Healthcare in AustriaAustria is known for having one of the most generous and greatest healthcare systems across the world. Healthcare needs are readily accessible to Austrian citizens at little to no cost. The vast majority of the Austrian population has access to healthcare, as long as an individual is not willingly choosing to be unemployed.

Healthcare in Austria

  1. Two-tiered system: In the first tier of Austria’s two-tiered healthcare system, healthcare covers 99% of the population, of which 75% is typically funded through public taxes. However, citizens can also pay to have supplementary healthcare, which allows individuals to see private practitioners. As of 2010, it is estimated that 130,000 individuals chose to pay for private healthcare.
  2. Life-long private providers: For those who choose to pay for private or supplementary healthcare, insurance companies are not allowed to have restrictions within contracts, nor are they allowed to terminate an individual’s healthcare without permission. The private healthcare services can only be terminated by the individual, allowing the user to have access to life-long healthcare services.
  3. High accessibility to hospitals and pharmaceuticals: Despite the decline in hospital bed availability around the world, Austria has 271 hospitals containing more than 64, 000 beds and around 45,000 doctors, classing the country as having one of the highest bed/patient ratios in Europe. Along with the availability of hospitals and other health centers, the cost of pharmaceutical drugs in Austria is low. In 2012, Austria’s pharmaceutical costs were an estimated 18.6% lower than the rest of Europe.
  4. Public healthcare covers four areas: Within the Austrian healthcare system, there are four specific areas in which those who choose to have public healthcare, rather than private healthcare, can be covered: illness, maternity, precautionary and therapeutic aid. Each of these categories requires certain criteria for the individual to be categorized into one of the four areas.
  5. Tourists have access to healthcare: For those visiting Austria with a European Health Insurance Card, access to public healthcare is enabled. While this does not cover any private healthcare, it does cover basic doctor’s visits, dental services and even emergency hospital visits. This allows tourists or students who may need emergency medical assistance to access healthcare at a reduced fee.

Through this dynamic healthcare plan, Austria is able to provide healthcare and benefits for its citizens. Whether it be a simple checkup or something more extensive, Austria’s public healthcare system alleviates healthcare burdens for its people. Even for those who pay for a private healthcare plan, the cost of medical expenses is far less than many places around the world, as it is estimated to only cost $243 a month. Whether it be private or public healthcare, Austria’s two-tiered system has found itself among the highest-ranking healthcare systems in the world.

Olivia Eaker
Photo: Flickr

Sen. Bob CaseySen. Bob Casey has been a U.S. Senator from Pennsylvania for 13 years since his election in 2006. Casey is a member of the Democratic Party. He is assigned to four Senate committees: Finance; Health, Education, Labor and Pensions, Agriculture; Nutrition, and Forestry; and the Special Committee on Aging. Consequently, this article shows the efforts made by Sen. Bob Casey to fight against global poverty and help poor people. He has been working to pass two significant bipartisan legislation regarding global poverty, as well as supporting people around the world to improve U.S. national security.

Debt Cancellation for Poor Countries to Combat Global Poverty

In 2007, Sen. Bob Casey (D-PA), Chris Dodd (D-CT) and Dick Lugar (R-IN) introduced the Jubilee Act for Responsible Lending and Expanded Debt Cancellation Act of 2007. Senator Casey sponsored bipartisan legislation to help poor countries that had spent money on repaying debt rather than taking care of their citizens in poverty. He said, “This legislation will help these nations get out of debt and help them free up resources to reduce poverty.” This comment and his support for the bill shows his commitment to reducing global poverty from the early period of his term as a senator.

Global Food Security

With Sen. Johnny Isakson (R-GA), Sen. Bob Casey introduced the Global Food Security Act in 2016. This legislation required the administration to assist targeted communities and nations to improve agricultural productivity and enhance food and nutrition security. It also emphasizes the importance of enhancing maternal and child nutrition. This act additionally recognizes the importance of tackling global food insecurity for developing countries and the U.S. economy and national security.

Sen. Bob Casey said, “The need to address global hunger is an urgent foreign policy and national security priority. It is in the United States’ best interest to promote initiatives that work to eliminate the causes of food and nutrition insecurity.” Likewise, the Global Food Security Reauthorization Act was passed in 2018, introduced by Sen. Bob Casey and Sen. Johnny Isakson. This bipartisan legislation ensures the extension of the Feed the Future initiative until 2023. For example, by 2018, the Feed the Future program helped more than 1.7 million households in 12 targeted countries.

