Affirmative Case Areas

STRENGTHENING PUBLIC HEALTH INFRASTRUCTURE

Sub-Saharan Africa lacks basic and effective public health infrastructure.[1]

A recent examination published by the World Economic Forum shows more than half the population of Sub-Saharan Africa lacks access to even basic health care services, either because they cannot afford them or because services simply do not exist in their communities.[2]
The World Bank estimates that more than half of donated drugs and medical supplies never get to the people they are intended for because the region lacks sufficient health care workers and clinics.[3]
Collapsing public health infrastructure not only undermines the ability to care for sick patients, resulting in death, but also undermines the ability to monitor and prevent the outbreaks of more deadly pandemics such as the avian flu.
A lack of medical personnel is a major problem in Sub-Saharan Africa. Doctors often move to the United States, Canada, or the United Kingdom where the standard of living is considerably higher than Sub-Saharan Africa. During the 1990s, 1,200 physicians were trained in Zimbabwe; only 360 were still practicing in Zimbabwe in 2001.[4]

Structural adjustment programs implemented in the 1990s which reduced spending on things like health in order to make debt repayment a priority reduced spending on public health infrastructure.[5]

The focus of grants on fighting specific diseases such as HIV/AIDS have reduced foreign assistance spending on the development of basic health infrastructure.[6]

Donors should focus on ways to improve the public health infrastructure and how to sustain the infrastructure once foreign aid decreases.

PREVENTING AND TREATING HIV/AIDS

HIV/AIDS is the leading cause of mortality in Sub-Saharan Africa:

Some 70 percent of the global total of HIV-positive people - 28.5 million people - live in Sub-Saharan Africa.[7]
In seven Sub-Saharan countries, one-in-five adults is living with HIV; in an additional five countries the adult HIV infection rate is higher than one in 10.[8]

20 million Africans are likely to die of AIDS by 2020.[9]

In addition to the enormous death toll HIV/AIDS has on the population, it also threatens development by depriving individuals of the most productive years of their lives.[10]

Increase Funding. A recent UNAIDS study reports that more funding is needed to fight HIV/AIDS. While $14.9 billion was needed to fight HIV/AIDS in 2006, only $8.9 billion was provided.[11]

Prevention. Increasing support for prevention programs involves things like education and condom distribution. Prevention programs in a number of Sub-Saharan African countries including Kenya, Uganda, and Senegal have proven effective.[12]

Treatment. ARVs (antiretroviral drugs) significantly slow the process that transforms HIV into full-blown AIDS. These therapies have been very effective at arresting AIDS development in the West, but in Africa more than 85 percent of those with HIV do not have access to these drugs.[13]

The protection of intellectual property is a huge issue related to ARVs. Large drug companies that make the ARV drugs have patents on the drugs that prevent copying and making them into less expensive generic drugs. Affirmative teams could increase HIV/AIDS treatment by increasing the number of generic drugs available to Sub-Saharan Africa.

U.S. Policy. In January 2003, Bush announced the Emergency Plan for AIDS Relief (PEPFAR). PEPFAR focuses on prevention, treatment and care for HIV/AIDS patients. PEPFAR promotes an ABC model (Abstinence, Be Faithful, or Use Condoms). Cook argues that the abstinence focus has reduced condom distribution because 2/3 of the money must be spent on abstinence or "be faithful" programs.[14] Affirmatives could increase public health assistance by removing this requirement.

PREVENTING AND TREATING MALARIA

Some 315 million to 450 million cases of malaria occur worldwide, and most are in Sub-Saharan Africa.[15]
Although it is treatable, nearly 1 million Africans die of the disease each year.[16]
71 percent of the victims are under 5 and 10 percent of maternal mortality is due to malaria.[17]

According to the Centers for Disease Control and Prevention, the primary factors prohibiting the eradication of malaria in regions like Sub-Saharan Africa are both technological and political: 1) The emergence of resistance to inoculation and the insecticides made available to these countries, 2) wars and massive population movements, and 3) lack of community participation.[18]

Prevention.

