly evolving frontiers of human resource requirements, information systems and medical interventions required to tackle a shifting burden of public health challenges. But the context for these challenges is a remarkable – even historic – cascade of health breakthroughs throughout sub-Saharan Africa over the past decade. Many of these breakthroughs were commonly deemed impossible at the turn of the millennium. Spurred significantly by global efforts to achieve the Millennium Development Goals (MDGs), six million people are now receiving life-saving AIDS treatment across the region, malaria deaths have fallen by about a third, polio is nearing eradication, and child mortality has declined by an average of 30 percent. Indeed, child mortality rates have fallen by as much as half since 2000 in Liberia and Senegal, and more than 70 percent in Rwanda. At the same time, the challenges of promoting health and strengthening health systems are typically most pronounced in the so-called ‘fragile states’ – a term currently applied to 18 of Sub-Saharan Africa’s nearly 50 countries (according to the most recent assessments of the African Development Bank and World Bank). These fragile states have seen less rapid progress than the rest of the region, averaging only roughly a 20 percent decline in child mortality since 2000, and even less in countries like the Central African Republic and the Democratic Republic of the Congo. Such conflict-affected environments embody some of the world’s deepest challenges for promoting the longer-term virtuous cycles of stability and development.”

» John W. McArthur is Senior Fellow with both the UN Foundation and the Fung Global Institute, and a Non-Resident Senior Fellow at the Brookings Institution. He was previously Manager and Deputy Director of the UN Millennium Project.

Baye Moussa Samba
…remonte aux maladies infectieuses (VIH, paludisme, tuberculose, etc.), au cancer du sein et du col de l’utérus, aux affections périnatales, à l’hypertension et au diabète, à l’insuffisance rénale, aux accidents de la circulation, et aux cas de viol.

Les causes principales de ces problèmes de santé publique sont malheureusement nombreuses.  Elles comprennent l’absence de stratégie des gouvernements des États africains pour la  mobilisation des fonds nécessaires pour développer des politiques de santé et assurer une couverture médicale adéquate et effective pour tous. Ensuite, on peut énumérer les facteurs suivants: l’instabilité des États africains avec la recrudescence des conflits armés; l’insuffisance des politiques des gouvernements dans le domaine de la promotion de la santé, de l’aménagement, de l’assainissement du milieu, ainsi qu’une certaine négligence de l’aspect préventif en matière de santé. Il y a aussi le fait que les États africains mettent la priorité sur le curatif, puis l’insuffisance de programmes axés sur la nutrition, l’alimentation, la promotion et la protection des couches vulnérables sur toute l’étendue du  territoire. L’absence de programmes visant à assurer une sécurité routière adéquate et efficiente; le déséquilibre dans la répartition des ressources humaines et matérielles en matière de santé au niveau des États – en  effet, une grande proportion des prestataires qualifiés et les moyens modernes de diagnostic ne se trouvent qu’en zone urbaine, ce qui rend parfois le recours et l’accessibilité aux soins de qualité très difficile pour les patients venant des zones rurales. Souvent ces problèmes entraînent un retard dans le recours aux soins – c’est-à-dire que le système de santé précaire peut difficilement assurer une prise en charge de qualité des patients.

On peut citer l’exemple de l’insuffisance rénale. Afin de bénéficier d’une séance de dialyse, les malades doivent se rapprocher des zones urbaines et patienter sur une liste d’attente, compte tenu de la pénurie d’équipement médical et de l’absence de personnel qualifié. Alternativement, on se fie à la médecine traditionnelle et une automédication non contrôlée, qui provoquent ainsi des pathologies rénales.

Pour pallier à ces problèmes, les États africains doivent agir à plusieurs niveaux. Pour ce faire, il faut emprunter une approche systématique touchant à tous les aspects politique, économique, réglementaire et institutionnel».

» Baye Moussa Samba fait partie de la Direction de l’action Sanitaire et sociale de la Mairie de Dakar au Sénégal.

(Photograph: Pius Utomi Ekpei / AFP / Getty Images)

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