Health in Africa in 2000-2001: a balance sheet

Harare-- The World Health Organization (WHO) and its 46 Member States in the African Region focused on the broad determinants of health and disease during the 2000-2001 biennium and were thus better able to bring about long-term and sustainable improvements in the status of its people.

This is contained in the Biennial (2000-2001) Report of the WHO Regional Director for Africa, Dr Ebrahim M. Samba, to be released at the 52nd session of the WHO Regional Committee for Africa (RC52) scheduled for 8 -12 October Harare, Zimbabwe.

Dr Samba states that during the period under review, funding from sources other than the Organization's regular budget reached a record US $312 million, compared to about US $30 million during the 1996 - 1997 biennium. He attributed this ten-fold increase in funding from other sources over the three biennia to "increased donor confidence as a result of WHO's improved performance in the field, combined with rigorous and transparent performance-reporting standards."

Communicable Diseases Prevention and Control

In the report, Dr Samba describes communicable diseases as being among the major killers in the African region, where they also continued to be the causes and consequences of poverty

On leprosy, for which the African Region reached the elimination target at the end of 2000, Dr Samba disclosed that the elimination of the disease had now been reached in 32 countries, and that its regional prevalence rate had dropped to 0.98 cases per 10,000 in July 2001, down from 1.29 per 10,000 in December 1999.

The biennium also saw a decline in the detection of wild poliovirus to seven in 2001, down from 12 in 1996; the virtual elimination of neonatal tetanus in 12 countries; a 55% reduction in the incidence of dracunculiasis in the Region, and the development of Regional strategies for the control of schistosomiasis, lymphatic filariasis, soil-transmitted helminthes and trypanosomiasis.

On TB control, Dr Samba said that in the 30 countries targeted, population access to Directly Observed Treatment Strategy, Short Course (DOTS) services increased from 70% in 2000 to 86% in 2001. Nineteen of these countries increased their DOTS coverage to 90% or more, while the treatment success rate for new cases increased from 62% in 1999 to 67 % in 2000 (although still falling short of the Regional target of 85%).

In the area of HIV/AIDS prevention and control, WHO provided support to 10 countries through the interagency working group on the prevention of mother-to-child transmission (MTCT) of HIV in order to pilot intervention in this area.

Noncommunicable Diseases Prevention and Control

Noting that noncommunicable diseases were a growing major public health concern in the Region, Dr Samba said that achievements recorded by the Regional Office in preventing and controlling this group of diseases included support for countries in undertaking situation analyses of noncommunicable diseases; capacity building in early detection and treatment of cervical cancer, in the epidemiology and management of diabetes, in the care of the elderly and traumatic restoraline treatment techniques as well as in preventive oral health care in districts.

WHO also elaborated a Regional Strategy for Health Promotion, produced guidelines on the formulation of health promoting schools, supported 15 countries in the implementation of the health-promoting schools initiative, and supported feasibility studies in food fortification, and training in breastfeeding.

In addition to supporting countries in the development of their Mental Health policies, activities were undertaken to drum up support for the Framework Convention on Tobacco Control, and the campaign against substance abuse.

Health Systems and Services Development

On health systems and services development, a critical landmark reached during the biennium was the adoption by RC50 of the Health for all policy for the 21st Century in the African Region: Agenda 2020.

Other achievements in this area included support to the five Portuguese-speaking countries in the Region for the preparation of a medium term plan (2002 - 2006) for the development of human resources for health; support to 34 countries in their health reform processes; support to 10 countries to undertake national health account studies, and to 10 countries for the strengthening of health systems. The Regional Office also awarded 556 fellowships, with 90 % of the fellows placed in training institutions within the Region.

The report also lists additional achievements in the area of health systems and services development as: the production of tools such as a training manual on the management of drugs at the health centre level; the preparation of protocols for the evaluation of traditional medicines and ethnomedical studies on HIV/AIDS, malaria, hypertension, diabetes, sickle cell and malaria; and support to 11 countries to finalize their national blood transfusion policies.

