African health sector under stress, but child mortality is the best story in dev't

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By Dr Majwala Meaud Major

Africa has a variety of problems, fortunes and misfortunes but now the most pressing one that needs urgent attention and concerted efforts is that of the appalling health conditions because it concerns our life and death episodes.

High rates of disease and premature mortality in sub- Saharan Africa have been costing the continent so dearly. Poor health causes pain and suffering, reduces body energies, and makes millions of Africans less able to cope with life, let alone enjoying it.

The economic conditions are immense. Poor health shackles human capital, leads to increased absenteeism at work, reduces performance and entrepreneurial activities, and holds back real social- economic development.

Africa child mortality is a tremendom success story that has barely been recognized. The biggest and best story is huge decline in child mortality that is now gathering pace across Africa.  16 out of 20 Africa countries which have had detailed surveys on living conditions since 2007 reported falls in their child mortality rates  (this rate is the number of deaths of children under five years per 1,000 live births).

According to the World Bank, Twelve countries had falls of over 4.8% a year, which is the rate of decline that is needed to meet the Millennium Development Goals of cutting by two thirds the child mortality rate between 1995 – 2015.

Four countries; Senegal, Rwanda, Kenya and Uganda have seen falls of more than 8% a year, almost twice the MDG rate and enough to halve child mortality in about a decade. These four now have the same child mortality as India, one of the most successful economies in the world during the past decade.

The decline in Africa child mortality is spreading up. In most countries it is now falling about twice as fast as during the early 2000s and 1990s. More striking, the average fall is faster than it was in China in the early 1980s, when child mortality was declining at around 3% a year, admittedly from a lower base.

The only recent fall comparable to the largest of those in Africa occurred in Vietnam between 1987 - 1992 and 1993 – 1997, when child mortality fell by 37%- and even that was slower than that of Senegal and Rwanda. Rwanda’s child mortality rate more than halved between 2006 – 2008 and 2011 – 12. Senegal cut its rate from 129 – 72 in five years (2006 – 2012). It took India a quarter of a century to make that reduction. The top rates of decline in African child mortality are the fastest seen in the world for at least 30 years.

To look for other explanations therefore we can study the role of foreign aid, the media, Non government organizations / civil society organization, charities by the churches and community participation and involvement in the provision and management of health services. 

For instance in Uganda, Mr. Kasozi Dickson of Healthcare Volunteers (Uganda) says that ‘working with partners mainly Humanity Direct and Platinum Hospital, we have managed to save lives of 1300 children in the last two years by offering free surgical operation to children affected with anemia and other complications that need such operations, on the top offering capacity in the fight against malaria, HIV/AIDS, Tuberculosis and others’’. Therefore the role of third sector cannot be ignored.

The central position of women in household management and reproductive health must be emphasized.  Inter-sectoral interventions to complement and sustain hygiene, environmental health, provision of clean water are important. These factors make crucial contributions to an enabling environment for health improvement and reduction of child mortality.

They are as important as improving incomes. Without them, the efficiency, effectiveness and efficacy of medical interventions are greatly reduced. Much health improvements can be achieved by reforming community–based healthcare systems to use available local human and financial resources more productively, and developing institutional frameworks with shared responsibilities for health care provision to decentralized entities, civil society and the non-government sector, we can ably spur reform.

In sub-Saharan Africa, private voluntary organizations already assume a large share of the responsibility for providing community based health care, and can do more since legal and regulatory environment are becoming increasingly conducive to the provision of health service by the private sector.

The writer is the president of Sustainable World Initiative-East Africa