Improving Access to Healthcare in Sudan

Healthcare in Sudan
Located in northeastern Africa, Sudan has long been a diverse region of interaction between continental Africa and the Mediterranean. The country is home to hundreds of sub-Saharan African ethnic groups, and political and security challenges in recent decades have impacted it. In addition to displacement, the scattered population has recently suffered several outbreaks of cholera, dengue fever, Rift Valley fever (RVF), chikungunya and malaria.

Healthcare in Sudan faces both unique geographical and financial barriers to access. Improvements in health indicators are difficult to measure since they vary by region. Additionally, efforts to improve healthcare access have met with challenges. These include ineffective implementation of policies and poor coordination between the health and education sectors.

Financial Barriers

Postcolonial Sudan had free access to healthcare until the 1990s when the government gradually withdrew healthcare service provision. To retain healthcare access, Sudanese people often relied on borrowing money from relatives, working more and reducing expenditure on other vital living expenses. Many resorted to buying partial recommended treatments, resulting in further health complications.

Despite reducing support for healthcare, the Sudanese government also invested in higher medical education around the same time. It opened 30 new medical schools and made Sudan the country with the highest number of medical schools in Africa. This investment was an important step in the sustainable progress of healthcare in Sudan. It ensured a steady increase of healthcare professionals for the growing population of 42 million. Consequently, the physician-to-patient ratio improved from 0.1 per 1,000 people in 1996 to 0.41 per 1,000 people in 2015.

In 1997, in an effort to compensate for reduced government spending on health, the Ministry of Health introduced social health insurance (SHI). By 2017, SHI covered most of the population in Khartoum state and a few others. Despite internal efforts, healthcare in Sudan receives little international support. Compared with 50% of healthcare expenditure in Rwanda, only 5.4% of Sudan’s healthcare expenditure comes from external aid. The Sudanese government spends a comparable amount on healthcare to other sub-Saharan countries. However, the cost of healthcare for Sudanese citizens remains high, and many are uninsured.

Current Challenges

Sudan is struggling to retain healthcare workers, many of whom leave the country for better living and working conditions. To reduce physician migration, the Sudanese government has offered various incentives to specialists, such as generous salaries, leading positions, housing, transport and free education for offspring. However, the government cannot afford to sustain these efforts in the long-term or extend these benefits to all physicians.

Michelle Bachelet, a U.N. High Commissioner for Human Rights, argued that sanctions that the U.S. imposed have barred Sudan from receiving international funding for healthcare and COVID-19 relief. Sudan is on the U.S. State Sponsors of Terrorism list, which makes it ineligible to access any of the International Monetary Fund-World Bank’s $50 billion Trust Fund. This fund is currently assisting vulnerable countries to fight COVID-19. Sudan’s health minister Akram Ali Altom has also confirmed that the healthcare system is in urgent need of funding.

Geographical Barriers

As in many African countries, the main challenges to healthcare in Sudan are in rural areas. There, conflict, lack of transport and uneven distribution of resources reduce the availability of healthcare workers. An estimated 70% of the total healthcare providers are in the capital city Khartoum, serving just 20% of the population.

One way that some Sudanese states have addressed the problem has been through the use of telemedicine. Telemedicine has the potential to break down geographical barriers and increase access to high quality, specialist care to patients. A two-year pilot program in Gezira introduced electronic health records into the area for the first time. More than 165,000 new patients were able to register for consultations.

Sudan has many challenges to overcome before telemedicine can become a national success. Consultants located in the Khartoum center were not responsive. Additionally, issues involving software licensing and equipment maintenance have hindered smooth operations. As Salah Mandil, who led the first telemedicine project in Khartoum, noted, poor collaboration between scattered telemedicine projects has hindered efficiency and growth. For instance, projects such as the Surveillance project (FMOH) and the eHealth project have begun independently in various areas. However, they do not communicate or coordinate efforts.

Despite challenges to stability and safety, Sudan has made steps toward improving healthcare access in the past decade. To ensure equal and sustainable healthcare in Sudan, it must address the remaining challenges through better cooperation, management and funding from the government and international aid organizations.

– Beti Sharew
Photo: Flickr

Diabetes in South Africa: 5 Essential Facts

Diabetes is a disease that occurs when the pancreas is unable to produce or use insulin well, resulting in a high blood sugar level. When the body fails to make insulin at all, this is type 1 diabetes. With type 2 diabetes, the body does not produce or use insulin effectively. Both types of diabetes come with side effects that are detrimental to a person’s lifestyle. In the African region, South Africa has the second largest population of people with diabetes. Here are five facts that you should know about diabetes in South Africa.

