Public health assistance to Sub-Saharan Africa

The population of sub-Saharan Africa (a region composed of forty-seven nations south of the Sahara Desert, such as Botswana, Kenya, Nigeria and Uganda) has suffered under the burden of infectious disease for decades. HIV/AIDS, malaria and tuberculosis cause millions of deaths in the region each year despite the availability of effective preventative measures and treatments throughout the developed world. Beyond the death toll, these diseases damage the social, economic and educational infrastructures throughout the region, further perpetuating the public health crisis.

Most advocacy groups consider foreign aid from the United States essential to combat infectious disease in sub-Saharan Africa. Currently, U.S. initiatives such as the President's Emergency Plan for AIDS Relief, the U.S. Leadership Against HIV/AIDS, Tuberculosis and Malaria Act and USAID are providing aid to the region.

Understanding the Discussion

Antiretroviral (ARV) Drugs: Medicines that block the replication of retroviruses such as HIV. Retroviruses have a genome made up of ribonucleic acid (RNA), instead of deoxyribonucleic acid (DNA), which is found in human cells. In order to infect a human immune system cell (T cell), HIV must copy its RNA sequence into DNA. The term "retro" comes from the order of this copying process, which occurs in the reverse of the typical DNA-to-RNA movement of genetic information. Antiretroviral drugs do not cure HIV positive-people, but they do improve their health by lowering viral loads.

Brain Drain: The phenomenon by which locally trained African medical professionals migrate to developed nations to practice medicine. The availability of advanced training, increased salaries and better working conditions often attracts newly qualified medical personnel to the United Kingdom and New Zealand.

HIV/AIDS: HIV stands for "human immunodeficiency virus"; AIDS stands for "acquired immune deficiency syndrome." These diseases are contracted through the exchange of bodily fluids, most typically through sexual intercourse and blood transfusions. About 22 million people are living with HIV. HIV/AIDS claims 1.5 million lives in sub-Saharan Africa every year. There is no cure for HIV/AIDS, but effective treatments are available.

Malaria: A disease caused by a blood parasite of the genus Plasmodium. The parasite is transmitted via infected mosquitoes. Symptoms include fever, chills, vomiting, blood in the cough, and coma. It is extremely treatable, but should be treated as an emergency.

Sub-Saharan Africa: The region of Africa below the Sahara Desert. This term is contentious, as some nations are both above and below the Sahara border. The World Bank and other organizations define sub-Saharan Africa as forty-seven autonomous nations. They are Angola, Benin, Botswana, Burkina Faso, Cameroon, Cape Verde, Central African Republic, Chad*, Comoros, Democratic Republic of Congo, Côte d'Ivoire, Equatorial Guinea, Eritrea, Ethiopia, Gabon, the Gambia, Guinea, Guinea-Bissau, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali*, Mauritania*, Mauritius, Mozambique, Namibia, Niger*, Nigeria, Republic of Congo, Rwanda, Sáo Tomé & Príncipe, Senegal, Seychelles, Sierra Leone, Somalia, South Africa, Sudan*, Swaziland, Tanzania, Togo, Uganda, Zambia, Zimbabwe (* = nations that have territory both above and below the Sahara border).

Tuberculosis: A disease caused by the bacteria Mycobacterium tuberculosis. The most common form is pulmonary tuberculosis, the symptoms of which include blood in the cough, chest pain, chills, fatigue, loss of appetite and subsequent weight loss, sweating and a persistent cough. Tuberculosis used to be called "consumption." Tuberculosis requires antibiotic treatment, and claims millions of lives around the world every year.

History

Humanity has always struggled with infectious diseases. Malaria, for example, has been a problem throughout recorded human history. In the Middle Ages, people believed that breathing in sour swamp air caused malaria. While malaria has been largely controlled in developed nations, sub-Saharan Africa has accounted for the largest number of malaria infections in recent decades.

Of the 300-500 million cases of malaria worldwide each year, one million deaths occur, 90% of which occur in sub-Saharan Africa. An African child falls prey to the disease every minute. However, malaria is highly treatable, as evidenced by the fact that the United States and other Western countries eliminated the disease from their shores nearly a hundred years ago. However, the cost of the drugs to treat malaria is prohibitive for most Africans, and Africans with malaria are often unable to work and raise funds for treatment.