His Support for Women in Afghanistan and People in Syria

To ensure the safety of women and girls in Afghanistan, Sen. Bob Casey introduced the Afghan Women and Girls Security Promotion Act. He also has been working to provide help for women who survived domestic violence or other crimes. Moreover, he has supported food and medical support for Syrian people in need because of the war.

As a representative of Pennsylvania, he has made several efforts to combat global poverty and hunger. In the interview by Penn Political Review, he said, “It is critical that U.S. foreign aid dollars be used efficiently and that they provide relief and promote opportunities for poor and underserved individuals and communities around the world.” It is therefore clear that Senator Casey’s efforts are critical in the fight against global poverty. Calling and emailing him to support these bills would be significant. As a result of helping these people, the U.S. can improve national security and economy.

Sayaka Ojima
Photo: Pixabay

corruption in healthcare
The healthcare sector in several countries around the world is commonly referred to as being among the most corrupt sectors. A 2013 Transparency International Study reported that more than 50% of citizens viewed their country’s health sector as corrupt in 42 out of 109 countries surveyed. The World Bank has regarded corruption in healthcare as a major barrier to achieving social and economic development.

Corruption and Poverty

Informal payments are a very specific form of corruption prevalent in weak health care systems around the world. Informal payments refer to under-the-table payments to receive services that are otherwise free or which are requested in addition to officially sanctioned required payments.  They are prevalent in the healthcare sector of many countries globally. For example, in Azerbaijan, informal payments account for 73.9% of all medical spending. This form of corruption often arises due to inadequate healthcare management, including inadequate public spending, resource deprivation, governance and human resource constraints and scarcity of providers.

Informal payments negatively affect healthcare at the individual and governmental levels. Due to the secrecy that often shrouds the transaction of informal payments, these payments are often made in cash and do not contribute to the collection of taxes. This translates into less money available to be reinvested in the healthcare system.

Further, informal payments are often regressive in nature, meaning that low-income individuals often tend to pay a larger proportion of their income respective to high-income individuals.  One study in sub-Saharan Africa identified informal payments as being highly prevalent among the poorest segments of society.

Informal payments represent severe barriers to accessing care for those living in poverty. In some cases, informal payments can push low-income individuals to borrow money often with high-interest rates. This indebtedness can lead to financial ruin for low-income families and can potentially push them into the poverty trap.  More concerning is the potentially deadly impact of patients to delay or forego medical care due to the inability to cover the expected informal payments.  Further, the informal nature of these payments makes exemptions to protect those in poverty increasingly difficult to enforce.

The Impact of COVID-19

The COVID-19 crisis can lead to further barriers to accessing care and may bring an increase in the prevalence of informal payments. Overwhelmed, weak health care systems around the world with resource and provider scarcity may push those seeking treatment to use informal payments as a means of accessing better care and at other times may be required to make up for inadequate funding. It is known that informal payments are tied to these scarcities. These factors are increasingly relevant in COVID-19 responses around the world.

There is a high risk of the prevalence of informal payments increasing in reaction to the pandemic. For those who cannot afford the cost of informal payments, the catastrophic virus may cause families to take on a high-rate of debt, pushing low-income families further into poverty. If individuals choose to forego testing or treatment for the virus due to a lack of financial ability to cover informal payments it could impact the response to fighting COVID-19 by accelerating the spread of the disease.  With the number of people living in extreme poverty projected to rise by 71 million due to the economic shocks brought on by the pandemic, there is an urgent need to address the issue of informal payments and broader corruption in the healthcare sector.

How to Take Action

According to the Carnegie Endowment, the spread of coronavirus, with corruption acting as a catalyst, poses a serious threat to U.S. interests and foreign policy objectives. There are a number of ways the U.S. can address the problem of corruption and the prevalence of informal payments around the world through the U.S. Global Coronavirus Response. The Countering Russian and Other Overseas Kleptocracy (CROOK) Act aims to address corruption through rapid action. The act has been introduced in the Senate after passing the House of Foreign Affairs Committee and shares bipartisan support. USAID in partnership with the State Department is addressing the corruption-coronavirus nexus by supporting transparent emergency procurement mechanisms and providing support to anti-corruption law enforcement.

Due to the discrete nature of informal payments and the provider-patient relationship, the U.S. influence is limited in combating informal payments. In low-income countries with weak healthcare systems, the most effective means of mitigating the impact of informal payments on those impacted by COVID-19 is prevention. The United States can help curb the spread of COVID-19 around the world by providing adequate funding for global health security in the next emergency supplemental COVID-19 response.

