Tropical Health Matters

Solomon Afolabi has delved into the challenges for public health in 21^st Century Africa in the posting below. He is currently an Advisor to the Upper Nile Institute (UNI) of South Sudan, Kiryandongo, Uganda and an Alumnus of the Johns Hopkins Bloomberg School of Public Health and its African Public Health Network.

As we move further into the 21st century, the challenges facing public health in Africa are becoming increasingly complex and difficult to address. Despite numerous advancements in medical technology, many African nations continue to struggle with a wide range of health issues, which have been their most pressing challenges. These issues span a wide spectrum, from infectious diseases like cholera, malaria, Ebola, HIV, and more recently, coronavirus, to an escalating burden of chronic diseases. However, these health concerns are not isolated; they intersect with broader socio-economic factors such as poverty, armed conflicts, and government mismanagement. WHO in April 2023 stated that, “for all the hard-won gains that have been made over the past 75 years, more than 100 health emergencies still occur in the African Region annually, including outbreaks of cholera, yellow fever, meningitis, measles, and Ebola. These emergencies still pose a significant threat to the health, well-being, and development of African countries”

Photo: Cholera active case finding team, Kalikiliki settlement in Lusaka, Zambia (October, 2023)

The battle against infectious diseases in Africa is still ongoing. While a significant number of these diseases have been largely eradicated in other parts of the world, they continue to pose a serious threat to the health and well-being of millions of people across the continent. As earlier stated, these diseases including tuberculosis  are still major public health concerns in many African nations, and efforts to address these issues are often complicated by factors such as poverty, lack of access to healthcare, limited resources and governments not making meaningful investments.

Another major challenge facing public health in Africa is the rising incidence of non-communicable diseases (NCDs), which includes conditions such as cancer, diabetes, and cardiovascular disease, often associated with lifestyle factors such as diet, exercise, and smoking. Contrary to the traditional thought of NCDs as diseases of affluence, they are becoming increasingly prevalent in many African countries. This is partly due to changing lifestyles and the adoption of more westernized diets, as well as limited access to preventative healthcare services.

A third major challenge facing public health in Africa is the impact of environmental factors on health. Poor air quality, contaminated water, and inadequate sanitation are all major factors contributing to a range of health problems across the continent. In many cases, these environmental factors are linked to poverty and lack of access to basic resources such as clean water and sanitation facilities. Climate change is also expected to have a significant impact on public health in Africa in the coming decades, with rising temperatures and changing weather patterns likely to exacerbate existing health challenges.

Photo: Climate change projected to cause global food shortages, WHO-AFRO

Furthermore, there is the challenge of ensuring that healthcare services are accessible and affordable to all. Many African nations continue to struggle with limited resources and infrastructure when it comes to healthcare and ensuring that all individuals have access to basic healthcare services remains a significant challenge. This is compounded by factors such as corruption, political instability, and conflict, which can disrupt healthcare services and limit access to care. Despite these challenges, there are also reasons for optimism when it comes to public health in Africa. Advances in medical technology and healthcare delivery are helping to address many of these issues, and there is growing awareness of the importance of preventative healthcare measures such as vaccination and early detection. Additionally, there are many dedicated healthcare professionals and organizations working tirelessly to improve vaccine production and health outcomes across the continent.

In conclusion, the challenges facing public health in 21st century Africa are many and varied. From the ongoing battle against infectious diseases to the rising incidence of non-communicable diseases and the impact of environmental factors on health, there are many complex issues that need to be addressed. However, with continued investment and dedication, there is reason to believe that progress can be made in improving health outcomes for all Africans.

Affordable pharmaceuticals play a major role in the control of infectious and tropical diseases. Dr Naveen Anaswara and Dr Ashok Kumar Kanaparthi explore the importance of quality generic medicines in India in a post on the class blog for the course Social and Behavioral Foundations of PHC. See their thoughts below.

Even though National Medical Commission(NMC) emphasizes the importance of prescribing generic drugs in India, it is not being implemented in the ground level. Many stake holders including Indian Medical Association(IMA) are skeptical regarding the quality of generic drugs compared to branded drugs. India is one country with highest out of pocket expenditure especially for drug purchases.Usage of generic drugs can reduce the out of pocket expenditure ensuring equity.

