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Health Focus/Africa: Continent's Health Systems Collapsing

By Lewis Machipisa

HARARE, Dec 1 (IPS) - The gospel, according to the clergy at the Bretton Woods institutions preaching the message of economic reform, is that it is easier for a slim government to find salvation than a fat one.

And as many countries try to adhere to this orthodoxy, governments are transforming from centrally planned to market-oriented economies. This shift has seen a collapse in most of the social services provided by the governments.

Hardest hit is the health sector. There are clear indications of growing inequities in health and health care in Africa. These indicators often seem to be ignored and are persistently downplayed as African governments implement policy changes that affect public health.

When Professor Norman Nyazema attends the People's Health Assembly 2000, to be held in Bangladesh next week, his message will be: ''involve the poor if health programmes are to succeed''.

One of the criticisms of primary health care as a route to achieving affordable universal coverage - the goal of health for all - is that it provides little attention to people's demands for health care, says Nyazema who is the co-ordinator for Consumers International Regional Office for Africa (CI ROAF), one of the conference's organisers.

Nyazema notes that as a result of this neglect, health programmes in Africa have concentrated almost exclusively on the perceived needs of grassroots people.

''Systems in Africa have failed because these two concepts did not match and the supply of services offered could not possibly align with both,'' explains Nyazema, who is also with the Institute of Continuing Health Education in Zimbabwe.

''What we now see happening is that only the simplest and most basic care for the poor, rather than all possible care for everyone, which means delivery to all of high-quality essential care, defined mostly by criteria of effectiveness, cost and social acceptability.''

Nyazema calls for the promotion of equal utilisation for equal need, a demand which would involve devising a system whereby use of health services would be allocated ''pro rata'' with need and demand.

''A health system will have to adopt either a demand or a need stance in order to ensure equity in health, at least at a primary health care level,'' says Nyazema.

''The intensifying struggle around scarce health resources in many African countries requires the recognition that equity needs to define and build a more active role for important stakeholders in health, including communities, health providers and funders,'' he adds.

Genuine, people-centred initiatives must be strengthened to find innovative solutions and to put pressure on decision makers, governments and private sector.

''Grassroots organisations in Africa need to form coalitions dedicated to changing the prevailing ailing health care delivery systems,'' suggests Nyazema.

This is one of the themes of the Bangladesh People's Health Assembly. More than 1,000 NGO and health activists from 90 countries in Asia, Latin America, Africa will be participating. The meeting is organised by activists and health workers and will explore preventive health approaches; investigate the effects of globalisation on health funding and policies; on the privatisation of health, and the links between poverty and health, and war and health.

Other areas will be the issue of access to drugs, patent rights, bio-piracy, and the politics of research funding.

While globalisation has brought with it huge benefits, some obligations and commitments for implementation of the agreements under the World Trade Organisation (WTO) have a negative impact on the health sector in Africa.

The cost of health services, in general, has increased beyond the capacity of most African countries and the gap between the developing and developed countries is widening.

A case in point is the WTO Treaty on the Right to Intellectual Property (TRIPS) which provides that companies that register patents for products or manufacturing processes have a 20 year protection period.

In the field of medicines, for example, this means that for drugs that fall under TRIPS, governments may not import them from another, possibly cheaper source or license them as necessary for public health and thus buy them from another supplier.

For example, Zimbabwe has an essential drugs list for its major diseases. These ''essential drugs'' are exempt from TRIPS provisions. However, many new drugs not yet on the essential drugs list would be covered by TRIPS. Amongst these are drugs for the treatment of AIDS related diseases, such as AZT.

''While some argue that protecting patents will encourage drug companies to invest in developing countries, patents raise a serious problem for developing countries: whether the drug is covered by patent or not makes a big difference to its price,'' says Rene Loewenson of Zimbabwe's Community Working Group on Health.

Fluconazole is a drug used to treat AIDS related diseases, such as styptococcal meningitis. It costs 70 US cents a day in Thailand and 20 US dollars a day in Kenya. In Thailand it is not patent protected. In Kenya, it is. In Zimbabwe, the drug costs the same as in Kenya.

''Trade liberalisation is increasing the marketing of harmful products at the same time as it is limiting government rights to control it,'' says Loewenson.

''Public sector cutbacks and privatisation of health services are leaving many poor people without access to quality health services, while the wealthy get costly private care.''

Says Nyazema: ''today and everyday, the lives of the African people, to a large extent, lie in the hands of health systems inherited from their colonial masters.''

''At the time of their evolution the health care was implemented primarily to cater for colonial administrators and expatriates, with separate or second-class provision made, if at all, for Africans,'' says Nyazema.

''The systems so evolved, however, now have a vital and continuing responsibility to the people throughout their life span and are crucial to the healthy development of individuals, families and societies in Africa,'' says Nyazema. ''This inevitably makes health care a practical as well as a political issue.''(END/IPS/lm/sm/00)