– Leah Bordlee
Photo: Flickr

COVID-19 in AfricaOn a world map of the distribution of COVID-19 cases, the situation looks pretty optimistic for Africa. While parts of Europe, Asia and the United States are shaded by dark colors that implicate a higher infection rate, most African countries appear faint. This has created uncertainty over whether or not the impact of COVID-19 in Africa is as severe as other continents.

Lack of Testing

A closer look at the areas wearing light shades reveals that their situation is just as obscure as the faded shades that color them. Dark spots indicate more infections in places like the U.S. However, in Africa these are usually just cities and urban locations, often the only places where testing is available.

Although insufficient testing has been a problem for countries all over the world, testing numbers are much lower in Africa. The U.S carries out 205 per 100,000 people a day. Nigeria, the most populous country, carries one test per 100,000 people every day. While 8.87% of tests come back positive in the U.S, 15.69% are positive in Nigeria (as of Aug. 4, 2020). Nigeria was one of 10 countries that carried out 80% of the total number of tests in Africa.

As a continent that accounts for 1.2 billion of the world’s population, the impact of COVID-19 in Africa is even more difficult to measure without additional testing. To improve this, the African CDC has set a goal of increasing testing by 1% per month. Realizing the impossibility of reliable testing, countries like Uganda have managed to slow the spread by imposing strict lockdown measures. As a result, the percentage of positive cases in Uganda was only 0.82% (as of Aug. 4, 2020).

A Resistant Population

COVID-19 in Africa has had a lower fatality rate than any other continent. Fatality rates may even be lower than reported. Immunologists in Malawi found that 12% of asymptomatic healthcare workers were infected by the virus at some point. The researchers compared their data with other countries and estimated that death rates were eight times lower than expected.

The most likely reason for the low fatality rate is the young population. Only 3% of Africans are above 65 compared with 6% in South Asia and 17% in Europe. Researchers are investigating other explanations such as the possible immunity to variations of the SARS-CoV-2 virus as well as higher vitamin D in Africans with more sunlight exposure.

Weak Healthcare Systems

Despite these factors, the impact of COVID-19 in Africa is likely high. Under-reporting and under-equipped hospitals contribute to unreliable figures. Most hospitals are not prepared to handle a surge in cases. In South Sudan, there were only four ventilators and 24 ICU beds for a population of 12 million. Accounting for 23% of the world’s diseases and only 1% of global public health expenditure, Africa’s healthcare system was already strained.

Healthcare workers have the most risk of infection in every country. In Africa, the shortage of masks, equipment and capacity increases the infection rate further amongst healthcare workers. Africa also has the lowest physician to patient ratios in the world. As it can take weeks to recover from COVID-19, the recovery of healthcare workers means less are available to work.

Additionally, those that are at-risk and uninsured can rarely afford life-saving treatment in Africa. For example, a drug called remdesivir showed promising results in treating COVID-19. However, the cost of treatment with remdesivir is $3,120 – an unmanageable price for the majority of Africans. These factors will determine the severity of COVID-19 in Africa.

Economic and Psychological Factors

Strict lockdowns have helped some nations in controlling the spread of COVID-19 in Africa but at a very great price.

Lack of technology often means that all students stop learning and many lose their jobs. More than three million South Africans have become unemployed due to the lockdown. The lockdowns have also resulted in much higher rates of domestic violence, abuse and child marriage. Many such cases go unreported and mental health services for victims or those struggling through the pandemic are unavailable. In Kenya, the U.N. has appealed for $4 million to support those affected by gender-based violence.

The slow spread of COVID-19 in Africa has allowed the continent and leaders to prepare, and the young population will lessen the impact. Although there’s reason to be hopeful, there’s no doubt that there will be an impact on Africa’s economy and future. This calls for the need of foreign assistance – not only in controlling COVID-19 in Africa but in the recovery of the continent for years to come.

Beti Sharew
Photo: Flickr

Tuberculosis in BangladeshTuberculosis (TB) is an airborne disease; common symptoms include cough with sputum and blood in some cases, chest pains, weakness, weight loss, fever and night sweats. TB can lead to the death of an infected person when left untreated. According to the World Health Organization (WHO), TB has caused about 2 million deaths worldwide, and 95% of deaths were recorded in developing countries. Bangladesh ranked sixth among high TB burden countries. The National Tuberculosis Control Programme (NTP) has attained more than 90% treatment success and more than a 70% case detection rate. Despite these successes, tuberculosis in Bangladesh remains a serious public health problem.

