Key Personnel from the World Health Organization have crystallized public health challenges facing the six Southern African countries considered most vulnerable to prevailing health hazards in the region.

At their 13 to 15 February meeting in Harare to consider how best to improve the humanitarian response of the health sector to communities suffering from system-wide disruptions to nutritional, water, energy and medical services, clear strategic priorities emerged to reinforce and harmonize the contribution of WHO expertise from Head quarter level, Regional level and country level. Given the effect of HIV/AIDS, WHO's overriding priority was to support national health ministries build a health intelligence system that was better able to acquire, analyze and synthesize health information.

WHO field personnel from the six countries most affected (Mozambique, Swaziland, Lesotho, Zambia, Zimbabwe and Malawi) reviewed the health situation in their respective countries. Common challenges were distilled and options explored for boosting the health sector response to the complex interplay of rampant HIV/AIDS infection (and other diseases), abnormal and extreme weather conditions, the hemorrhaging of professional health care workers to better off countries, socio-economic decline and deficient policies.

Participants unanimously identified insufficiency of epidemiological data gathering as the main concern. For example, Dr Pierre Kahozi, an epidemiologist from Mozambique showed how the pattern of cholera outbreaks in Mozambique over the past 20 years demonstrated a trend toward shorter intervals between outbreaks and increasing severity. This exponential trend suggested that, while public health interventions have had short-term curative effects, the disease is gaining ground over the long term.

To what extent this trend is widespread could not be established however, for want of comparative epidemiological surveillance systems in all countries. Having this would require competent field personnel to collect data, technically qualified personnel to rigorously analyze the information, and effective leadership to synthesize the information for effective priority setting and policy making. Concerted and substantial effort to employ, train and mobilise such personnel was thus urgently required from all Public Health stakeholders

To enable WHO to assume a more prominent leadership role in leading the Health Sector Response to the emergency and to support the six country teams, WHO/AFRO has established an Inter-County Team, based in Harare, to provide technical support. It has also deployed senior staff to work with other UN agencies in the UN Regional Inter-Agency Coordinating Support Office (RIACSO) in Johannesburg to amplify the health aspects of the emergency, build information networks and mobilise resources.

Several countries reported a disturbing tendency of declining attendance at community health care clinics, causing vital epidemiological data to be lost, making disease surveillance and response difficult, and thus increasing the risk of outbreaks of communicable diseases and reversing progress made in eliminating endemic diseases.

One participant observed that when poor people stopped coming to community health care clinics, this did not indicate health needs had been satisfied. Rather it was an indication that the priority of poor families had shifted to issues of immediate survival and caring for family members too sick to leave their homes.

This required health care workers to perhaps leave the clinic and re-enter the domestic and community environment to make their diagnoses and offer treatment, approaching their task in terms of 'what is keeping people alive' and 'what care will prolong that life' rather than simply 'what is killing them and what do I have that will cure them'. By so doing the seeds from which to grow the strategy for longer term rehabilitation and recovery will be discovered.

In the most affected countries, national and inter-regional plans and some funding are in place. A major challenge is to secure higher levels of funding to sustain on-going activities.

To inform and guide the further development of the Health Sector Response strategy, participants agreed with the following particulars:

• The Integrated Management of Childhood Illness (IMCI) strategy offers a tried and tested structure and system as an intervention strategy around which to rebuild the health intelligence gathering process. The IMCI strategy could inspire the development of a similar integrated package of key components for emergency response 
• The health related programmes of other UN agencies, such as the Water and Sanitation programme of UNICEF - needs to be supported and affirmed wherever required with the technical expertise that WHO possesses. 
•  Appropriate Indicators of health that use existing information & build on it need to be used for the sake of practicality 
•  In developing funding proposals , clear connections need to be made between food security, HIV/AIDs and particular health concerns. 
•  Responses need to cover short, medium and long term activities, so that Emergency Health interventions are framed in developmental terms. 
•  The HIV/AIDs situation in Africa offers WHO an opportunity to refocus the world's understanding on WHO's definition of health as a holistic concept, that is essentially about healthy human relationships. 
•  Nutrition related programmes of other UN agencies and NGOs, particularly nutrition surveys and surveillance, case definitions of nutritional deficiencies and nutritional management of the severely malnourished need to be supported with WHO technical expertise in the field. 
•  In order to prevent and reduce malnutrition morbidity and malnutrition related mortality, appropriate capacity building and training (particularly in the safe, appropriate and adequate feeding of infants and young children) is readily available from WHO. 
•  A good proportion of deaths that occur during emergencies like that being experienced in Southern Africa is due not to starvation but to epidemic-prone diseases; therefore, while food delivery is desirable, a range of health and health-related interventions should be a key priority

For further information, please contact 
Division of Healthy Environments and Sustainable Development 
Emergency Humanitarian Action Unit 
World Health Organization - Regional Office for Africa
P.O. Box 6 Brazzville, Congo. 
E-mail: chellouchey [at] afro.who.int (chellouchey[at]afro[dot]who[dot]int)