5 Facts About Diabetes in South Africa

  1. Diabetes is a leading cause of death in South Africa. With non-communicable diseases (NCDs) like diabetes on the rise globally, South Africa is no exception. In 2016, diabetes and other NCDs caused 16% of the total deaths in the country. Diabetes is one of the three leading causes of death in South Africa, the other two being tuberculosis and cerebrovascular diseases. Among the South African population, there is a major lack of awareness of the disease and access to proper healthcare. Because the prevalence of diabetes in South African adults is 12.8%, it is crucial that other countries continue to support the funding and research of diabetes in South Africa.
  2. There are many ill-side effects for those living with diabetes. Diabetics must consistently track their blood sugar levels to ensure they don’t go into a diabetic coma. Additionally, diabetics are two to three times likelier to experience cardiovascular problems, like heart attacks or strokes. Diabetes can cause an individual’s kidneys to stop working. In most healthcare facilities in South Africa, they lack the procedures necessary to help a diabetic undergoing kidney failure, like renal replacement therapy by dialysis or through transplant. Another symptom of diabetes is neuropathy – or nerve damage – in the feet, which can lead to infection or potential amputation. In healthcare centers in South Africa, there is little equipment available for testing nerve damage in the feet and symptoms like this can often slip under the radar. Through an increase in funding from other countries, individuals suffering from diabetes in South Africa can have access to more equipment and medication necessary for dealing with diabetes.
  3. Socioeconomic disparities and other factors contribute to the prevalence of diabetes in South Africa. In South Africa, proper healthcare is inaccessible in poorer communities. The deficiency of experienced health professionals and respectable clinics makes it hard for citizens to undergo testing or treat the disease if they have it. More than one million citizens in South Africa do not know if they are diabetic. With more accurate and accessible testing, a greater population can begin treatment for the disease. It is crucial that the government receive funding to build diagnostic centers and train medical staff.
  4. Diabetes in South Africa is preventable and treatable in many ways. Though diabetes is irreversible, there are ways to keep symptoms at bay. Type 1 diabetes often develops in childhood and is usually impossible to eliminate. However, type 2 diabetes can go into remission with medication and changes in lifestyle. A common medication used to treat diabetes is metformin. Exercise and good eating habits are helpful treatments for diabetics. The most effective way to decrease the prevalence of diabetes in South Africa is to prematurely educate citizens and encourage healthy decision making. South Africa is currently working towards this goal.One recent preventative measure taken by the South African government is the implementation of a sugar tax. By charging more for sugary drinks and foods, the government is fighting obesity and helping citizens make more conscious decisions. In July 2019, South Africa briefly launched a Diabetes Prevention Programme (DPP). The DPP aims to integrate intervention treatments into a culturally relevant context through household questionnaires and group gatherings for at-risk individuals. In the conclusion of this program, the DPP will focus on using the information they gathered to create a curriculum that can educate communities about diabetes. To prevent rising cases of diabetes it is important that there is more pervasive awareness of the causes of diabetes. Citizens can learn how to manage obesity and understand when they should seek testing.
  5. Many countries and organizations help by funding testing centers and medical treatment in South African cities. The International Diabetes Federation (IDF) works with several organizations in the South African region to help combat the severity of the disease through advocacy, funding and training. The three organizations that are a part of IDF are Diabetes South Africa (DSA), Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) and Youth with Diabetes (YWD). DSA is one organization that does its part in educating citizens and lobbying the government for better facilities and cheaper healthcare. DSA is a nonprofit that centers around mobilizing volunteers to demand better treatment for those with diabetes.

– Danielle Kuzel
Photo: Flickr

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Reducing Hunger in Sri Lanka

 

Hunger in Sri Lanka
Sri Lanka has experienced notable progress in several developmental areas. The country has achieved improvements to primary education, a reduction in childbirth rate and decreasing poverty levels. However, food insecurity remains a consistent problem. Hunger in Sri Lanka is a major obstacle to the nation’s socio-economic development. According to the 2019 Global Hunger Index, Sri Lanka scores 17.1, ranking 66 among 117 qualifying countries.

The Numbers

According to a UN report, more than 800 million people worldwide were estimated to be chronically undernourished as of 2017. Over 90 million children under five are underweight. Sri Lanka ranked poorly on the Global Hunger Index (GHI) and global food security index, two major indicators of food security in any country. A Food and Agriculture Organization report from 2014 to 2016 found an average calorie deficit in Sri Lanka of 192 kcal per capita per day. In South Asia, only Afghanistan (36.6%) and Pakistan (30.5%) had higher rates of food inadequacy.

A study by the Asian Human Rights Commission (AHRC) revealed that more than 13% of minors in Sri Lanka were malnourished between the period of 2006-2010. The survey found that 23% of children between six and 59 months of age were stunted, 18% wasted and 29% underweight.

AHRC also found that remote and underdeveloped areas suffer more from hunger than larger cities. Although Sri Lanka has moderate percentages of food accessibility (54.5%), availability (52.8%), quality and safety (49.5 %), it is still struggling to achieve the United Nation’s goal for zero hunger by 2030.

