by Tendai Msengezi
This is the first of a four-part series on health in the southern African region.

Holding a bloody handkerchief to his mouth and gasping for air, Afonso Henriques, a Mozambique national, braces himself for yet another bout of coughing. A lifetime of working in South African mines as well as heavy smoking have taken their toll.

The 58-year old Henriques suffers from a lung infection. His situation is worsened by the distance he has to travel to get medical attention.

On a daily basis, he bas to walk about 20km to get to the nearest hospital in Maputo and, at times, he misses treatments because he is too ill to make the journey.

Henriques is one of many people in southern Africa who has no easy access to health facilities.

“I know that my chances of regaining good health are slim, but I just wish the hospital was nearer. This would make life a whole lot easier for me and others in a similar position,” says Henriques.

Despite the efforts to eradicate the policy of apartheid in South Africa, inequalities in health remain and blacks are still disadvantaged in that country. Most blacks suffer from poverty-related diseases such as tuberculosis, cholera, kwashiorkor and infectious diseases caused by overcrowding, lack of sewage facilities, poorly staffed and equipped clinics and an inadequate supply of potable water.

Even after announcements by the Health Minister, Dr Rina Venter, to the effect that all provincial Hospitals are now “open” to all races, the opposite is true.

Signs which read “blacks and Indian patients must be treated and handled as in the past” can be found at the Zeerust hospital near Johannesburg – a notice signed by the hospital superintendent. Ambulance services were only available for whites, while blacks had to do with an old van.

The situation in the homelands is even more appalling. The KwaZulu St Benedict hospital which serves about 150,000 people is overcrowded. There are no partitions between beds and treatment takes place in full view of other patients. Women in labour are accommodated in makeshift beds on cold cement floors.

The destabilization policies adopted by the South African government against its neighbours since the 1970s and 80s have resulted in a combined loss to SADCC countries of more than USS60 billion. Health facilities were destroyed in several countries.

Mozambique and Angola have borne the brunt of South African destabilization, resulting in the destruction of a large percentage of their health facilities.

In Mozambique, this state of affairs means that it is virtually impossible to finance health programmes. Any new rural infrastructure that was built was immediately destroyed, leading to the closure of more than 1,000 health units.

“The overall impact has been to halt the previous rapid expansion that had been made by government to improve health conditions for the people,” says a health ministry report.

In Angola, the situation is no better. The 16-year war between the government and UNITA which ended last year has had adverse effects on the country’s health programme. Those few health units that are still fully functional are inadequate and overcrowded.

Women with screaming children tied on their backs can be seen crowded on the floors hoping that the busy doctors can eventually attend to them. Some of them sit for hours before getting treatment and, in some cases, patients fail to get the prescribed medicines because of drug shortages.

A United Nations report estimates that between 15 and 25 percent of primary health facilities have been destroyed and many post-independence advances in health reversed. This situation is further compounded by the number of war victims who need medical attention. Angola has the largest number of amputees of any country in the world at well over 40,000.

Health facilities in other SADCC (Southern African Development-Co-ordination Conference) countries are in better shape than those of Angola and Mozambique.

The Ministry of Health in Zimbabwe operates rural primary health centres which provide basic preventative, curative and rehabilitative care. The Department of National Nutrition, which works at district hospitals, rural health centres and village health programmes, assesses and supervises the nutritional status and growth of children, so that those at risk can be identified. Similar programmes are also provided in urban areas.

This has enabled the lives of many sick children in remote areas to be saved because illnesses have been identified early. Up to 1,000 health posts have been established throughout the country and more are being built.

The Minister of Health, Dr Timothy Stamps, has talked of a programme of upgrading some mission hospitals into government-aided district hospitals
Zimbabwe is, however, having problems in retaining doctors who prefer to go to work in neighboring countries where conditions, including salaries, are more favourable.

“Conditions in the rural areas are difficult to work under and the pay is not so good in this country,” complains a medical student who plans to leave the country once he has completed his degree.

