|AUF GENERAL POLICY ON AFRICAN HEALTH
A FUNDAMENTAL SHIFT FROM A COLONIAL HEALTH STRUCTURE
The AUF recognizes the need for public dialogue on African health. Connections between environment and health are now firmly established in scientific discourse. It is important to systematise the attitudes of local African authorities in the management of health.
The decisions by authorities must be informed by an integrated approach to health matters, that is applicable in their communities. They must be made aware of the historic relations between African disease and neocolonial repression, as well as the methods that are respectful of African values. These are the central root to the problem of African health, that has to be addressed and not the periphery consequences and other secondary issues.
The neocolonial and anti-African health regimes are characterised by the lack of transparent transgenerational accounting in health matters, by failure of corporate social responsibility, by weak environmental law, and by the effects of economic habits of neocolonial consumption. The adverse and direct effects on Africa's life support system have to be reversed if Africans are to enjoy the great health that once made Africa famous for the remarkable achievements of profoundly healthy communities.
Health is integral to the cultural and social mores of all African communities. Health has suffered under the repressive structure of neo-colonial domination and the conflict it generates. Health management in Africa has become a repressive model of production, and anti-community development, and in many cases serves the extreme exploitation of the Africans by foreign interests. The corporate pharmaceuticals, population control lobbies, and foreign religious establishments, have put the Africans at risk of every form of infection and injury.
RESTRUCTURING HEALTH MANAGEMENT IN THE AFRICAN UNION:
The AUF supports efforts to create a single All-Union agency with the mandate to oversee and co-ordinate the integration and evaluation of health management in the African Union, including funding and augmentation of physians associations, and health care facilities. The Council will regulate the administration and evaluation of pharmaceutical regimes, monitor drug safety and efficacy, as well as review birth control, infection control and disease management programs across the African Union and the African Diaspora. The Council will set the standards for proper conduct of the international epidemiological studies, genetic research, and international relief operations, and ensure that development activities do not compromise the health of African communities.
THE CASE OF NIGERIA
In December 1999 the Nigerian government issued a directive to stop all public officials including the President, from seeking medical treatment abroad as first recourse. To serve as acceptable alternative, President Olusegun Obasanjo gave orders for the upgrade of six Federal teaching hospitals to international standards.
There is need for increasing the capacity of public health to meet an increasingly diverse array of public health challenges.
Many major health threats in Africa are still associated with poor hygiene and poor sanitation (e.g., cholera, typhoid), diseases associated with poor nutrition (e.g., pellagra and goiter), poor maternal and infant health, and diseases or injuries associated with unsafe workplaces or hazardous occupations (e.g., construction).
Chronic diseases (e.g., cardiovascular disease and cancer) are increasing. Community action to address public health issues must foster public support for the growth of institutions that are components of the public health infrastructure.
The focus of public health research and programs must shift to respond to the effects of chronic diseases on the public's health. While continuing to develop and refine interventions, and enhancing morbidity and mortality surveillance, we must strive to improve the capacity of epidemiology and to increase public health training and programs.
African Epidemiology, the population-based study of disease and an important part of public health, must acquire greater quantitative capacity. The inadequacy of both study design and periodic standardized health surveys have resulted in false statistics and misdirected energies in the fight to control all kinds of infection.
Methods of data collection, from simple measures of disease prevalence (e.g., field surveys) to complex studies of precise analyses (e.g., cohort studies, case-control studies, and randomized clinical trials) must be augmented.
High-powered statistical tests and analytic computer programs are still unaffordable, and coupled with the underfunded research institutions in Africa, it is still hard for multiple variables collected in large-scale studies to be measured and for the development of tools for mathematical modeling. Advances in epidemiology have not permitted elucidation of risk factors for AIDS, heart disease and other chronic diseases, nor have they led to success in the development of effective interventions.
Few communities in Africa have ever undergone a population-based survey that included a focus on chronic disease as well as estimates of disease prevalence for major causes of death, or measured the burden of infectious diseases, assessed exposure to environmental toxicants, or measured the population's vaccination coverage.