Causes of Persistent Hunger

A food-insecure family lacks access to an optimum quantity of affordable and nutritious food. The immediate and obvious impact of food insecurity can be observed in physical health. Children struggle to concentrate in school and adults find it hard to perform well in their job. The household hunger scale (HHS) measures food insecurity in Sri Lanka on the basis of three factors: lacking access to food, sleeping hungry because of not having enough to eat and household members spending the whole day and night without eating anything.

There are several drivers behind hunger in Sri Lanka. Stagnant growth in crops in recent years has created a shortage of essential food. As the population continues to grow, this problem worsens. Furthermore, 35% of crops end up being wasted, never reaching hungry people. Rising food prices are also a concern in Sri Lanka. Changes in import duties and non-tariff barriers have caused increases in food prices as well.

Unemployment is also a major factor behind food insecurity and hunger in Sri Lanka. Many families have one or more members unemployed. One report shows that around 30% of the households depend on casual wage labor for their livelihood and food security. Around 90% percent of households in the city of Jaffna and 75% in the Vavuniya District were unemployed around 2012.

Initiatives to Address Hunger

Agriculture is one of the key ways to combat hunger and malnutrition. Different policies are intended to help fulfill Sri Lanka’s food requirement, including the National Climate Change Policy and the National Adaptation Plan for Climate Change Impact. A climate-smart agriculture system is working on increasing climate-resilient crops, rainwater harvesting, crop diversification and use of technology.

Under the National Nutrition Policy, every Sri Lankan citizen has the right to access adequate and appropriate food — irrespective of geographical location or socio-economic status. In addition to these efforts, global agencies like the World Food Program are working to combat hunger in Sri Lanka. UNICEF is also working to improve child and maternal nutrition.

Additional Ways to Combat Hunger

Socially vulnerable groups — like the elderly or female-headed families — are more prone to food insecurity. Sri Lanka’s government and other organizations should supply food vouchers to these vulnerable groups.

Because livestock production in Sri Lanka offers vast opportunity, the government should also encourage training and veterinary services to promote livestock production. In addition to this, privatizing the fish industry could help generate employment.

 

Moving forward, the government and other humanitarian organizations need to make reducing hunger in Sri Lanka a priority. Policies like the ones listed above are crucial for reaching the U.N.’s goal of zero hunger.

– Anuja Kumari
Photo: Flickr

Combating Tuberculosis in Sierra Leone

Tuberculosis in Sierra Leone
Sierra Leone, a country in West Africa, has been recovering from a civil war since 2002. While the country is still healing from the war, as well as combating disease, Sierra Leone’s life expectancy sits at about 52 years. This is 20 to 30 years younger than many wealthier nations. The prevalence of tuberculosis (TB) and other health crises threaten the nation’s strained healthcare system. In 2016, Sierra Leone struggled with the Ebola outbreak. Now in 2020, they fight TB while grappling with the COVID-19 pandemic.

Tuberculosis in Sierra Leone

Sierra Leone is among the 30 countries most impacted by TB, with 14,114 cases reported as of 2016 and many more potentially uncounted. There are around 170 centers in Sierra Leone that offer treatment for TB.

Bacteria cause TB, which most often affects the lungs. Occasionally, TB can also affect joints, bones and the central nervous system. The disease spreads through the air. The World Health Organization (WHO) reported that, “When people with lung TB cough, sneeze or spit, they propel the TB germs into the air.” People can also get TB by drinking unpasteurized milk contaminated by bovine TB.

Combating Tuberculosis

The National TB Programme at the Ministry of Health and Sanitation launched TB-fighting programs in Sierra Leone, backed by WHO, USAID and the CDC. As of 2018, 13,396 people successfully underwent preventative therapy for TB.

In 2015, following the Ebola epidemic, the CDC established an in-country center that partnered with the Ministry of Health and Sanitation. Through this partnership, they improved treatment and diagnosis services for HIV and TB, as well as making them more accessible to the population. This partnership has been the source of several high-tech facilities intended for testing for HIV/TB, drug-resistant TB and HIV/TB coinfection.

Other Obstacles

Poverty, war and epidemics like the 2015 Ebola outbreak — all things Sierra Leone still endures — can further ravage already fragile health programs in impoverished countries.

HIV, another disease Sierra Leone fights, is not only another pressure for a struggling healthcare system but a fast track for people to develop active TB. People with HIV are at a greater risk for contracting TB since HIV attacks an individual’s immune system. This is especially true if the patient is not being treated for HIV via antiretroviral therapy, which suppresses the virus. Children living with both HIV and TB face the added obstacle of a difficult diagnosis process because it is harder to identify the bacteria in child samples. TB is also the leading cause of death in people who are living with HIV.

Another strain on the system comes from the poverty, which Sierra Leone is fighting to end. National economic struggles and the low wages of healthcare staff contribute to the rising prices for TB treatment, even for those within the national subsidized program.