Reasons for Higher Infection of Tuberculosis in Bangladesh

  1.  Delays in the Initiation of Treatment: Patients in Bangladesh often receive late treatment. Delays in treatment increase chances of negative treatment results, death and community transmission of TB. A study on 1,000 patients reported that, on average, there were 61 days of delay in the treatment of women and 53 days of delay in the treatment of men.
  2.  Role of Informal Health Practitioners: Most of the impoverished people in Bangladesh prefer to go to their local practitioners due to the ease of accessibility and low cost. A recent survey showed that approximately 60% of the Bangladesh population prefers to go to these uncertified doctors. However, such doctors typically lack formal training. This may lead difficulties in accurately diagnosing and treating TB.
  3. Lack of Awareness: Directly observed treatment short-course (DOTS) has been recognized as one of the most efficient and cost-effective approaches for treating TB. In 1998, the DOTS program became an integrated part of the Health and Population Sector Programme. The inclusion of the DOTS strategy in the Programme helped TB services transition from TB clinics to primary level health facilities. These health facilities typically incorporate GO-NGO (government-organized non-governmental organization) partnerships, and the NGOs have advocated for work on literacy, social awareness along and health care development. As part of the Health and Population Sector Programme, DOTS is freely available to the public. Unfortunately, many remain unaware of the treatment option.  As a result, detection of new TB cases has stagnated at around 150,000 cases per year since 2006.
  4. Poverty: A large portion of the country is still suffering from poverty. Poverty can often lead to overcrowding and poorly ventilated living and working conditions. People with less income also cannot afford food, leading to higher incidences of malnutrition. The culmination of these factors typically make the impoverished population more vulnerable to contracting TB.

The Effort to Combat TB

Tuberculosis is a major public health problem in Bangladesh. However, continuous efforts by the NTP and various NGO organizations have played an important role in decreasing the spread of the disease. DOTS, for instance, demonstrated a 78% cure rate in 1993. Due to its success, a phase-based treatment plan was implemented in 67 million rural populations in 1996.  Since implementation, the NTP has attained a 90% treatment success rate. Further efforts to combat the disease include development of the FAST program (Find cases Actively, Separate safely and Treat effectively). The program intends to detect active TB cases and decrease spread of the disease in healthcare facilities. However, despite efforts by the NTP and a number of NGOs, significant delays in care-seeking and treatment initiation still exist as major hindrances to the program’s goals. 

Challenges to TB Programs

Tuberculosis in Bangladesh kills more than 75,000 people every year. Despite free services like DOTS and other NTP programs, limited access to quality service, lackluster funding and insufficient screening prevent adequate detection and treatment of the disease. The lowest quartile of the population is still five times more likely to contract TB, potentially due to a lack of awareness of TB-treatment programs among the general public. Adding to the problems for TB programs, private health professionals are typically inactive in national programs. While NTP programs have made progress in addressing the disease, these challenges persist, and tuberculosis remains a major health problem in Bangladesh.

Solutions

To stop the growth of tuberculosis in Bangladesh, community organizations such as the Bangladesh Rural Advancement Committee (BRAC) have shown impressive results in lowering the percentage of those afflicted by TB. Effective treatment of TB includes investment in medicine, local health services and diagnostics. To ensure full recovery, social protection of patients is also required. Multidrug-resistant TB (MDR-TB), for instance, requires two months of drug treatment and a four month continuation period. If treatment programs can satisfy requirements investment and social protection requirements, the chance of curing TB patients reaches 92%. The application of a more successful method will help in curing the most complex TB cases, such as drug-sensitive TB, with improved results. With the implementation of proper and effective treatment strategies, we can eliminate tuberculosis in Bangladesh and the benefit even the poorest members of society.

– Anuja Kumari

Photo: Pixabay

Tuberculosis in Tuvalu
Tuberculosis (TB) is the world’s deadliest infectious disease, yet millions of people remain undiagnosed. TB diagnosis is a challenge for many island communities. In order to be diagnosed, patients usually have to go to the main island. This was the case for tuberculosis in Tuvalu.

Tuvalu is a remote Pacific island with a population of 11,500 and only one hospital. Travel to the hospital is difficult and increases the risk of transmission, especially when it includes a crowded boat full of people. TB rates are high in Tuvalu but are declining with only about 15 new cases each year since 2016 – a great improvement from the rate of 36 new cases each year in the 1980s. The death rate in 2017 was 19 per 100,000 people. Thanks to a couple of developments that have made diagnosis more achievable – namely GeneXpert machine, portable x-ray machines and training for health teams – Tuvalu is actively reducing rates of TB since 2018.

