After a long silence

Hello everyone. It's been a while since I last posted on this blog due to some other activities that were really occupying my time. However starting next week I will start regular postings and will update you on all the various new and exciting things that I am engaging in with regard to health care both in Africa and health care as it relates to Africans in the United States. Furthermore this blog will have a new look and a lot of important links that will be of interest to you. Thanks for visiting my blog.

The Anti-Corruption Commission's report on health care in Sierra Leone

As I stated recently the Anti-Corruption Commission's Report has not yet been posted to their web site but I have posted it to an online folder for your benefit. I would not attempt to summarise it, but my impression after readng is that the entire health care system needs a major overhaul. Please read it and share your opinion. Few questions I would like to ask though are :
What in the report stands out as the greatest problem facing Sierra Leone's health care system? Can any one sector carry blame? Does Sierra Leone have the will and resources to follow through with the recommendations? Let's talk.
Innocent

District Councils (or Boards) of Health for Sierra Leone??

I believe that as part of its efforts to adequately address the health issues facing the country, Sierra Leone should enact the establishment of district councils (or boards) of health. Yes I know that a lot of people are tired of governments setting up so many councils, committees and boards that haven’t yielded much by way of improving the lives of people in the areas of interest, but for some reason, I just think in this case it might work.
Being that through devolution, management of local affairs is mostly delegated to district councils, I believe by having councils whose sole purpose it is to address the health care issues of the respective districts will go a long way. The councils will:
(1) Serve as primary advocates of the people of the respective district
(2) Educate Central/National government about specific needs of each district; better understanding of unique cultural and social dimensions
(3) Better understand the reasons for lack of utilization or access to health care (being members from that community) and make recommendations accordingly.
(4) Monitor with greater authority health care delivery by government’s secondary and tertiary centers, NGO’s, and medical practitioners.
(5) Maintain strong communication between health care delivery channels and the community
(6) Be accountable to the people they represent; the people in turn being closer to policy makers and be able to give input in their affairs
A centralized medical system have proven over the years to be short of stated goals, even with so much national and foreign government as well NGO financial and material input. Many reasonable explanations have been given by various observers but I think the one missing link could just be giving greater authority to the people through locally established district councils/boards (whatever name they choose to give it) of health.
What do you think? Do you think there is more to the problem than this? Do you think it would be unnecessarily politicized? Would this become another avenue for corruption or bureaucratic inefficiency?
Innocent

South Africa: Tests negative in second suspected swine flu case

There we have it. The second suspected case of swine flu in South Africa is negative. And reports indicate that there has been a substantial activation of a response systems across various African countries. Should we now relax and assume that all is well in Africa?

South Africa swine flu update: One negative; awaiting results from the other

Some sigh of relief as it is reported that tests so far are negative for one of the two suspected cases of swine influenza in South Africa. This was reported in an article titled No swine flue in SA? in the on line news outlet iafrica.com. As results are being awaited from the second case, doubts are being raised however about the adequacy of the specimen collected. We will follow up with appropriate authorities for a clear picture.

Africa's first cases of swine influenza in South Africa

OK folks, according to reports, two possible cases of swine influenza are being investigated in South Africa. Both patients have a recent history of travel to Mexico and symptoms consistent with the disease. What is even more alarming is that, the most economic, scientific and medically resourced country in Africa does not seem to be well prepared in the case of a national outbreak or a global pandemic. A report titled Southern Africa: not enough drugs to handle a pandemic is one that shows the extent of unpreparedness in that part of the world. With the current pandemic threat level raised by WHO to phase 5, just how much devastation could be done to the entire African population in the event of a pandemic is still unimaginable. Your thoughts.

How prepared is Africa should the swine influenza hit?