Efforts of CISMAT-SL

Accessibility of treatment and testing are major obstacles for those in Sierra Leone suffering from TB. As of 2009, only 5% of people living with HIV tested for TB, with less than 1% receiving Isoniazid preventive therapy.

The Civil Movement Against Tuberculosis in Sierra Leone (CISMAT-SL) is a collection of civil society organizations, both community and faith-based, to help those fighting TB. CISMAT-SL advocates for TB prevention, early diagnosis and treatment and the classification of TB as a human rights issue. The movement is working to shift the priority of healthcare onto the health of the population, rather than the economics of it. CISMAT-SL strongly advocates for the early start of antiretroviral therapy, Isoniazid preventive therapy (sterilization of lesions to prevent active TB from developing), TB case finding and infection control. The movement work to make these efforts more widespread.

 

Testing and treatment for TB exist, developing further with the rise of drug-resistant TB and TB/HIV coinfection. In impoverished countries, already existing treatments and testing are harder to access due to fragile infrastructures and less supported healthcare systems. In Sierra Leone, and other impoverished nations dealing with TB, the first step to improving the health and welfare of the population starts with making testing and treatment measures accessible. This is the battle CISMAT-SL and other humanitarian organizations are waging to help stave off tuberculosis in Sierra Leone.

– Catherine Lin
Photo: Flickr

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Women’s SHGs Combating COVID-19 in India

Combating COVID-19 in India
Women’s self-help groups have empowered women across rural villages in India to become self-reliant by building their skills and providing access to financial assistance, enabling them to increase their income. However, due to the COVID-19 crisis, there is a predicament of bleak income opportunities due to a lack of transport and marketing facilities to sell their produce and non-availability of credit. It has forced millions of migrants to move back to their villages from big cities due to the lack of income opportunities. With the movement of people to rural areas, there is a need to ensure proper health care, spread awareness about COVID-19 and maintain a supply of essential commodities for the people. Women’s self-help groups (SHGs) in rural areas are combating COVID-19 in India.

SHGs are informal groups of people that come together to address problems by mutually supporting and helping each other. They have been able to uplift and empower individuals by facilitating health care, education, rehabilitation, credit and campaigning. In India, there are 67 million women members of six million SHGs. The SHGs fall under the National Rural Livelihood Mission, a policy that the World Bank has aided. Here are five ways women’s self-help groups are combating COVID-19 in India.

5 Ways Women’s Self-Help Groups Are Combating COVID-19 in India

  1. Making PPE Kits and Face Masks: The women’s self-help groups in Mahabubnagar district, Telangana, were facing a slowdown in work due to the 40-day lockdown in India in March and April 2020. To revive their earning capabilities, they received the responsibility of stitching facemasks and personal protective equipment (PPE). To date, they have stitched over 550,000 masks. Similarly, many other SHGs across the country have engaged themselves in stitching PPE kits to meet the shortfall. Female members in Odisha who previously stitched school uniforms are using their skills to produce face masks. Meanwhile, in Assam, women received training to stitch facemasks using a traditional Assamese cotton towel.
  2. Producing Sanitizers and Disinfectants: In Jorhat, Assam, Rural Women Technology Park under CSIR-North East Institute of Science and Technology collaborated with female members of SHGs to produce hand sanitizers and liquid disinfectants for their families and poor people in nearby villages to control the spread of the infection. At a time of scarce job opportunities, women’s self-help groups across districts in India are training women to produce sanitizers and disinfectants using raw materials such as Dettol, ethanol, glycerin and essential oils.
  3. Delivering Essential Commodities: Women’s self-help groups have taken various initiatives to ensure the delivery of essential commodities to abide by the mandated social distancing norms. Their service includes doorstep delivery of food kits, fresh vegetables, dry rations and cooking oil as well as personal hygiene products like washing soaps and sanitary napkins. Many states have used the concept of ‘floating supermarkets’ and ‘vegetables of wheels,’ and provided women with electric vehicles. Members also support children, pregnant women and lactating mothers. Women’s self-help groups are also supporting frontline health workers in the delivery of essential child, adolescent and maternal health and nutrition-related entitlements.
  4. Feeding Poverty-Stricken People Through Community Kitchens: In Kerala, the SHGs in collaboration with the local government prepared food for the poverty-stricken families in community kitchens. The beneficiaries of these small packages of food were the migrant workers, daily wage workers and people under home quarantine. Meanwhile, in Tripura, SHGs that engaged in the catering business earlier received contracts to support the community kitchens. Additionally, women’s self-help groups in Arunachal Pradesh provided food throughout the day to the police personnel. Women’s SHGs across the country have taken various initiatives to feed those in need with the support of their local government.
  5. Spreading Information About COVID-19: Along with the spread of COVID-19, there was also a spread of misinformation concerning it across rural areas. SHGs prepared posters to create awareness about COVID-19 and the precautionary measures that people should take during the pandemic.