Experts believe that tuberculosis has existed for nearly 20,000 years. Often referred to as consumption because it appeared to destroy a person from the inside out, tuberculosis persists on a worldwide scale. However, most Western nations had controlled the spread of tuberculosis until the 1980s, when new strains of the disease began to appear. These strains affected sub-Saharan Africa and the rest of the world, causing an international health emergency.

Each year, over one million cases of tuberculosis (TB) affect sub-Saharan Africans. Approximately 10 percent of those infected with TB will become ill. Additionally, the presence of HIV/AIDS exacerbates the condition of those with TB; the reverse is also true. TB claims over 2 million lives around the world annually, and another 8 million contract the disease. It has been projected that over the next fifteen years, tuberculosis will kill 30 million people throughout the world. Children are more likely to die from tuberculosis. The region's damaged infrastructure and prohibitive economic conditions allow the disease to persist in sub-Saharan Africa.

HIV/AIDS was only discovered in 1980, though reported cases appeared as early as 1959. While the taboo associated with HIV/AIDS initially stifled efforts to curb the disease in Western nations in the 1980s and early 1990s, education regarding preventative measures and the spread of the disease significantly stemmed the number of new cases. Furthermore, the development of antiretroviral drugs has increased the life expectancy of most patients in developed nations. However, sub-Saharan Africa has not benefited from either of these advances, due to the lack of sexual health education and the high cost of antiretroviral drugs.

The HIV/AIDS pandemic in sub-Saharan Africa has taken the most significant toll on the infrastructure of the region. As adult workers die from AIDS complications, the number of available workers able to contribute to the economy declines. Often included in this toll are educational and health workers, who could help curb the pandemic through education and treatment.

In sub-Saharan Africa, nearly 23 million people are infected with HIV/AIDS. Another 1.5 million die as a result of complications of AIDS every year. A total of 17 million sub-Saharan Africans have died from the disease. Though only a small percentage of the world's population resides in sub-Saharan Africa, about two-thirds of the world's HIV/AIDS population lives there. HIV/AIDS has caused more deaths than all of the violent conflicts in the region many times over. It has reduced life expectancy to only forty years in several sub-Saharan African nations.

While the disease is rampant among adults, children are also affected: over 13 million sub-Saharan African children have been orphaned as a result of the epidemic. Experts suggest that HIV/AIDS will produce as many as 40 million orphans in only a few years. It is expected that there will be more teenagers than legal adults in sub-Saharan Africa in less than fifteen years. However, new infection rates showed a marked decline in the first decade of the twenty-first Century. Between 2001 and 2010, the number of new HIV infections in sub-Saharan Africa fell 25 percent, from 2.4 million in 2001 to 1.8 million in 2010.

The effect of infectious diseases throughout sub-Saharan Africa was largely ignored by the United States government and other nations through the early 1990s. In 1999, the World Health Organization (WHO) reported that HIV/AIDS had negatively impacted the life expectancy in sub-Saharan Africa, and had exacerbated the spread of tuberculosis and malaria.

A worldwide response to the widespread presence of infectious diseases such as HIV/AIDS, malaria and tuberculosis in sub-Saharan Africa was not initiated until the twenty-first century.

Public Health Assistance to Sub-Saharan Africa Today

In 2001, the United Nations reported that two-thirds of all AIDS-related deaths occurred in sub-Saharan Africa. That year, South Africa declared a state health emergency. In 2003, United States President George W. Bush began a health initiative called the President's Emergency Plan for AIDS Relief (PEPFAR). PEPFAR has helped to pay for antiretroviral treatments for AIDS patients in over ten African nations. On May 31, 2007, President Bush announced that he would provide $30 million in U.S. public assistance over five years to the global fight against HIV/AIDS.

On May 23, 2005, President Bush signed the U.S. Leadership Against HIV/AIDS, Tuberculosis and Malaria Act into law. The act was designed to fight infectious diseases throughout sub-Saharan Africa. Specifically, it provides funding for preventative education, and allocates treatments based on need.