GeneXpert Machine

The United Nations Development Programme (UNDP) and the Global Fund have provided a GeneXpert machine to the government of Tuvalu. This machine reduces the duration of the TB test and allows for diagnosis of the drug-resistant strains, which are increasingly becoming a problem. Using the machine, the test only takes about two hours. Without this technology, the TB test takes at least two-six weeks.

It is a relatively new test that works on a molecular level to identify mycobacterium tuberculosis as well as rifampin resistance in a sputum sample. Another positive is that limited technical training is required to run the GeneXpert tests. These tests are being used around the world and prove to be an incredible feat of science.

Portable X-ray Machines

Because x-ray machines are now portable, more people can be reached and examined, including those on the outer islands. Mobile health teams travel to smaller islands and carry out chest x-rays for those presenting TB symptoms.

Thanks to portable x-ray technology, the number of TB diagnoses is increasing. Dr. Lifuka at the Tuvalu hospital said, “We can now actively find cases in the outer islands where there are no facilities, and we can assess everyone, even those who previously faced difficulties coming to the hospital.”

Training for Health Teams

Of course, none of this would be possible with the technology alone. Trained professionals are needed to help diagnose and treat people with tuberculosis in Tuvalu. They travel to patients’ houses and provide medication. Because of the stigma surrounding TB, patients won’t always get their treatments. This is why Tuvalu Red Cross community-based health promoters and other trained professionals treat patients at home.

Though TB rates remain rather high in Tuvalu, as well as throughout the Pacific, the new technology implemented in 2018 is promising. Technology will not be enough, however; system-wide approaches aimed at reducing poverty and development of infrastructure on the outer islands will also be needed in order to eradicate TB. Furthermore, Tuvalu needs to continue to improve TB surveillance in order to inform public health agencies of the strategies proven to be most effective. Hopefully, the new technology will help spread awareness of TB to all the members of the community. The change is already evident, as cases of tuberculosis in Tuvalu have declined consistently over the past 10 years, and detection has increased. In 2008, they were only able to diagnose eight cases a year. In 2017, there were 23. The new technology and training programs will continue to save lives on this small, isolated island.

Fiona Price
Photo: Flickr

Healthcare in Maldives
People know the Maldives internationally for its beautiful beaches and remote atolls. This south Asian nation has a unique healthcare system with a design specific for an island. Here are seven facts about healthcare in the Maldives.

7 Facts About Healthcare in the Maldives

  1. Universal Healthcare: The Maldives has universal health insurance that covers a plethora of primary care services. The country’s health scheme is called Husnuvaa Aasandha and the state-owned company Aasandha runs it. Husnuvaa Aasandha means “healthcare for all without a ceiling protection limit” according to the Aasandha website, and it receives funding from the Maldives’ government. Notably, the plan pays for citizens to go abroad for certain medical treatments if the treatments are not available in the Maldives.
  2. Tier-based System: The Maldives has a “tier-based” healthcare system. Every inhabited island, even the most sparsely populated, has a primary care facility. Every inhabited atoll, or island chain, has a secondary care facility. Larger urban areas also have tertiary care centers.
  3. Government Spending: According to a 2018 report from the World Health Organization (WHO), 9% of the Maldives’ GDP goes toward healthcare. The country spends a higher percentage of its GDP on healthcare than any country in Southeast Asia, where the average expenditure for the region is 3.46%.
  4. Operation: Primary medical facilities often struggle to operate effectively. A report from 2019 revealed that a lack of supplies and equipment is a major factor hampering the Maldives’ primary health facilities. These facilities also have high staff turnover rates and are expensive to operate.
  5. Medicine: Medicine can be unusually expensive in the Maldives. Importing pharmaceuticals is often costly, as the Maldives is a fairly remote island nation. Furthermore, an analysis from 2014 found that price controls on medicine did not experience enforcement. Some pharmaceuticals cost patients more than 100% of their importation costs.
  6. Disease: Noncommunicable diseases such as respiratory diseases, cancer, diabetes and cardiovascular diseases cause the most deaths in the Maldives. Noncommunicable diseases such as these cause almost 80% of deaths in the country according to a 2018 WHO report.
  7. Life Expectancy: The Maldives has an above-average life expectancy. The life expectancy in the Maldives was 78.6 years in 2019, while the world average the same year was 72.6.

