IS AIDS DESTROYING SOUTHERN AFRICA'S HEALTH SYSTEM?
| As the International Symposium on HIV/AIDS and Sexually Transmitted Diseases (STDs) to
be held in Lusaka, Zambia nears, focus is increasing on the strain that this epidemic has
put on southern Africa's health delivery system. Preparatory discussions for the Lusaka symposium so far have revealed international concern on the strain the health services in the region are currently under, visa-vis budgetary allocations by governments. In Zambia, where the AIDS symposium will be held, writer, Mildred Mpundu, says that by the year 2005, hospital bed occupancy is expected to rise to alarming rates. Bed requirements for AIDS patients is rising from about six percent in 1990 to 43 percent by 2005, according to Ministry of Health's Central Board of Health projections. Like in all southern African countries, treatment of infections resulting from AIDS is costly and will place considerable pressure on the delivery of health services in Zambia. In an interview, the AIDS symposium coordinator, Dr Moses Sichone said; "Since the first AIDS cases were reported in the 1980's there were not many patients in the wards. Patients filled hospital wards with acute illnesses like malaria. People were discharged within a few days. Now there are long illnesses and the average stay of patients in hospitals has increased." The World Bank says that this year, the average direct cost of treating an AIDS patient from the time of diagnosis until death ranges from US$100 to US$1100. According to government figures, AIDS care expenditures in Zambia rose from US$1.7 million in 1990 to US$12.9 million in 1995 and is expected to rise to US$21.0 million in 2005. The effect of increased expenditure on AIDS care is the inevitable diversion of money from other important health care needs. However, Zambia has been one of the pioneers of Community Based Care for the AIDS patients in response to the difficulties faced in hospitals. "When the situation got serious, we started negotiating with families and communities," Dr Sichone said, pointing out that the emphasis has shifted from medical institutions to community care. One contributor to a pre-conference discussion on AIDS on the internet, Koudaogo Ouedraogo of Burkina Faso has the same observations about the strain the epidemic is causing on Africa's health delivery. "In many developing countries, HIV/AIDS has come to increase the burden of the infectious diseases that are still major public health problems," writes Oudraogo, adding that although HIV/AIDS was ranked 26th it will be among the top ten causes of morbidity and mortality in the developing world. "In the context of scarcity of resources and a large number of development priorities, what must be the proportion of the health budget allocated to HIV/AIDS, keeping in mind equity and effectiveness of the interventions?" he asks. According to Ouedrago, the impact of HIV/AIDS on the health systems in Africa can be measured at three levels: on priorities definition within the health department, on health services organisation and management on health care providers. "Now that attention is on the introduction of short term anti-retroviral therapy for pregnant women in Africa, we are suddenly seeing all the other missing bits of the response to AIDS. All the failures of health services to respond adequately to the epidemic are being exposed". Another writer points out that the rational position is not to oppose pre-natal prevention programmes, but to assure that they are being developed at the same rate and with the same priority as an integrated health sector response to HIV. "Where are the counselling services? What happens to the mothers after they deliver? What about the fathers? What happens to the child once the mother dies? Where is the care for the sick and dying," asks Ghanaian, Josef Decosas in an article published by the African Forum on AIDS (AF-AIDS). Decosas stresses that "the decision on how much public services to reduce pre-natal HIV transmission should be provided must be a local decision taken in the context of all other health and HIV-related services that can be sustained locally. If the decision is made in response to international pressure groups or short-term international funding programmes, we will once again head for trouble". It has emerged that Mozambique has a relatively low percentage rate of HIV/AIDS compared to other countries in the region. "No doubt social, anthropoligical, political and factors related to sexual mores (latino culture) and a significantly high Muslim population contribute. On the other hand the country has been devastated by colonialism of the land and the mind, civil war, destabilisation and recently rapid urbanisation," says one Mozambican online pre-conference discussant. In Malawi, the AIDS pandemic has reportedly reached crisis proportions. A recent World Bank funded report on AIDS indicates that AIDS has reached "crisis proportions" in Malawi. The report says that over half of the country's skilled workers may die of the disease in the next 10 years. The report also shows that the majority of the sexually active population does not use condoms and that 62 percent of blood donors for the military, tested HIV positive in 1991. Moreover, 35 percent of pregnant women receiving antenatal care in Blantyre were infected with HIV in 1996, up from 3 percent a decade ago. In response the government has created a cabinet committee on AIDS. AIDS awareness groups have also sprouted as the country tries to reduce the rate of HIV infection. Meanwhile, Uganda and South Africa have signed an agreement to co-operate in fighting HIV/AIDS. The deal was signed recently by health minister, Dr. Crispus Kiyonga and his South African counterpart, Dr. Tshabalala-Msimang in Kampala. In a matter of five years, Uganda managed to reduce the rate of infection from 17 to seven percent per year. After realising that the pandemic was wiping out the economically active most the Ugandan government rapidly masterminded a multi-pronged strategy to combat the disease. This included intensive education campaigns, condom distribution, voluntary HIV testing, pop songs, billboards, drama groups, counselling and support services. At an AIDS seminar in Kampala, Tshabalala- Msimang reportedly blamed South Africa's tardiness in dealing with the disease on the apartheid government, which she said had ignored AIDS because it was a "black disease". While there is some truth in this view, some among her Ugandan audience will have been presumably puzzled to hear a regime that has been in place for five years blaming a retarded AIDS programme on its predecessor. A high-powered delegation from the Zimbabwean government visited Uganda last year to "learn" from the Ugandan experience in dealing with the AIDS epidemic. Since then, a more positive response seems to have taken root in the country with an increase in government led awareness campaigns as well as opening up of voluntary testing centres. In Lesotho, the United Nations' Integrated Regional Information Network (IRIN) says the government is trying to reduce the rate of HIV infection which is threatening to derail the country's economic gains. A recent report by the ministry of health noted that by the end of last year, there were 7,317 reported AIDS cases. An estimated 3,242 of these were reported last year alone, a 30 percent increase in just one year. According to the report, most of the reported AIDS cases occurred among the 20-39 age bracket, with about 54 percent of these being female. About 10 percent of the entire adult population is either HIV positive or living with full blown AIDS. "One disturbing trend that has emerged is the number of children that are HIV positive or who have full blown Aids. Of all reported cases , 12 percent children under the age of four. Last year a total of 395 children in this age group were recorded as HIV positive," says IRIN. The United Nations Children's Fund (UNICEF) says the government of Lesotho has shown a "clear commitment" to the Aids epidemic and has declared it a "national epidemic." According to the Botswana Gazette, the country's Members of Parliament have launched their HIV/AIDS awareness campaign aimed at the youth of the country, although belatedly. "We have been warning that unless our leaders break out of their cocoon of silence and openly, and aggressively, campaign on HIV/AIDS issues, Botswana will never be able to reverse the escalating spread of the disease which has already impacted on Botswana's everyday life," reads part of the editorial in the paper. Botswana, like Lesotho, Malawi, South Africa, Zambia and Zimbabwe, has one of the highest infection rates in the world - over a quarter of the population is infected. The recent SADC summit in Maputo expressed concern at the region's high HIV/AIDS prevalence rates, which they said has far reaching social and economic consequences with the most vulnerable being the working age group. The summit urged member states to put more resources in the fight against the pandemic. (SARDC). |
15 Downie Avenue, Belgravia |