Other population-based surveys (e.g., Behavioral Risk Factor Surveillance System, Youth Risk Behavior Survey, and the National Survey of Family Growth) were developed to assess risk factors for chronic diseases and other conditions, OUTSIDE Africa, and many of these simply projected onto African communities without regard for intrisic differences in social mores. The pressure to explain the AIDS scourge for instance led to the propagation of the view that Africans have loose sexual mores...yet on a closer examination...the rate of death from HIV infection in Africa is mathematically impossible. There is no way that the death rate can be accounted for merely by the virus. The lack of proper survey methods has resulted in a lot of mistrust between African leaders and the international scientific establishment.
African statisticians and scientists need to develop methods to address issues such as sampling and interviewing techniques should enhance survey methods used in epidemiologic studies. The resources for disease monitoring across the African Union are too meagre. They must be augmented.
The African Union must authorize the collection of morbidity reports on disease for use in quarantine measures, and provide funds to collect and disseminate these data, to expand authority for weekly reporting from contituent states and community authorities, and to provide forms for collecting data and publishing reports.
The use of an annual summary of diseases in Africa must included reports of all major diseases from all the states, regions, and districts. All states, must participate in the reporting of diseases. The AU must enable the an organization of African epidemiologists to determine which diseases should be reported to the AU Commission for Health (which does not exist at this time). Efforts at surveillance that focus on tracking persons with disease, must be combined with tracking trends in disease occurrence.
Today US and Geneva based Centers for Disease Control and Prevention (CDC) and UN medical arms have assumed responsibility for collecting and publishing African data on diseases.
The number of schools and students of public health in Africa needs to be increased. It is necessary to change the certification structures for public health students, and requirements for people to have prior medical degrees that take too long and require study abroad have to be discarded. The post graduate education outside Africa is designed to accomodate concerns about the job market in those countries, it is harder and harder to obtain medical degrees in some countries...and African students go through the same processes even if in fact they would have ready jobs if they spent less time in medical school. They are needed desparately at home...yet many stay abroad trying to acquire more and more qualifications to guarantee employement.
Medical training does not have to be a second degree, and in must instead be a primary health discipline). Schools of public health must emphasize the study of: hygiene and sanitation; public health (including biostatistics, epidemiology, health services administration, health education/ behavioral science, and environmental science). Programs must provide field training in epidemiology and public health.
The process of certifying training of physicians in public health administration, and allow for a large number of local health departments to run accredited preventive medicine and public residency programs.
The African Union must develop surveillance protocols to guard against dumping of toxic waste on African soil and in African and international waters. Budgeting for environmental health, waste management and radiation control must be integral to all public administration.
It is necessary to establish regional and local health boards all across Africa...and to include community leaders in health planning, regulation of health care and emergency services, and health statistics). Communities in Africa must have easy access to public health laboratories that provide direct services and oversight functions (assessment, policy development, assurance, study rural health)
Public health resources represent a small proportion of overall health-care costs. The public health infrastructure should allow for organized and systematic observations through morbidity and mortality surveillance, well-designed epidemiologic studies and other data to facilitate the decision-making process, and individuals and organizations to advocate for resources and to ensure that effective policies and programs were implemented and conducted properly.
Public Health Goals for Africa
-- Motor-vehicle safety
-- Safer workplaces
-- Control of infectious diseases
-- Healthier mothers and babies
-- Control of coronary heart disease and stroke
-- Safer and healthier foods
-- Drinking-water safety
-- Elimination tobacco and other health hazards
THE COMPASSION INDUSTRY
Although medical staff at Africans hospitals are well-trained, they often lack basic supplies such as medicine and bandages.
There is lack of coordination in the material donations of made to African hospitals. There are no established procedures on selection of drugs, nor what the quality assurance and shelf-life for certain drugs are. A significant percentage of donated supplies are expired on arrival. A lot of the drugs are unidentifiable or irrelevant.
There are numerous NGOs across Europe and America, such as the National Society of Collegiate Scholars, that organize collection of medical supply donations for the District Government Hospital in Ho, Ghana. NSCS sent its first 200-pound shipment Spring Quarter and is preparing to send a one ton shipment by the end of this quarter.