Healthcare in the Maldives is rapidly improving, with the country having an above-average life expectancy and basic health services on all inhabited islands. However, some areas of the nation struggle to receive essential medical supplies and medicine can be expensive. Overall, these seven facts about healthcare in the Maldives show that the country is making progress a priority and heading towards promising results.

– Kayleigh Crabb
Photo: Pixabay

Healthcare in Suriname
The Republic of Suriname is an upper-middle-income country located on the northeastern coast of South America. Around 90% of the country’s population lives in urban or rural coastal areas. Healthcare in Suriname is accessible for both the public and private sectors. Here are eight facts about healthcare in Suriname.

8 Facts About Healthcare in Suriname

  1. Infant and Maternal Mortality: Suriname’s infant mortality rate in 2013 was around 16 deaths per 1,000 live births. The most prevalent reasons for mortality reported in children under 1 year of age were respiratory problems, fetal growth retardation, congenital diseases, neonatal septicemia and external causes. The maternal death ratio averaged 125 deaths per 100,000 live births from the years 2000 to 2013. For mothers, the most prominent causes included gestational hypertension and hemorrhage. In 2010, prenatal checkup coverage was around 95%, and more than 65% of pregnant women had had four prenatal checkups. In addition, almost 93% of births happened in a health center, and trained health workers carried out around 95% of births.
  2. Life Expectancy: In 2016, the average life expectancy of a male was 69, while the average life expectancy of a female was 75. These estimates are slightly below the average male and female life expectancies in the rest of South America.
  3. Mosquito-borne Illnesses: In late 2015, the preliminary issue of Zika virus was found in Suriname. The disease spread quickly throughout the country’s 10 districts, but there are no current outbreaks. Conversely, Suriname has eradicated malaria from all but one district of Suriname. However, the rate of new imported cases (principally among gold miners from French Guiana) increased by more than 70% in 2015.
  4. HIV and Tuberculosis: By 2014, Suriname’s human immunodeficiency virus (HIV) rate among the 15-49 age group was 0.9%. HIV/AIDS caused 22.4 deaths per 100,000 people in 2010, decreasing to 16.4 deaths per 100,000 people in 2013. From 2012 to 2014, the estimated tuberculosis diagnosis rate increased from 58% to 71%. To combat the disease, the country started the direct implementation of observed treatment, resulting in higher treatment success from 61% in 2010 to 75% in 2013.
  5. Government Contribution and Coverage: Suriname experienced vast economic growth from 2010 to 2014. During this period, healthcare in Suriname received increased funding for various services and facilities. It expanded and decentralized private laboratory diagnostic services, private primary care, dental care and paramedic practices. In 2015, vaccination coverage was almost 90% for DPT3 and above 90% for the trivalent vaccine (MMR1). In 2014, the total estimated health expenditure as a percentage of GDP was 6%. For health insurance, employees’  premium rate is 50%, and employers pay the other half. For low- or no-income citizens, the government subsidizes health coverage.
  6. Hospitals: Of Suriname’s five hospitals, two are private and three are public. The Academic Hospital in Paramaribo has recently renovated and expanded its facilities and invested in equipment and staff for specialty care like gastroenterology, oncology, intensive care, renal dialysis and more. In 2013, government and external funds also helped other hospitals invest in new facilities and healthcare worker training programs.
  7. Sanitation: Suriname’s lack of an integrated waste management policy has created illegal dumps and caused refuse to accumulate on roadsides and in open waters. This infrastructure problem results in health risks and environmental hazards. According to the Pan American Health Organization (PAHO), Suriname does not have facilities for storing or eliminating hazardous waste, nor does it regulate the safe use or storage of pesticides.
  8. Accessibility: In 2014, Suriname passed its national basic health insurance law. It provides access to a basic package of primary, secondary and tertiary care services for all Surinamese citizens. In 2013, all people under the age of 16, as well as people aged 60 and over, had the right to free health care that the government paid for. Universal access to healthcare for pregnant women and newborns remains a challenge for healthcare in Suriname.

Persistent voids in access to healthcare in Suriname are related to drawbacks in funding. The healthcare system has seen an expansion in the past decade, but there are still plenty of health challenges to confront and improve.

Anuja Kumari
Photo: Flickr

Tuberculosis in BotswanaBotswana is a southern African country with just over 2 million residents living inside its borders. Every Batswana lives with the threat of tuberculosis, an infectious disease that remains one of the top 10 causes of death on the African continent. Tuberculosis has a 50% global death rate for all confirmed cases. Investing in tuberculosis treatments and prevention programs is essential. Botswana has one of the highest tuberculosis infection rates in the world with an estimated 300 confirmed cases per 100,000 people, according to the CDC. Preventative and community-based treatment shows promise in combating tuberculosis in Botswana.