Women’s self-help groups have taken up various responsibilities such as spreading awareness about COVID-19, preparing sanitizers and stitching facemasks, running community kitchens as well as delivering essential food supplies. At the time of the COVID-19 crisis, women in the rural areas of India have participated meaningfully to ameliorate the predicament.

– Anandita Bardia
Photo: Flickr

The Importance of Microfinance in Bolivia

Microfinance in Bolivia
With microlending and financial services that empower business owners and promote development becoming more readily available, Bolivia is considered to be a microfinance success story. Microfinance allows vulnerable populations to access capital and financial services that would ordinarily be out of reach. Most commercial banks, unwilling to work with very low-income markets, alienate those living in extreme poverty. As a result, the World Bank reports that 73% of people living below the global poverty line are unbanked. However, in many developing countries, microlending systems allow entrepreneurs to take out small business loans in safer manner. Because the economy relies on a great deal of informal labor, access to microfinance in Bolivia has been crucial for its economic improvement. Today, almost 20 government-regulated microfinance providers service the country’s small business owners and entrepreneurs, serving 12.2% of the population and 16.4% of the labor force.

How do Microloans Work?

Since the 1980s, microloans have been used to empower borrowers in developing companies and give them the needed infrastructure to earn a sustainable income. They range from about $100 to $25,000, accrue interest like conventional loans and are capped at fair interest rates that do not put borrowers at risk of sinking deeper into debt, unlike the same services of many commercial lenders and private ‘loan sharks’. According to the World Bank, more than 500 million people currently benefit from microfinance initiatives.

Banco Sol and Microfinance in Bolivia

With the lowest GDP per capita and the second-lowest Human Development Index in South America, Bolivia faces clear economic challenges. However, pioneering infrastructure has allowed many economically disadvantaged Bolivians to borrow the capital necessary to advance their own businesses. In fact, Bolivia boasts one of the world’s lowest microfinance interest rates, at 13.5%.

Banco Sol is the largest microfinance company in Bolivia, and the world’s first commercial bank entirely dedicated to providing microfinance services; it also has one of the lowest delinquency rates in the world, marking the success of both the company and borrowers. Kurt Koenigsfest, Banco Sol’s CEO, markets the bank’s services as tools of social mobility and poverty management, saying “this is one way that has been proven to provide jobs and investment in the hands of those who, before its creation, had no access to financial services.”

Human Benefits

Bolivia is home to the world’s largest informal economy, with roughly two-thirds of Bolivians employed by the informal sector.  Many of these business owners sell goods like clothing, food and cosmetics in simple market stalls or shops. With an economy structured in this way, Bolivia has unsurprisingly benefited from financial infrastructure that services self-employed entrepreneurs who need capital to initiate growth in their business. The country’s physical remoteness and low population density, however, make it especially difficult for the rural poor to access both the national market and necessary financial resources. Banco Sol utilizes mobile branches, or trucks with banking facilities, to overcome this obstacle, so that even the most rural villages can gain access to banking.

A Path Forward

Exclusion from financial services can be a hurdle for those experiencing extreme poverty. Lenders like Banco Sol have given many small business owners the means to grow their capital while still maintaining ethical lending practices. Following the introduction of microfinance in Bolivia, the country has welcomed a new class of empowered, rising entrepreneurs that have secured higher positions in the nation’s marketplace.

– Stefanie Grodman
Photo: Unsplash

Telemedicine Plays a Bigger Role in Healthcare in Ghana 

Healthcare in GhanaFor Ghanaian students enjoying Empower Playgrounds, Inc.’s (EPI) merry-go-rounds, scrapes, cuts and bruises are shrugged off with a laugh. However, treating medical emergencies like malaria infection, especially in rural areas, is no laughing matter.

EPI, A nonprofit organization based in Ghana, operates in remote locations where electricity is almost nonexistent, and medical centers are extremely scarce. By building playgrounds that generate electricity, EPI prioritizes children’s entertainment as much as their health and education.

The Borgen Project had the opportunity to speak with Ben Markham, the founder of EPI, about healthcare in Ghana. According to Markham, when a student falls extremely ill at school, a teacher will accompany the student to the nearest trained nurse, if one exists. The student and teacher will often travel by foot out of town, and if the medical emergency is severe, the teacher will leave the student at the facility and walk back to the community to inform the child’s parents.

Fortunately, healthcare in Ghana is transitioning to include more technology and communication channels. With substantial telehealth investment injected into rural Ghanaian towns, these communities stand a chance to receive basic health supplies and on-demand medical attention through telehealth methods.

Telemedicine is More Accessible Than In-Person Visits

In response to COVID-19, Ghana’s Ministry of Health proposed to open 94 new hospitals across the country between 2020 to 2021. In a statement addressed to the nation, Ghanaian president Akufo-Addo said that the pandemic exposed “the deficiencies of the healthcare system,” casting blame towards under-investment. So how will the addition of more hospitals benefit areas outside of the country’s municipalities?