Currently, NSCS has collected about 1,500 pounds of supplies and also plans to ship a ventilator and an electric cautery machine. Members are working to fill the Ghana hospital's wish list, which includes operating room lamps and a high-powered microscope.
International shipping lines generally agreed to ship the goods for reduced rates, and government agencies in Africa and help to clear customs regulations at the ports of entry.
In 1999 the Accra Premier Lions Club on Friday presented assorted items worth over five million cedis to the University of Ghana Hospital as its contribution to the Golden Jubilee Anniversary of the University. Items donated include catheters, infusions, ventilators for the lungs, blankets, bed-sheets, volumetric infusion pumps, a breast pump, laboratory and feeding bottles.
US and EU drain Africa of its Nurses
Hospitals in the United States face a severe shortage of registered nurses. Heavier workloads aimed at cutting costs have driven people away from the profession and few new replacements are attracted. Instead of increasing salaries and improving working conditions, however, U.S. hospital managers have looked to a solution they've used in the past. They've made an effort to lure new immigrant nurses from poorer countries where even modest U.S. salaries are attractive.
In doing so, they have increased the already great suffering of the Third World, and especially, in this case, Africa. At a time when the HIV/AIDS crisis is ravaging Africa, when the continent most needs its nurses, recruiting centers from the industrialized countries in Europe and North America are taking them away.
It's well known that African hospitals are already understaffed and in desperate need in this period. In Burundi, for example, a reporter saw people sleeping overnight on the floor in front of a clinic in order to be the first seen by a nurse the next day. Then they must wait again to be seen by a doctor.
Yet this desperate situation has not slowed down the global flow of talent from poor to rich lands. Recruiting offices promise a salary 20 times what can be made in Africa. They attract people even though the nurses who apply often have to travel for more than six hours--and then pay a $150 fee for their application.
The marketplace in humans
When most people hear the term "market," the first thing that pops up in their mind is some sort of material goods or commodities. But now you can't leave out human beings as part of that market.
Water, food, technicians, doctors, labor-saving equipment--all are in short supply in Africa. The only thing remaining is nurses. Now it's possible to steal these nursing services from Africa. Here is how it is done: If hospitals need nurses, they contact the nurse recruiter in Africa. In order to avoid negative publicity about a "brain drain" from Africa to the United States, the recruiters follow a complicated route.
There are already nurses from Nigeria and South Africa in Britain. There are nurses in the Netherlands from Ghana, Nigeria and other West African countries. To send a nurse to the United States, a recruiter will make a request to the Netherlands or Britain to find experienced nurses for the United States.
British and Dutch recruiting agencies, which operate within Africa, will offer high pay to Africans to bring them to Britain or the Netherlands. Before, nurses from South Africa had been sent directly to Britain. After the South African government complained to the British government, the agencies simply changed the target hospitals and sent these nurses directly to the Unites States.
Ghana: 300 graduate, 600 migrate
The U.S. and Western European hospital industry wanted Ghana, Nigeria and South Africa to play the same role that some Asian countries like the Philippines did a few decades ago: supply a great many nurses. The difference this time is that there was not even an agreement between the African governments and the big powers, as there was with the Asian governments. Almost 600 nurses were lured from Ghana in 2000-- nearly triple the number of departures in 1999, and more than twice the number of nursing graduates in Ghana in 2000.
It should be clear that the kind of fair exchange of medical information and skills--as is practiced between socialist Cuba and some of the African countries or Jamaica--has nothing to do with the theft of skilled people by the rich nations. Under these fair conditions both countries gain from the aid they give each other.
Africa has survived the slave trade, one of the harshest systems known to humanity, only to have to face colonial rule. During that colonial period the rule from abroad produced hardly any trained nurses and doctors. Almost all were trained after the countries of Africa won political independence. Now the industrialized countries, the former colonial rulers, have opened up a new trade in human beings that drains the African continent of its skilled health-care workers.
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