Treating Tuberculosis in Botswana

Tuberculosis treatment cures patients by eliminating the presence of infectious bacteria in the lungs. The first phase of treatment lasts two months. It requires at least four separate drugs to eliminate the majority of the bacteria. Health workers administer a second, shorter phase of treatment to minimize the possibility of remaining bacteria in the lungs.

Early identification of tuberculosis is a crucial step in the treatment process and significantly reduces the risk of patient death, according to the Ministry of Health. Preventative treatment methods are vital because they inhibit the development of tuberculosis infection. They also reduce the risk of patient death significantly.

Health workers detect tuberculosis with a bacteriological examination in a medical laboratory. The U.S. National Institutes of Health estimate that a single treatment costs $258 in countries like Botswana.

Involving the Community

Botswana’s Ministry of Health established the National Tuberculosis Programme (BNTP) in 1975 to fight tuberculosis transmission. The BNTP is currently carrying out this mission through a community-based care approach that goes beyond the hospital setting. Although 85% of Batswana live within three miles of a health facility, it is increasingly difficult for patients to travel for daily tuberculosis treatment. This is due to the lack of transportation options in much of the country.

Involving the community requires the training and ongoing coordination of volunteers in communities throughout the country to provide tuberculosis treatment support. Community-based care also improves treatment adherence and outcome through affordable and feasible treatment.

The implementation of strategies such as community care combats tuberculosis. For example, it mobilizes members of the community to provide treatment for tuberculosis patients. The participation of community members also provides an unintended but helpful consequence. For example, community participation helps to reduce the stigmas surrounding the disease and reveals the alarming prevalence of tuberculosis in Botswana.

A Second Threat

In addition to the tuberculosis disease, the HIV epidemic in Africa has had a major impact on the Botswana population, with 20.3% of adults currently living with the virus. Patients with HIV are at high risk to develop tuberculosis due to a significant decrease in body cell immunity.

The prevalence of HIV contributes to the high rates of the disease. The level of HIV co-infection with tuberculosis in Botswana is approximately 61%. African Comprehensive HIV/AIDS Partnerships (ACHAP), a nonprofit health development organization, provides TB/HIV care and prevention programs in 16 of the 17 districts across the country in its effort to eradicate the disease.

Fighting Tuberculosis on a Global Scale

The World Health Organization (WHO) hopes to significantly reduce the global percentage of tuberculosis death and incident rates through The End TB Strategy adopted in 2014. The effort focuses on preventative treatment, poverty alleviation and research to tackle tuberculosis in Botswana, aiming to reduce the infection rate by 90% in 2035. The WHO plans to reduce the economic burden of tuberculosis and increase access to health care services. In addition, it plans to combat other health risks associated with poverty. Low-income populations are at greater risk for tuberculosis transmission for several reasons including:

  • Poor ventilation
  • Undernutrition
  • Inadequate working conditions
  • Indoor air pollution
  • Lack of sanitation

The WHO emphasizes the significance of global support in its report on The End TB Strategy stating that, “Global coordination is…essential for mobilizing resources for tuberculosis care and prevention from diverse multilateral, bilateral and domestic sources.”

– Madeline Zuzevich
Photo: Flickr

Apps that aid in healthcare in developing countries It can sometimes be difficult for people in developing countries to access healthcare, specifically those living in poverty. In order to address this problem, healthcare apps are being used to provide greater access. Here are 10 healthcare aid apps that are impacting access in developing countries.