Dichloro-diphenyl-trichloroethane (DDT) is very effective at preventing malaria by killing malarial mosquitoes. Several global initiatives have developed to eradicate malaria worldwide. For example, the World Health Organization (WHO) began an effort to eradicate the disease by spraying with residual insecticides, using anti-malarial drug treatment and promoting education about the disease. Unfortunately, most of Sub-Saharan Africa was simply excluded from the campaign.[19]

Bed nets can also be used to prevent malaria. Currently, 15 percent of African children sleep under a net, but only 2 percent sleep under nets that are regularly treated with insecticide. Studies have found that if 60 percent or more of the population in a given area sleeps under insecticide treated bed nets, malaria will decrease overall and as many as one-quarter of all child deaths will be prevented.[20]

Treatment. Treatment of malaria usually involves several doses of antimalarial drugs. When properly treated, someone with malaria can expect a complete cure. There are several drugs used to treat malaria.

Chloroquine is inexpensive and until recently was very effective. This made it the antimalarial drug of choice for many eyars in most parts of the world. However, not many forms of malaria are resistant to chloroquine. Over the past decade, the new group of anti-malarias, ACTs, have been deployed on an increasingly large scale.

The poor level of quality control over anti-malarial drugs has been a key problem. Incomplete treatment, incorrect dosages, and counterfeit drugs have lead to an increase in the rate of resistance.[21]

INCREASING INFECTIOUS DISEASE CONTROL

According to the World Health Organization, 90 percent of all infectious disease deaths are caused by 6 diseases: TB, malaria, HIV/AIDS, pneumonia, diarrheal disease, and measles.[22]

Limited public health budgets have taken a toll on basic infrastructure to control disease.

In many cases, countries have abandoned the training of medical workers and volunteers and have not built medical facilities in years.
In some cases, the lack of public health funds has forced governments that previously offered free health care to charge for such services. As a result, the extremely poor have lost access to health care entirely.
In addition, most countries have no monitoring or surveillance program for communicable disease.

The spread of infectious diseases can occur so rapidly and have such a dramatic impact on countries that the spread of such disease are likely to trigger state collapse and civil conflict. Travel means that these diseases could spread very quickly.

IMPROVING PRENATAL HEALTH CARE

A lack of prenatal care threatens child survival:[23]

Over 2 million babies die before their first birthday every year in Sub-Saharan Africa.
Sub-Saharan Africa accounts for 25 percent of the world's newborn deaths.

According to the World Health Organization (WHO), the top three causes of newborn death are preventable: infection, birth asphyxia, and preterm births.

The WHO reports that Sub-Saharan African countries spend on average, $0.58 per person on maternal, newborn and child health services. This means that a majority of the population, especially those living in rural and remote areas, do not have access to maternal care either because those services simply do not exist in their communities or because they are too expensive to afford.

If Sub-Saharan African countries spent $1.97 per person, they could provide 90 percent of women and children in their country with prenatal care. This would include vaccination, STI treatment, and lesson in birth and emergency care.

DECREASING VACCINE PREVENTABLE DEATHS

There are a number of diseases in Africa that are easily preventable through vaccines. These include the measles, neonatal tetanus, whooping cough, diphtheria, polio, meningococcal disease and pneumonic disease. Unfortunately Sub-Saharan Africans do not receive the recommended vaccinations:

In 2004, only half of Sub-Saharan African children received the recommended vaccinations.[24]
Vaccines preventable diseases killed over one million African children in 2005, approximately half of the vaccine preventable child deaths in the world.[25]

The World Bank's estimated that child immunization is one of the most cost-effective health interventions available. Four vaccines (polio, diphtheria, pertussis, and tetanus) that are routinely given through the WHO's Expanded Programme on Immunization can together be given for no more than about $20 in developing countries.[26]

Other organizations that work to increase children's access to vaccines in poor countries: Global Alliance for Vaccines and Immunizations (GAVI) and the International Finance Facility for Immunization (IFFI).