Healthy environments and sustainable development

Food safety, protection of the human environment and health in sustainable development also featured prominently in the work of WHO during the 2000-2001 biennium. Dr Samba stated that to enhance its work, the Regional Office strengthened its food safety programme by increasing its expertise in the area and creating two sub-units - food safety and hygiene, and food, health and development. Technical assistance in the areas of water and sanitation, policy formulation and risk assessment was also provided to all countries. Other activities carried out included the publication, by the Regional Office, of a position paper and the successful organization of a regional consultation on poverty and health; support for poverty alleviation through the implementation of poverty and health projects, and the raising of awareness of poverty and health issues among decision makers Region-wide.

Family and Reproductive Health

The focus of support to Member States in this area during 2000 - 2001 was the promotion of reproductive health of families and individuals and individual women, men, adolescents and children. Activities undertaken and achievements recorded included: support to 22 countries to undertake and utilize the findings of reproductive health research; and support to countries for reproductive health needs assessment, for the development of a perinatal survey tool, for the development of a national reproductive health plan, and for the organization of maternal, perinatal and neonatal surveys.

Achievements recorded in the prevention of MTCT of HIV included training of nationals from 11 countries in the integration of reproductive health and HIV/STI; strengthening of laboratory diagnosis capacity in 20 countries; production of a set of four clinical guides for providing care for HIV-positive pregnant women, development and field-testing of a training package on value for health and social workers; support to nine countries to implement pilot projects in the MTCT of HIV; development of indicators for monitoring and evaluating the prevention of MTCT, and the ongoing development of a strategy paper for policy makers and programme managers for the design of national programmes for the prevention of MTCT of HIV.

Under WHO's Making Pregnancy Safer initiative, the following were among the activities supported in Member States: a needs assessment survey at facility level for emergency obstetric care, capacity building in life-saving skills, procurement of equipment and supplies for emergency obstetric care, strengthening of the referral system, and the production of The Road to Safe Motherhood, a publication which addresses the three delays to the reduction of maternal mortality. Member States were supported to produce advocacy tools for accelerated maternal mortality reduction.

Dr Samba also reported that during the biennium, WHO supported the establishment of national multidisciplinary collaborative groups on Female Genital Mutilation, a harmful traditional practice still prevalent in 27 countries. 

Programme development and management

In the area of general programme development and management, Dr Samba listed achievements during the biennium as including: improved quality of technical documents for meetings of governing bodies through rigorous in-house peer review; effective participation of Member States in Meetings of the World Health Assembly and the Executive Board as a result of adequate briefing of African delegates on the agendas and procedures of these meetings; the implementation of a fully integrated and result-based management system throughout the WHO African Region, and the implementation of the newly-adopted WHO Country Cooperation Strategy.

Other achievements in this area were improved access to health information through increased production of radio and television programmes and the issuing of health and health-related print products in the three working languages of the Region; support to countries for the development of national research policies and priorities; the finalization of a regional database on health and health-related information, and the training of resource persons from 18 country offices in economic evaluation, study of national health accounts, economic viability analysis and health facility analysis. The Regional Office trained 12 consultants in the Region in vulnerability assessment. It also trained and deployed Emergency and Humanitarian Action (EHA) focal points of WHO and Health Ministries in 43 countries, and created a decentralized pool of country-based experts trained in various aspects of emergency preparedness and response.

Administration and Finance

The Regional Office made steady progress in improving the quality and presentation of valid, statutory, technical and scientific information products. Similar appreciable progress was made in implementing efficient, effective and proactive financial and human resources management practices and procedures.

Positive results were also achieved in the area of work of informatics and infrastructure services.

Challenges

In the report, Dr Samba lists some of the challenges facing the Region : the deterioration of macro-economic conditions, the threat posed by the HIV/AIDS pandemic; the rapid rise in poverty and the diseases of poverty (HIV/AIDS , TB and Malaria), and in social and political instability; the persistently high maternal and neonatal mortality; the prevalence of polio in some countries and the rise to prominence of noncommunicable diseases such as cancer, hypertension, cardiovascular diseases, diabetes, tobacco related illness, drug abuse and neuro-psychiatric illnesses.

He concludes: "In the African Region, WHO is now addressing these problems at the divisional level. While there is no doubt that WHO has done well in the African Region, we must now do even better. We must work faster. We must do with less. With the continuing support and cooperation of our Member States, and development partners, we are ready." 


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