This week we all had to read an article called “The Challenge of Global Health.” The article basically discusses the state of global public health today and the various obstacles and challenges that need to be faced and addressed. In the past few decades or so, there has been an incredible increase in public and private money being donated towards numerous pressing global health issues. You would think this is a good thing but, unfortunately, the efforts that the money is going to are very disorganized. Also, the money is being directed at specific diseases, rather than at general public health. Another huge problem for the developing countries is their shortage of doctors and nurses. Reasons for this include that more and more local talent from developing countries are coming to the more developed countries for work and leaving their countries behind.
I think that this lack of staff is one of the most valid reasons for why public health is worsening in the developing world. The numbers are quite staggering. In Ghana, for example, of the 871 medical officers that were trained between 1993 and 2002, 604 of them now practice overseas. These types of numbers are similar in Zimbabwe, Zambia, Malawi, and many other developing nations. Another factor contributing to the shortage is how large a percentage of the healthcare workers are infected with HIV/AIDS themselves. One study estimates 18-41 percent of the healthcare force in Africa to be infected. The workers are dying faster than they can be treated, triggering the entire system to collapse. What good are the drugs if there is no one to distribute them? But this problem is being addressed! There is now a $270 million plan in place, supported by PEPFAR (President’s Emergency Plan for AIDS Relief), trying to bring back half of the lost health care workers using financial incentives and training.
Another thing that is stressed in the article is that increased maternal survival rates and increased overall life expectancy should be the two main goals of the world health community. Instead of money being funneled into hundreds of different, single diseases, they should be aimed at these two simple goals. The rate of maternal mortality is very telling of the status and efficiency of the overall healthcare system. With clean surgical facilities staffed by enough well trained professionals using sterile equipment, there should be a low maternal mortality rate. Similarly, life expectancy gives an idea of the overall public health services. With safe drinking water, nutritional food, easily accessible immunizations performed with sterile tools, there should be high life expectancy.
While it is great that there has been such a surge in aid and finances, faulty systems and lack of sustainability of funds often lead to the disease states that are worse than originally seen. According to a World Bank report, half of all funds donated for health efforts in Sub-Saharan Africa, such as HIV/AIDS, TB, or malaria, never reach the end of the line. Money is lost along the way to payment of ghost employees, padded prices, selling of drugs to the black market, and the sale of fake medications. There needs to be more oversight and guidance of the massive funds being donated. Another issue is how dependent these underdeveloped countries become on foreign aid. Without proper exit strategies, the entire system could collapse once the wealthier countries transfer control to the underdeveloped nations, helping no one in the process.
This article was super informative and very interesting to read. Global health is and will be one of the greatest challenges for my generation and generations to follow!
Excellent summary and discussion. I will just comment on one aspect of the article, which is the "brain drain" and lack of health care personnel. That was a big issue in Botswana, where I spent the year as a pediatrician. I was indeed one of those US doctors who went to Africa to help with the AIDS epidemic, but my program tried very hard to develop local capacity, and we set a five year time limit in which to "bridge the gap" before we turned over care to local physicians. So, as part of our mission, we trained local doctors in how to take care of children with HIV, and we tried to employ more and more local doctors in our clinic. Botswana did not have a medical school, so we were helping to set one up. All of the doctors in Botswana were foreigners (e.g. from Kenya, Nigeria, Ethiopia, India, USA), so the issue of local development of physicians was paramount. I am hopeful that the development of a medical school in Botswana will help address this problem, but as the article points out, the UK, US, and other developed countries absolutely need to support the training of healthcare professionals in their own countries so that we are not recruiting from developing countries.
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