IMPROVING MENTAL HEALTH CARE

Mental health is increasingly seen as fundamental to physical health and quality of life. In order to improve overall health and well-being, mental health needs to be addressed:

The World Health Organization estimates that mental health disorders make up more than 12 percent of all diseases, and will likely rise to 15 percent by 2020, making it the second largest disease burden worldwide.[27]
Sub-Saharan Africa currently has the third highest disease burden from mental disorders in the world.[28]
It is difficult to get mental health care in Sub-Saharan Africa. In many countries there is one psychiatrist of every half million people. Other countries have no mental health professionals at all.[29]
Experiences with genocide, poverty, and conflict can easily lead to unresolved grief, post traumatic stress disorder, substance abuse, and depression.[30]
Because distressing events affect such a large number of Sub-Saharan Africans, if left untreated, the African population will be made up of deeply traumatized and unstable people.[31]

To solve the problem, efforts are being made to train mental health care workers and bring them to local communities. Dr. Fred Kigozi, Director of the Butabika National Referral and Teaching Hospital in Kampala is testing the use of rehabilitation villages. Here mental health patients are sent to camps where health care professionals provide them with treatment and closely monitor their progress.[32]

INCREASING ACCESS TO CLEAN WATER

Currently, only 55 percent of the population in Sub-Saharan Africa has access to clean water.[33] The lack of clean water contributes to health problems and costs the continent billions annually:

Unsanitary water leads to the spread of diarrhea, a disease that in developing regions accounts for over 90 percent of deaths in children under 5. [34]
Improved water supply reduces diarrhea morbidity by 25 percent.[35]
According to WHO, lack of drinking water and sanitation kills about 4,500 children a day.[36]

The WHO estimates that better drinking water and sanitation would lead to health care savings of US $7 billion per year for health agencies and US $340 million for individuals.[37]

Household water treatment, such as chlorination at the point of use, solar disinfection, and water filters have been promoted in some African countries. For example, in Madagascar, locally produced hypoclorite, has been used by 18 percent of all households since its introduction in 2000.

According to the WHO, improvements in drinking water quality through household water treatment leads to a reduction of diarrhea episodes by 39 percent. [38]

COMBATING VITAMIN DEFICIENCY

A lack of basic vitamins and minerals in the diet is damaging the health of Sub-Saharan Africans. A report by the World Economic Forum find that a lack of key vitamins and minerals is responsible for impairing intellectual development, compromising immune systems and causes birth defects.[39]

The World Economic Forum maintains that whole populations can be protected against vitamin and micronutrient deficiencies inexpensively:

Food Fortification: Adding essential vitamins and minerals to foods that are regularly consumed by most people (such as flour, sugar, salt, etc.). This costs only a few cents per person per year.
Supplementation: Providing vulnerable groups (particularly children and pregnant women) with vitamin and mineral supplements. This costs only a few cents per person per year.
Education: Informing communities about the kinds of foods that can increase the intake and absorption of needed vitamins and minerals.
Fresh Vegetables: Providing families with vegetable seeds. The Grameen Bank found success with this method in India, virtually eliminating night blindness (caused by Vitamin A deficiency) in several communities.
Disease Control: Decreasing the incidence of diseases like malaria, measles, diarrhea, and other infections can help the body to absorb and retain essential vitamins and minerals.

DECREASING DOMESTIC ABUSE

Violence against women is a widespread problem in Sub-Saharan Africa:

Surveys conducted in Sub-Saharan Africa reveal that between 40 and 60 percent of women report regular physical abuse.[40]
Violence has a significant impact on the health and life expectancy of women. The World Bank estimates that violence against women accounts for 5 percent of healthy years of life lost to women in developing countries.[41]

Domestic violence can have long-term psychological effects. According to some estimates, one out of every four suicide attempts by a woman is preceded by abuse.[42]

Children in abusive households also suffer from the effects of violence. Children who witness violence may experience depression, aggression, nightmares, and other symptoms.[43]

[1] The U.S. Department of Health and Human Services defines public health infrastructure as, "the resources needed to deliver the essential public health services to every community-people who work in the field of public health, information and communication systems used to collect and disseminate accurate data, and public health organizations at the State and local levels in the front lines of public health." [http://www.healthypeople.gov/Document/HTML/Volume2/23PHI.htm]

[2] Neelam Sekhri, "From Funding to Action: Strengthening Healthcare Systems in Sub-Saharan Africa," World Economic Forum White Paper, 2006.