Added to the problem of brain drain is that of the effects of the Economic Structural Adjustment Programme (similar programmes which also have adverse effects on health are being carried out in most regional countries) and the drought.

In order to recover costs, the government has allowed prices to go up. This means that the average citizen can no longer afford medical bills. The government, however, still maintains that those earning below US$30 should get free medical attention.

The drought currently ravaging southern Africa has added to the problems of health care. Children, in particular, have been seriously affected and the health ministry recently reported that an increasing number of children are being admitted into hospitals because of malnutrition.

Health facilities in recently independent Namibia are characterized by a disproportionate provision of good services to the white community, particularly in the urban areas. One or two white people occupy a room with some empty beds while many blacks can be seen jostling for a chance to get treatment.

“These are some of the situations which we expect our government to redress because that is what we fought against,” says a patient in a hospital in the capital, Windhoek. Just under half of the beds provided in the 16 centrally-administered hospitals are located in Windhoek and two other centres and these are under-utilized.

Namibia currently has no medical school, but a small number of black Namibians reached training as doctors overseas under UN and other international agency programmes and most have returned to their country.

The government’s health sector policy focuses on the rationalization of existing services under the health and social services ministry, and an extension of primary health care facilities in rural areas.

Soon after independence, Zambian health facilities were greatly improved but have been declining over the years. The fall in world copper prices reduced funds available for the implementation of its policies of universal primary health care.

When the country gained independence in 1964, health services were concentrated almost exclusively in urban areas with one doctor serving an average of 11,400 people in rural areas. Despite these problems, the situation improved and by 1984, this figure had been dramatically reduced. This is reflected by the increase in average life expectancy from 40 years to the current 53 years.

According to the health ministry, the economic difficulties of the past decade have hit the health sector hard, resulting in shortages of drugs and equipment. Medical schemes like those found in Zimbabwe are virtually non-existent. The erosion of real incomes has meant that many Zambians cannot afford medical care and many doctors are leaving for greener pastures.

At the University Teaching Hospital, workers have often been accused of stealing the few medicines and health equipment that is available for reselling.

While the Malawian government remains committed to primary health care, it has experienced difficulties in implementing its policies because of inadequate government funding of the health ministry and the demands of the three central hospitals which absorb most of the total health spending.

Currently, the country has three schools that offer training for nurses. Missionaries and private doctors are also encouraged to run private health institutions. Of the BLS countries (Botswana, Lesotho and Swaziland), Botswana has had more success than most with its health programmes. Like neighbouring Zimbabwe, the country has made commendable progress in providing its citizens with basic health facilities which are within reach of some 85 percent of the country’s population. The concentration of the population along the country’s eastern strip means that
only a small number of the rural communities in the south east and west are not covered, but the government is working out a programme to rectify this problem.

The small kingdom of Lesotho has had moderate success in improving the standard of health. However, people live in overcrowded conditions and often have to use “bush toilets” as an alternative.

Water-borne diseases are spread by lack of proper sanitation and there is malnutrition which was exacerbated by the drought in the 1980s as well as the current one. The quality of primary health care in the rural areas has improved.

In Swaziland, the health situation is in need of improvement. Conditions remain inferior to those of other countries with similar income levels, despite a number of projects undertaken by western agencies in recent years to improve the condition of health services and increase the number of people having access to clean water. The government has increased health allocations in the last two budgets.

The Tanzanian health sector has been badly affected by the country’s adjustment programme. The government has had to cut down funds for the health ministry from six percent of total government expenditure in 1980 to 4.8 percent in 1988.

”The situation is so bad and funds are often lacking to purchase even the most essential medicines,” says the deputy district medical officer at a health clinic in Dar es Salaam. The programme, however, secs health as one of the priorities and more money is likely to be allocated to this sector in the future.

While encouraging results have been achieved in improving health facilities in the SADCC countries a lot still needs to be done. With the promise of peace in Angola, Mozambique and South Africa, more money should be channeled to those projects which are of real benefit to the ordinary person. (SARDC)

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