10 Apps That Aid Healthcare in Developing Countries

  1. Peek has its sights set on helping people with vision impairment issues and blindness, a problem exacerbated in developing countries by a lack of resources. Peek can identify people with vision problems. The app then works with healthcare providers to pinpoint an economically feasible way to supply the treatment they need, before allocating the appropriate resources. Currently, Peek is being used by the International Centre for Eye Health at the London School of Hygiene and Tropical Medicine, which is administering a population-based survey of blindness and visual impairments in Cambodia.
  2. SASAdoctor focuses on making healthcare consultations more accessible in Kenya. In the country, only 12% of people are insured. About 8 million are reliant on the National Hospital Insurance Fund, leaving 35 million Kenyans uninsured. Available to all Kenyans with an Android smartphone or tablet (65% of Kenyans have one), SASAdoctor decreases the cost of an in-person consultation for the uninsured and makes it free for those with insurance. Patients will have their medical history, list of medications and other such medical notes in their ‘file’ on the app, so that whoever tele-consults with them will have the information they need to create an informed medical opinion. SASAdoctor can decrease the cost of uninsured visits with a doctor to Kes 495 (the equivalent of $4.66) for a projected 80% of Kenyans who are predicted to have smartphones in the next few years.
  3. iWander allows people to keep track of Alzheimer’s patients. Set with tracking technology that can be discretely worn by the patient, it offers whoever uses the app several options on how to deal with situations involving the patient. Solutions can range from a group calling session to making an emergency medical call or summoning a caregiver. iWander gives families more control over the care of a loved one, which can have a positive impact in countries where healthcare may be less accessible. In the US, the average cost of care for a single person is $174,000 annually. About 7 out of 10 individuals with dementia remain at home to receive care, where 75% of the costs fall to the family to pay. In helping families be proactive instead of reactive to crises, iWander can help in cutting these costs, especially in poorer countries, where many families are struggling to keep up with the high costs of at-home care.
  4. Kenek O2 allows the user to monitor their oxygen and heart rate while they sleep. Kenek O2, built for the iPhone, also requires a pulse oximeter which connects to the phone and retrieves the data to be stored in the app. Together, the cost for these two items is around $100, compared to the price of a regular hospital oximeter and other similar products, which could easily cost more than $500. Having effectively been used in North America, South America, Asia and Africa, Kenek O2 is currently working on developing a special COVID-19 device to watch for early signs of hypoxia, or the deficiency of oxygen reaching tissues.
  5. First Derm is an app that requires a smartphone-connected device, called a dermatoscope. This allows detailed pictures to be taken of skin conditions and lesions to better allow for remote, teleconsultations. In places where doctors are few and far between, and public transport is less reliable, this can make getting a second medical opinion much easier. So far, First Derm has helped in more than 15,000 cases from Sweden, Chile, China, Australia and Ghana, ranging from ages of just 3 days old to 98 years. Of these cases, 70% could be treated without a doctor, most often by over-the-counter treatments available at local pharmacies.
  6. Ada takes user-input symptoms and provides appropriate measures to take as a result, like a personal health assistant. It’s intended to assist those who don’t have the means to seek an in-person consultation right away. The app has been released in several languages, which makes it more accessible. Currently, 10 million people around the world are using Ada for symptom evaluation.
  7. Babylon is intended to mitigate the obstacle of going to see a doctor in person by allowing users to input symptoms or solve common health problems via teleconsultation with a doctor. Babylon specializes in non-emergent medicine, allowing patients to skip a trip to the doctor’s office entirely if their condition allows it. This is beneficial in places where doctors are sparse, or the patient lacks the financial means or a method of transportation in getting to the hospital. Babylon caters to users across the U.S., U.K., Canada, Rwanda and several countries across Asia-Pacific and the Middle East. The app aims to expand to more countries in the upcoming years.
  8. MobiSante, through its ultrasound device, allows versatility in diagnostic imaging by bringing the ultrasound to the patient. This allows quality, diagnostic imaging to be done outside the confines of a hospital or clinic. As a result, it provides more holistic and informed treatment where people may need it most but have previously struggled in accessing a healthcare center with the necessary technology. While having a computer at home with a desk is much less common in developing countries, the world’s increasing reliance on the internet is shifting the status of internet technology from a luxury to a basic necessity. This means that technology such as smartphones are becoming somewhat of a necessity in impoverished countries, making an app like MobiSante effective in using smartphones to make diagnostic imaging more accessible.
  9. Go.Data is a tool released by the WHO. It is specifically for collecting data during global health emergencies. During the Ebola outbreak in Africa, Go.Data was praised for tracing points of contact. The app also tracked infection trends and helped in arranging post-contact follow up.
  10. Mobile Midwife is a digital charting app that stores information in a cloud so that healthcare workers have access to all pertinent patient information. It works even in cases of power outages, or home births where internet connection may be less reliable. This app can help in areas where mother and infant mortality is higher, ensuring that healthcare providers can efficiently access patient information to ensure the best care. It can also cut the extra time it takes to find records that could otherwise make procedures more dangerous for both mother and child.

Bridging healthcare accessibility with smartphone apps isn’t a perfect solution, as it comes with accessibility issues of its own. However, these healthcare aid apps can help people without insurance, or who are physically unable to visit a physician, access health consultations. As a result, more people are provided access to healthcare, empowering a healthier (and more health-conscious) population.

– Catherine Lin
Photo: Flickr