Lack of basic healthcare in Ghana stands as a serious issue in the non-urban areas of the country. Nearly half (49 percent) of Ghanaians live in rural communities, and many communities lack a central facility and have a shortage of medical professionals. The Ghana Health Service (GHS) has partnered with various entities to solve this problem on the ground.

For example, Community-Based Health Planning and Services (CHPS) trains volunteers to provide health services in rural communities. Additionally, GHS has partnered with Novatoris Foundation to develop teleconsultant centers. These centers allow community nurses, who usually lack equipment and staff, to speak with urban nurses over the phone when medical urgencies arise, such as childbirth.

Within the last ten years, healthcare in Ghana has seen emerging interest and attention directed toward telehealth. When the first teleconsultant centers opened in 2011, 60 percent of calls were maternity-related, mainly due to the fact that the majority of maternal mortality occurred in rural areas. In effect, telemedicine became an avenue of investment to bridge spatial and temporal gaps for remote Ghanaians.

Vodafone Proves to be a Major Player in Ghanaian Health

Among technologies and assets helping Ghanaians stay informed about their health, the cellular company Vodafone stands out.

The company has partnered with Ghana’s healthcare industry through its philanthropic arm, Vodafone Ghana Foundation. In 2019, the foundation cleared the medical debts of 180 Ghanaian patients who had been discharged yet detained due to outstanding hospital bills. Upon settlement, all 180 former patients were released from detention. In 2018, the company partnered with the central government to monitor epidemics, specifically targeting the Ebola virus, by aggregating heat maps from customers’ GPS movements. They are doing the same with coronavirus today.

In the spring of 2020, as the novel coronavirus moved into Ghana, Vodafone stepped in to dispel misinformation. The Vodafone Healthline Medical Centers, call centers equipped with medical experts, expanded services to include representatives who communicate in a variety of local languages including Ga, Twi, Fante, Ewe and Hausa.

Managing Expectations

Markham and his staffers know of telemedicine services, but they remain skeptical. Cellular signal breaks up where cell towers are not present, and towers can often be 32 kilometers outside of a remote community. In addition, many Ghanaians turn their cell phones off to save battery, since many of them are still powered with AA batteries rather than chargers. Cell phone credits are also considered precious, leading to many people turning their devices off to save unused credits. All these factors could inhibit the ability of telemedicine to improve healthcare in Ghana.

However, Markham feels optimistic about the role that technology can play in providing health services to rural-based Ghanaians. He believes grassroots efforts, such as the Community-Based Health Planning and Services, should continue to expand at the same rate as telehealth and tech-based health initiatives.

– Victoria Colbert
Photo: Empower Playgrounds, Inc.

Fighting Corruption Worldwide

corruption worldwideThere has been no shortage of Americans raising awareness about the domestic hardships of disadvantaged communities at the hands of an imperfect system. At the very least, Americans are still able to protest systems and spread their message to a broad audience across social media. What is less known, however, is how many people experience similarly dehumanizing conditions globally but lack the tools to change their environment or even tell others about their struggles. American protests for equality have been and always will be important, but it is a humanitarian necessity to address social injustices and corruption worldwide, not just where it is convenient for people to do so.

What is Corruption?

Before addressing the logistics of foreign poverty, it is necessary to define what that word “corruption” means in this context. The Corruption Perception Index (CPI) will be the standard definition of what corruption is, as it has been a common definition since 1995. The CPI ranks countries in terms of how much they embody “the abuse of entrusted power for private gain.”

Where to Find It

Even with the guidelines provided by the CPI, there is still room for interpretation, and as such there are many different survey results from individual sources (two, for example, come from the World Population Report and U.S. News and World Report). However, that is not to say there are not general trends throughout each of the results. Several lists that were used as sources cited at least half of the top 10 most corrupt countries as coming from South America, Africa or the Middle East.

The ways in which corruption has reared its head have mostly been economical. For instance, bribery is so prevalent in Afghanistan that 38% of the population sees it as normal. Somalia has a similar perception and prevalence of corruption. Ever since the Siad Barre regime was overthrown in 1991, there has been no strong government in control of the entire country. Instead, pirates, militias and clans fight over individual territories, preventing any chance of united progress without foreign intervention.

How Does This Relate to Poverty?

Anyone can understand in a broad sense how corruption is related to poverty, since one would assume that any country riddled with poverty would have to be the result of a misuse of power. For any changes to occur, however, people need to understand clearly what exactly is going on. In 2010, a sample of 97 developing countries was examined by the University of Putra Malaysia in a study that attempted to find the casual relationship between corruption and poverty.

In short, the study’s original data and other literature it cited concluded that “countries with high income inequality have high levels of corruption… After countries attain a specific level of income equality, corruption exponentially decreases.” This is no surprise considering how authorities in Sudan, Afghanistan and other nations have bribed and hoarded billions of dollars that should have helped citizens out of poverty.