The Hatch-Waxman Act, also known as the Drug Price Competition and Patent Term Restoration Act, was passed on September 24, 1984, during the 98th United States Congress. It created the current system of government regulation for generic drugs in the country and encouraged the pharmaceutical industry to produce generic drugs.Many countries follow the generic drugs prescription.The generic drugs should be with the same efficacy and quality as the branded drugs.

Unlike in US , India lack stringent quality checking mechanisms.India has struggled with the problem of illegal narcotics for a considerable amount of time. The Central Drug Standard Control Organization (CDSCO) found that approximately 4.5% of generic medications sold on the domestic market in 2018 were below par. In the meantime, the country’s dearth of high-quality testing facilities is the root of the problem.

When the Department of Pharmaceuticals introduced the Jan Aushadhi Scheme (JAS) (Public Medicine Scheme) in 2008, the Government of India (GOI) appeared to be taking a strong stand against the private pharmaceutical industry’s outrageous drug prices by providing generic medications at reasonable costs.But due to lack of enough publicity, poor supply chain and lack of prescriptions from doctors this scheme could not flourish.

India have to take the campaign for generic drugs prescription. At the same time Ministry of India should ensure the standard quality of all generic drugs.

Our Stance: Support for Generic Drug Promotion

1. Public Awareness Campaigns: Initiating comprehensive public awareness campaigns can empower patients and families with information about the benefits of generic drugs.
2. Incentives for Healthcare Providers: Offering incentives to physicians, pharmacists, and hospitals for prescribing and dispensing generic drugs can drive adoption.
3. Enforcement of Policy: Stronger enforcement measures by government health authorities are essential both for prescriptions and quality assurance.

Embracing generic drugs in India is not merely a policy suggestion but a pathway to equitable and affordable healthcare. By working collaboratively with stakeholders, advocating for informed choices, and implementing concrete strategies, we can make quality healthcare accessible to all.

Tom Kehinde has posted an important perspective on local and community action in HIV control on the blog for the course Social and Behavioral Foundations of Primary Health Care. See the key issues from that posting below.

Nigeria grapples with one of the highest burdens of HIV/AIDS globally, with an estimated 1.9 million people living with the virus. Despite significant international assistance, the country heavily relies on external financing to combat the epidemic. This dependency on foreign aid is unsustainable in the long term and undermines Nigeria’s ability to address the epidemic effectively, perpetuating health disparities and social inequalities. Marginalized populations, such as women, youth, face heightened vulnerability to HIV infection due to limited access to prevention, treatment, and care services. To confront this pressing issue, empowering local HIV control organizations through increased domestic funding not only enhances their capacity to deliver targeted interventions but also fosters community ownership and sustainability.

(Photo source: The guardian)

Highlighting the position of stakeholders on this issue, firstly, WHO plays a pivotal role in providing technical guidance and support to countries like Nigeria in combating HIV/AIDS. Collaborating with WHO to develop evidence-based guidelines and technical assistance programs could bolster Nigeria’s efforts towards mobilizing domestic resources for HIV financing. National Agency for the Control of AIDS (NACA): the leading agency responsible for HIV/AIDS control in Nigeria, NACA advocates for increased domestic financing and empowerment of local HIV control organizations. Partnering with NACA to strengthen advocacy efforts and capacity-building initiatives could drive policy change. Despite the importance of mobilizing domestic resources for HIV financing, several challenges persist. These include inadequate funding allocations in national budgets, limited institutional capacity for effective resource mobilization and management. Developing a strategic plan such prioritizing advocacy for increased domestic funding for HIV/AIDS programs, enhance coordination among stakeholders, strengthen institutional capacity for resource mobilization and management, and promote community engagement and ownership of HIV/AIDS interventions. To conclude, mobilizing domestic resources for HIV financing is vital for Nigeria’s epidemic control. WHO must provide tailored guidelines, technical support, and advocate for local engagement. NACA should prioritize policy advocacy such as lobbying for increased budget allocations, strengthen collaboration as establishing joint task forces with other government agencies and NGOs, facilitating resource-sharing and coordinated efforts, and enhance community involvement. These concerted efforts will empower local organizations, bolster health systems, and mitigate the HIV burden, fostering sustainable development.