[3] David Hirchmann, "Aid Dependence, Sustainability, and Technical Assistance," Public Review, Vol. 5, 2004.

[4] Lehmann and David Sanders, "Human Resource Development," South African Health Review, 2002.

[5] Ezekiel Kalipeni, "Better Health in Africa: Experience and Lessons Learned by World Bank," African Studies, Vol. 40 No. 1, April 1997.

[6] Laurie Garrett, "The Challenge of Global Health," Foreign Affairs, January/February 2007.

[7] "The Aids Pandemic in the 21^st Century," Global Population Profile: 2002, The U.S. Census Bureau, 2006. Available at http://www.census.gov/ipc/prod/wp02/wp-02006.pdf.

[8] Ibid.

[9]Nicholas Cook, "AIDS in Africa," Congressional Research Service, 2006.

[10] Robert Rotbert, Africa: Progress and Problems-AIDS and Health Issues, (New York: Mason Crest Publishers, 2006).

[11] Nicholas Cook, "AIDS in Africa," Congressional Research Service, 2006.

[12] "Action Today, A Foundation for Tomorrow: Second Annual Report to Congress on PEPFAR," USAID, 2006.

[13] Nicholas Cook, "AIDS in Africa," Congressional Research Service, 2006.

[14] Ibid.

[15] Jason L. Riley, "Biting Back," The Wall Street Journal, April 4, 2007.

[16] Ibid.

[17] Robert Rotbert, Africa: Progress and Problems-AIDS and Health Issues, (New York: Mason Crest Publishers, 2006).

[18] "Frequently Asked Questions about Malaria," Fact Sheet, Centers for Disease Control and Prevention, February 2005. Available at http://www.cdc.gov/malaria/faq.htm

[19] There have been other institutional roadblocks to Africa's eradication of malaria. In addition to the factors indicated elsewhere in this paper, African governments also faced resistance to DDT by environmental groups in the developed world who were willing to put politics before health.

[20]"Malaria," The UNICEF-UNDP-World Bank-WHO Special Programme for Research and Training in Tropical Diseases, 2006; "Traditional Economy of the Kavango", Economist Documentary, 2007.

[21] "Malaria," The UNICEF-UNDP-World Bank-WHO Special Programme for Research and Training in Tropical Diseases, 2006.

[22] Susan McGugh, "Health in Developing Countries The U.S. Response, 2001.

[23] "Opportunities for Africa's Newborns," World Health Organization, 2006.

[24] World Development Indicators, 2007.

[25] "Weekly Epidemiological Record, World Health Organization, May 2006.

[26] GAVI Alliance, 2006.

[27] "Promoting Mental Health," World Health Organization, 2005.

[28] "Disease Control Priorities Related to Mental, Neurological, Developmental, and Substance Abuse Disorders," World Health Organization, Disease Control Project, 2006.

[29] William Eagle, "Underdevelopment and Conflict Plague Efforts to Improve Mental Health Care in Africa," VOANews, June 2, 2007.

[30] Ibid.

[31] Ibid.

[32] Ibid.

[33] "The State of the World's Children," UNICEF, 2007.

[34] "Water for Life," World Health Organization, 2005.

[35] Ibid.

[36] Ibid.

[37] Ibid.

[38] Ibid

[39] "Reducing Vitamin Deficiency Can Improve World Economy," UNICEF, 2004.

[40] K. Wood, R. Jewkes, "Violence, Rape, and Sexual Coercion: Everyday Love in a South African Township," Gender and Development, 1997.

[41] Heise LL, PitanguyJ, and Germain A. "Violence Against Women: the Hidden Health Burden," World Bank Discussion Papers, No. 225, 1994.

[42] Ibid.

[43] Ibid.