Solutions

The study found three main ways to create a culture change in the corruption of developing nations.

  1. Promoting Inclusiveness: Citizens need to have a voice in their government through establishing democratic policies.
  2. Promoting Lawfulness: There must be laws and punishments by police for the disproportionate mistreatment of the disadvantaged.
  3. Promoting Accountability: Governments need to be made aware of the relationship between poverty and corruption and how officials may be implicit or responsible for these hardships.

These ideas may seem like common sense, but in a country that is not taking action, they need to be restated, just as they have been for America’s own domestic issues. All it takes to begin the fight against global corruption is simple civil engagement, such as an email to a senator.

– Bryce Thompson
Photo: Flickr

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5 Facts about Healthcare in Algeria

Healthcare in Algeria
Algeria is located on the Northern coast of Africa and is home to 42.2 million people. The nation adopted a universal single-payer healthcare system in 1984, which allows anyone to access healthcare at no cost to themselves. The nation’s economy is largely reliant on oil prices and sales, but these have proven to be volatile in the past several decades. Due to this economic instability, 23% of the population lives below the poverty line, even though the nation has some of the largest oil and gas reserves in the world. What is even more startling is the 29% youth unemployment rate. Given that such a large segment of the population falls below the poverty line and cannot find work, many Algerians are reliant on their publicly funded healthcare system to provide for them in times of need. Here are five facts about healthcare in Algeria in light of the country’s economic hardship.

5 Facts About Healthcare in Algeria

  1. The Public Healthcare Network has Struggled Recently: In 2019, Algeria’s public healthcare network ranked as the 173rd most secure healthcare network out of 195 nations. This stems from the chronic economic insecurity that dominated the nation due to drops in oil prices. The “breakeven” price for oil in Algeria was $157 per barrel in 2020. However, the price fell to just $20 a barrel, leaving the nation to stumble upon hard times. Yahia Zoubir notes that many Algerian medical professionals have chosen to take their practices out of the nation due to the “chronically insufficient healthcare system.”
  2. A Private Healthcare Sector Exists within Algeria: In 2015, there were 250 operational private clinics, and the government approved plans for the construction of the first private hospital in the nation. Many questioned the utility of the private sector because it fills in the gaps of the public sector, but it can only serve those who could afford it. Essentially, the presence of the private sector heightens disparity in the quality of care that the healthcare system provides to Algerians in different socio-economic classes.
  3. COVID-19 has Highlighted Major Issues with the Public Healthcare Network: As noted before, the national economy took major hits in 2019, and the nation announced a 50% cut in public spending as a result. Due to an inability to provide physicians with the necessary equipment and a general lack of human capital, there were 17 beds per 10,000 Algerians, according to the World Health Organization (WHO) in 2015. Because of this limited hospital capacity, COVID-19 patients easily overran public healthcare in Algeria.
  4. Where Health Officials Fail, the People Provide: Throughout the pandemic, government officials were notorious for failing to communicate with the public to slow the spread of the virus. Villages located further away from urban centers encountered these issues most prominently. Despite this, the Algerian people demonstrated resilient and innovative capabilities. The United Nations Development Program notes two distinct ways Algerians are reacting to the pandemic. First, in urban centers, many merchants are turning away from their cash-based system and moving toward e-commerce. E-commerce limits the amount of person-to-person contact involved in economic transitions of all sorts. Meanwhile, villages are working together to limit the spread of the virus themselves. Notably, a village called Tifilkout went into self-confinement to protect its citizens and other villages in the area. This plan originated from the tradition of “wise men” leading the village. These solutions demonstrate that while healthcare in Algeria may be unstable, the people will still assist one another regardless.
  5. The Algerian Struggle has Incited a Global Response: Non-Governmental Organizations (NGOs) have also stepped up to assist in COVID-19 relief. The Bill and Melinda Gates Foundation has pledged to donate $20 million to fight COVID-19 in Africa. The money will go towards ensuring that PPE and treatments are available to all who need them, not just those who can pay the most. While these efforts going towards Africa generally, The Bill and Melinda Gates Foundation has demonstrated its commitment to Algeria in the past. In 2002, it joined groups working to fight the spread of malaria, and through its assistance, Algeria was the second nation in Africa to become malaria-free.

Healthcare in Algeria has struggled for years, and the COVID-19 pandemic exposed many of its weaknesses. However, the pandemic has also allowed communities to respond to such weaknesses in full force. While Algerians are working to protect one another through e-commerce and social distancing, the international community is banding together to support the nation as well.

– Allison Moss
Photo: Flickr

The Regional Disparities of Healthcare in Paraguay

Healthcare in Paraguai
Healthcare in Paraguay has improved tremendously over the past decades. The life expectancy of both males and females has increased by about 10 years since 1990. In the same period of time, the mortality rate of children under 5 years old decreased from 34.6 deaths to 14 deaths per 1,000 live births. Still, many communities remain underserved and face the repercussions of limited access to healthcare.