The United States federal agency USAID has directed funds to fight HIV/AIDS in sub-Saharan Africa. The organization has also helped to re-develop the infrastructure of the damaged region by establishing standards for free trade between it and the United States. It has also intervened in a number of the violent conflicts within the region, which often prevent patients from getting the treatment they need.

The Institute of Medicine has proposed a subsidy to buy medication from large pharmaceutical corporations to treat malaria. Various pharmaceutical companies have refused to increase their production of anti-malarial medications unless the medications were ordered in bulk. The Institute of Medicine, a governmental scientific organization, also proposed that the subsidy be utilized to provide the medications to the population of sub-Saharan Africa at a discounted rate of just 10 cents per dose.

Numerous agencies and experts have noted that the situation in sub-Saharan Africa will not improve unless the region's infrastructure is addressed. Currently, the medical, educational and governmental systems in place in sub-Saharan Africa are damaged and sometimes corrupt.

The medical establishment throughout sub-Saharan Africa has experienced a shortage of health professionals, such as doctors, nurses and anesthetists. In Ghana, for example, there are only nine doctors for every 100,000 people. Tanzania's shortage is even more extreme: there are only two or three doctors for every 100,000 people. In Zimbabwe, nearly a quarter of all medical positions are unfilled. Such statistics are common throughout sub-Saharan Africa: Zimbabwe, Ethiopia and Uganda have all named the lack of trained health providers as a major impediment to fighting infectious disease.

Such shortages are typically attributed to the "brain drain" phenomenon. This refers to the migration of locally trained health professionals from throughout sub-Saharan Africa to New Zealand, the United Kingdom and the United States. Factors such as salary and working conditions drive these professionals to migrate to developed countries. In 2003, the United Kingdom absorbed thousands of trained health professionals from countries in sub-Saharan Africa.

However, brain drain is not the only factor depleting the number of available trained health professionals in sub-Saharan Africa. Infectious diseases, such as HIV/AIDS, have taken their toll on medical professionals. In Zambia, more medical professionals were lost to HIV/AIDS than migration over the last two decades.

The broken educational system also contributes to the pandemics. Because the various illnesses have resulted in the deaths of numerous educators, the availability of basic and sexual health education in Africa is marginal at best. Without the necessary education, new health providers cannot be trained and the increasingly young public will not learn how to prevent or address infectious diseases. Furthermore, children orphaned by the diseases are often unable to attend school.

Corrupt governments and unaccounted expenses may have potentially undermined the efforts of various aid organizations. The Global Fund to Fight AIDS, Tuberculosis and Malaria had to temporarily cancel its funding to Uganda because a large portion of money was unaccounted for. Officials suspected that large portions of the fund were funneled to government officials, political campaigns and unauthorized travels rather than the medical and social expenses for which the funds were intended. Sub-Saharan Africa also absorbed millions of unaccounted dollars from the World Bank and PEPFAR. Experts have suggested that the region's infrastructure must be addressed before more aid is provided.

When West Africa faced an Ebola epidemic in 2014, the United States committed more than $175 million to assisting the affected nations. The US Africa Command participated in transporting supplies, building treatment centers, and training healthcare workers in Ebola treatment. USAID also provided Ebola prevention kits to communities and families. The effectiveness of such efforts was called into question, with some arguing that donations made and programs instituted in response to an existing emergency were too little, too late for countries with weak public health infrastructures, where in many cases much of the population lacked access to hospitals and medical professionals equipped to handle treatment were scarce. The CDC itself warned that the lack of trained staff could render the new treatment centers useless. Regardless, the World Health Organization (WHO) declared an end to the epidemic in January 2016.

The United States currently contributes the most to the fight against infectious diseases in sub-Saharan Africa in pure dollars. However, the United States only offers .1575 percent of its gross national product per year, the least of any developed nation. Experts have advocated for a worldwide fund drive to address the health disparities in sub-Saharan Africa; the suggested tab for the drive is $20 billion per year in foreign aid. The elimination of Africa's foreign debt (over $350 billion), which could potentially help the continent address its health issues, has also been called for.

These essays and any opinions, information or representations contained therein are the creation of the particular author and do not necessarily reflect the opinion of EBSCO Information Services.

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