BMJ 2002;324:688-689 ( 23 March )
Africa can solve its own health problems
But first, the continent must reorder its priorities and
commit to distributive justice
See also Papers p
On the evidence of such archaeological finds as Lucy, the australopithecine
female unearthed in Ethiopia's Hadar region, Africa is the cradle of
the human race. Africa was also home to notable ancient civilisationsthe
Egypt of the Pharaohs, the Ashanti Empire of the Gold Coast, and the
Zimbabwe settlements in the south. Given such a head start, it is
ironic that Africa should now find itself at the bottom of the ladder
in terms of human development. Most of the countries in sub-Saharan
Africa lag far behind other developing nations with respect to
critical health indicators such as maternal and infant mortality and
Granted, Africa's legacy of particularly exploitative colonial occupation by
European powers is partly to blame. However, Africans themselves must
bear the responsibility for failing to create an enabling environment
for better healthsafe
water and sanitation, secure supply of food and nutrition, education,
and higher status of womenin
the period since the continent's political emancipation that began
with Ghana's independence in 1957.1
Instead, many countries have seen both opportunity and resources
squandered on political adventurism, civil wars, misguided macroeconomic
policies, and greed.
Nevertheless, with sufficient will, commitment, and vision, and by making the
right choices, Africa can successfully address its own health
challenges and start to contain the morbidity and mortality from
diarrhoeal diseases, childhood infections, parasites, and maternal
and perinatal morbidity, as well as emerging and re-emerging
infections of HIV, malaria, and tuberculosis. Africa's health
challenges are not insurmountable. In most cases, the solutions are
straightforward and inexpensive, requiring only that the right
political choices be made.
The World Health Organisation has identified poverty in Africa as "the single
biggest threat to health."2 And in an unpublished
speech to Kenya's Medical Research Foundation on 19 January 2001, Britain's
minister for the Department for International Development, Baroness
Amos, warned that "in the short term and in the long run, African
governments, leaders, and individuals will need to exercise more
leadership, set agendas, and mobilise far more resources, for a
sustained response to lift people out of poverty."
Africa's top priority must therefore be to grow the economy, which in the
view of the World Bank means buying into the global economic
movement. David Dollar of the World Bank cites the example of
Vietnam, where the proportion of the population in poverty fell from
75% in 1988 to 37% in 1999 as the country "opened up to foreign
trade."3 This view is not universal, however, as
has been evident in the "anticapitalism" protests spanning the
globe from Seattle to Genoa. Certainly, globalisation has been
responsible for crises in banking and currency, steep rises in
poverty rates, and widening income inequalities in many countries.4
While African countries cannot escape the global movement, they must embrace
it with the necessary circumspection. Two harms of globalisation come
to mind. The first is the use of Africans to test drugs from which
they will never benefit, either because the drugs are too costly or
because they are designed to treat conditions that largely affect
industrialised nations.5 The second is
the global proselytising of first world values that are detrimental
to Africa. The ban on dicophane (DDT)a
cheap and highly effective weapon against malariabecause
it was thought to be harmful to US bird species cost millions of
African lives, whereas no African has ever died from the normal use
The mere accumulation of national wealth is not sufficient to deal with
poverty as a health risk. Africa must commit to equity and economic
distributive justice in order to address national health needs. With
this approach, the poor Indian state of Kerala has achieved health
indicators almost comparable to those of the United States despite
its per capita income being 99% less and its spending on health being
$28 per capita compared with $3925 in the United States.7
China, Costa Rica, and Sri Lanka have made similarly impressive
This means that African countries must address the highly unequal access to
personal health care that exists between rich and poor, between urban
and rural populations, and between ethnic groups. They must develop
coherent and equitable national health systems, redirecting resources
from curative care in urban hospitals using expensive high tech
equipment to primary and preventive care encompassing immunisation,
nutrition, and other elements of an enabling environment for better
Finally, Africa must look for what South Africa's President Thabo Mbeki,
speaking of HIV and AIDS, characterised as "African solutions to
African health problems." To this end, Africa must revive its
universities, once heralded as beacons of progress and hope. In the
late 1960s and early 1970s African medical schools such as those at
Ibadan (Nigeria), Accra (Ghana), and Makerere (Uganda) were counted
among the finest in the developing world, engaged in the basic and
applied research of typically African health problems. Only when a
critical mass of African researchers working on African soil has been
restored will Africa begin to generate new knowledge relevant to its
most pressing health problems.
Daniel J Ncayiyana, editor, South African Medical
Vice Chancellor's office, ML Sultan Technikon, PO Box 1334, Durban
4000, South Africa
||World Bank. Better health in Africaexperience
and lessons learned. Washington, DC: World Bank, 1994:29.
||Brundtland GH. Address to the regional committee for
Africa, 48th session, Harare, Zimbabwe, 31 August 1998. www.who.int/director-general/speeches/1998/english/19980831_afro.html
(updated 15 May 2001).
||Dollar D. Is globalisation good for your health? Bull
World Health Organ 2001; 79: 827-833[Medline].
||Cornia G. Globalisation and health: results and options.
Bull World Health Organ 2001; 79: 834-841[Medline].
||McDonald R, Yamey G. The cost to global health of drug
company profits. West J Med 2001; 174: 302-303[Full
||Lieberman AJ, Kwon SC. Facts versus fears: a review of
the greatest unfounded health scares of recent times. New York: American
Council on Science and Health, 1995.
||Thankappan KR. Some health implications of globalisation in
Kerala, India. Bull World Health Organ 2001; 79: 892-893[Medline].
||Halstead SB, Walsh JA, Warren KS. Good health at low
cost. Conference report. New York: Rockefeller Foundation, 1985.
© BMJ 2002
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BMJ 2002 324: 702.
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