It is possible that by the time you finish reading this piece, the current data reported about suspected or confirmed cases of the swine flu may be old. So much information is filtering through; we have to constantly change our understanding of the level of threat posed by the current swine influenza. Consequently I have had to change the focus of my postings; the last one thrown out after the World Health Organization (WHO) raised the pandemic threat level to phase 4 defined as “sustained human to human transmission”. Furthermore a statement from the WHO Director General’s office states that focus should be on "mitigating" measures as "containment is not feasible".
Browsing through the maps and alerts as they are updated, I notice African countries been spared at least for now. In as much as I have some relief, I have serious concerns about how well prepared these countries are, should the disease reach the continent or were this to progress to a global pandemic level.
Africa, especially sub Saharan Africa is predominantly lagging behind in key indices of socio economic and human development. Lack of trained medical personnel, poor access to water, poor sanitation, poor health infrastructure and delivery systems are but just a few of the parameters that make the health capacities of these countries very precarious. In seemingly normal or more appropriately usual circumstances, the predominant infectious diseases like Malaria, Tuberculosis, and HIV/AIDS are constantly taking their toll on the population – in some cases dessimating entire communities and regions – and death from some commonly preventable diseases contribute to the low life expectancy. Without NGO’s and foreign government aid, most departments of health could not function or adequately address the health care needs of the respective countries.
It is thus important that African countries, in addition to maintaining membership of the World Health Organization be signatories to other international organizations and regimens for Disease control. One such regimen is the International Health Regulations (IHR). http://www.who.int/en/
Due to some events prior to but more importantly shortly after the SARS threat, the IHR in its current form (IHR 2005) was put in place as a regimen to “prevent, protect against, control and provide a public health response to the international spread of disease” in 2005 taking effect in 2007 in all member countries. It required member states to have minimum core public health capacities including notification of WHO of events constituting health emergencies of international concern. The three top priorities for member states were to establish functioning national IHR focal points, adhere to reporting requirements and verification of public health events and assess and strengthen national capacities. Decision instruments for assessment and reporting of unusual cases of influenza, among other diseases were established.
Having established that the current swine influenza is of the type A/H1N1 genetic strain, we now know that (at the time of writing this) it has been reported in all continents except Africa. Direct air transportation between Mexico and African countries is not as common it is with the rest of the world which is evident in the current pattern of spread. But the rate of current intercontinental travel means there is no safe zone on teh planet. How well African countries deal with the potential spread is dependent upon several factors; awareness by the general population of symptoms and seeking immediate medical care; adequate diagnostic tools for confirmation of the current swine influenza strain; availability of medication for treatment of possible mild cases as has been done in some of the countries reporing cases now; availability of vaccines for at risk individuals. It is not clear how much public awareness campaigns have been done to influence individuals to seek help as soon as they experience symptoms. Mass media outlets are not sufficiently available and accessible to most people, especially in rural Africa, so how public awareness campaigns affect immediate behaviour change in the present circumstance is uncertain. There is also a significant lack of health care facilities in most countries; and of those available, lack of equipment and personnel means numerous cases going undiagnosed and unattended to. At the time of writing, enquiries have already been sent to various agencies requesting data on African countries with regard to the minimum core public health capacities as outlined in the IHR. Furthermore it would be important to know which countries have activated systems for disease surveillance both within the resident population and at points of entry - land, air and sea - in the current situation.
While waiting for those responses, A report by IRIN news services titled “EAST AFRICA: Swine flu scare prompts surveillance scale-up” that I read this afternoon provides some clue( http://www.irinnews.org/Report.aspx?ReportId=84144). It clearly shows an overall lack of preparedness on the part of East African countries. If we were to go by their rankings in human development as well as health indices over the years the same would be the case for most of the other African countries.
It probably is too late, but the question now is what can be done? More importantly what can international agencies and well equipped foreign governments with established systems in place offer by way of mitigating the effects should it reach Africa or become a global pandemic? Should African countries be allowed to ride out this health hurricane and thereafter learn to develop systems efficient at dealing with situations like these? Should they be tasked with the responsibilty of stretching their resources in an already critical global economic situation? So many more questions, but let us know what you think.

Zambia malaria deaths down by 66 %

Yes guys, I raised a question few days ago about World Malaria Day tomorrow 4/25/09 and African countries' roles toward achieving the malaria milestone of universal coverage by 2010. Well there is good news about Zambia's malaria deaths down by 66 % way ahead of 2015, not talking about 2010. I would encourage you to go to http://www.who.int/en/ to read this front page article and tell me what you think. Let's talk