Sudan’s Mental Health Crisis: Community-Led Peer Mental Health Counseling

Omnia Hassan has posted about a unique program of peer-led mental health counseling. Read her thoughts below and check them in the class blog of Social and Behavioral Foundations of Primary Health Care. As Sudan faces persistent war and conflict, the focus must turn to Sudanese internally displaced persons (IDPs) who are unable to escape the country, facing increasing incidence rates of several serious mental health burdens. Graphs Source: Mental health consequences among Sudanese due to the armed conflicts and civil unrest of 2023: a cross-sectional study In Sudan, there are only two psychiatric hospitals and seventeen outpatient mental health facilities for a population of over 40 million. To support the IDPs with improved access to mental health care, the development of a community-led mental health counseling program may be beneficial where community members are educated on how to counsel their peers through mental health burdens. This initiative aims to reduce the effects of mental health illnesses, create a space to speak about difficult experiences, provide accessible mental health resources, and empower Sudanese individuals, restoring their autonomy. A successful example of this program in Uganda with Rwandan and Somali refugees with PTSD where the evidence demonstrated that 65% of participants no longer fulfilled the criteria for PTSD. Universities in Sudan, such as Ahfad University of Women, have committed themselves to the education and training of community members to equip them with the knowledge and skills to provide mental health counseling for their peers. The Sudan Ministry of Health (MoH) has lent staff and workers to increase the numbers of those being trained to become lay counselors. Funding is a particular point of discussion, and the United States has frequently sent funds to Sudan for humanitarian assistance. The U.S. Department of State funded a grant for the Ahfad University of Women before as part of the University’s Trauma Training Treatment Center. Photo Source: Reuters The UN Refugee Agency acknowledges the displacement issues brought upon the Sudanese population during the war. They have explicitly commented on the displacement of Darfuris in the western region of Sudan, sharing the interventions they have implemented to mitigate mental health issues, such as promoting social cohesion. With over 10 million people uprooted and 9 million people internally displaced, Sudan’s war fuels the largest displacement crisis in the world. The mental health of these individuals needs to be addressed as they endure the most grueling event of their lives.

 

Sue Lee has posted about the progress being made with Seasonal Malaria Chemoprevention in Mali on the class blog site for Social and Behavioral Foundations for Primary Health Care. Learn more about the issue below.

As highlighted by the U.S. President’s Malaria Initiative, Mali’s Kita district is grappling with a significant health challenge — malaria. Seasonal Malaria Chemoprevention (SMC) has emerged as a potent strategy to combat this, yet hurdles such as inadequate healthcare infrastructure, logistical issues, and insufficient community education hamper effective delivery. We advocate for policy enhancements and increased funding to improve the healthcare delivery system for SMC in Kita, Mali.

The Ministry of Public Health and Hygiene plays a crucial role. By highlighting SMC’s successes in similar settings and urging the integration of these strategies into national policies, supported by evidence, we can persuade the MoH to prioritize improved healthcare delivery mechanisms for SMC, ultimately enhancing child health in Kita.

Collaborating with the Malaria Consortium offers technical expertise and resources, which could amplify our efforts, ensuring the program’s best practices and enhancing our advocacy and fundraising capabilities.

Community Health Workers (CHWs) face challenges due to inadequate resources and training, particularly concerning SMC. Enhanced education and financial support for CHWs can bridge the gap between communities and healthcare services, allowing higher community engagement and effective delivery of health interventions.

Engaging local community leaders, such as village heads, through informational sessions and providing them with educational materials can foster community support and amplify SMC acceptance.

Caregivers of children under five are central to the success of the SMC program; Engaging caregivers through targeted awareness campaigns and providing clear, simple information about SMC’s benefits can foster trust and increase program uptake.

Lastly, the Global Fund’s role is also crucial. By crafting detailed proposals that resonate with their strategic objectives, we can secure the necessary funds and support to expand our SMC initiatives effectively.

The fight against malaria in Kita requires collective action to overcome logistical and educational barriers, ensuring all children under five are not just survivors but thrivers in the face of malaria. By uniting stakeholders, from government officials to local communities, we can transform the landscape of malaria prevention in Mali, ensuring a healthier future for the most vulnerable. Join us in this critical mission to combat malaria and safeguard our children’s futures