The Rural-Urban Divide

The improvements in Paraguay’s healthcare system have occurred mostly in urban areas. This makes sense considering that more than 60% of Paraguay’s population lives in the urban perimeters of Asunción and Ciudad del Este. In fact, about 70% of healthcare workers operate within the Greater Asunción area.

In contrast, rural populations do not receive the same access to healthcare. While the more rural regions located to the West of Asunción represent 61% of the national territory, only about 31% of the national paved road network reaches these regions. As a result, transportation from isolated rural communities to urban areas with better access to healthcare is not an easy feat.

The Family Health Units and Coverage

In 2008, the Ministry of Public Health and Social Welfare created family health teams to carry out healthcare in a coordinated, comprehensive and continuous manner. Each team is organized in Family Health Units (USF in the Spanish acronym) and serves the populations to which they are assigned. These teams must provide consultation, home care and ongoing medical evaluation to their communities.

While USFs have successfully improved the health of urban populations, they have largely left behind those who live outside of urban centers. For example, only about 50% of the Alto Paraguay residents have USF coverage.

The following reasons help explain this disparity in USF coverage between city and country areas:

  • Rural areas generally have low population density and exist between small towns. Therefore, providing USF coverage to many rural communities can be inefficient and challenging.
  • Many healthcare workers who are originally from rural areas often decide to either move to urban areas or leave Paraguay completely due to the poor working conditions and precarious employment contracts.
  • There are few incentives for healthcare workers to practice in rural areas.

As a result, rural areas, where poverty rates are the highest, are also most susceptible to experiencing USF shortages.

The maternal mortality rates (MMRs) by region reflects the disparity in USF coverage. In 2015, the rural areas of Boquerón, Amambay and Canindeyú recorded MMRs of 347, 190 and 167 per 100,000 live births, respectively. This data stands in stark contrast to the average MMR of the entire nation which is 132 per 100,000 live births. Clearly a significant imbalance in healthcare access exists between geographic locations in Paraguay.

Addressing MMR in Rural Communities

Several initiatives emerged to address this problem, although some deemed some of them unsuccessful. The Maternal Health and Child Development Project, which operated from 1996 to 2004, aimed to improve the health of mothers and their children in underserved areas. As the World Bank notes, the outcomes of this project were unsatisfactory.

A joint project between the Pan American Health Organization (PAHO) and the World Health Organization (WHO) is currently in effect with the goal of strengthening the care of mothers and children and improving responses to obstetric emergencies. PAHO and the WHO implemented this project in 19 municipalities across Bolivia, Argentina and Paraguay, reaching approximately 400,000 people. It is too early to discern the impact of this project as it only emerged in 2017. Nevertheless, since it only serves a few municipalities in Paraguay, many rural, underserved Paraguayan communities have not received the assistance necessary to improve their MMR.

The COVID-19 Pandemic

In spite of the challenges Paraguay faces in terms of its healthcare system, the country has kept COVID-19 under control in rural and urban communities alike. As of July 19, 2020, there have been confirmations of 3,721 cases and 31 deaths in a country with over 7 million people. One can attribute this successful containment of the virus to the government’s quick and effective response. The first COVID-19 case in Paraguay received confirmation on March 7, 2020, and the country went into full lockdown on March 20, 2020. While the country is not in the clear yet, Paraguay is among the most healthy South American countries with regards to COVID-19.

Bringing Healthcare to Rural Areas

The situation for rural regions, however, is not hopeless. Since urban areas observed significant successes in healthcare through the implementation of the USFs, one could reasonably apply similar tactics to rural areas. Having said that, the biggest hurdle in bringing healthcare access to rural areas will be providing incentives for healthcare workers to settle in areas with low population density.

Luckily, in 2010 the Ministry of Public Health and Social Welfare launched a rural internship program that incentivizes doctors to work in rural areas. As a result, the concentration of healthcare workers in rural areas should increase as more doctors graduate from medical school.

Nevertheless, the Ministry must continue to pay special attention to rural areas, especially those where impoverished and indigenous people reside. The healthcare system has historically underserved these communities while urban, wealthier communities continue to experience improvements in healthcare. In order to provide healthcare for all residents of Paraguay in an equitable manner, the government must ensure that all Paraguayans can receive the same basic healthcare regardless of geographic location.

There are certain challenges that should receive special attention as Paraguay continues to improve its healthcare system for residents. Many regions still struggle with maternal mortality, especially in rural areas. In addition, viruses that mosquitoes transmit, such as Zika, chikungunya and dengue, cause intermittent regional epidemics. Lastly, about 18,000 people in Paraguay live with HIV or AIDS. However, given the government’s swift and effective response to COVID-19 as well as the success of USFs across the country, these challenges certainly are not insurmountable. If USFs expand significantly into underserved areas, Paraguay should be better able to effectively handle these health challenges.

– Alanna Jaffee
Photo: Flickr