HIV/AIDS in Africa
The HIV/AIDS epidemic remains a significant public health problem in southern Africa. In the last decade, infections have drastically dropped while awareness of HIV status and availability of treatment has increased. This progress aligns with the UNAIDS 90-90-90 goal. Meeting this goal means that at least 90% of people with HIV are aware of their status, 90% are receiving antiretroviral drug treatments and 90% are virally suppressed. Viral suppression means that the virus will not negatively affect a person and that that person will not be able to transmit it to another person. Some of the most HIV-afflicted countries in Africa have met and even exceeded the 90-90-90 goals. Eswatini has the highest HIV prevalence in the world today at 26.8%. It has reached 95% in all categories and is on its way to reducing new infections.

HIV/AIDS and Conflicts

Despite recent progress, international aid has been focusing on HIV/AIDS less and less, especially as the COVID-19 pandemic has become a more imminent global threat. Sub-Saharan Africa still has the highest rates of HIV/AIDS in the world. It is also one of the most conflict-ridden regions in the world.

HIV/AIDS has a history of destabilizing political and social institutions in countries and leaving them vulnerable to violent conflict. The International Crisis Group estimated that one in seven civil servants, including government employees, teachers and the armed forces in South Africa were HIV-positive in 1998.

How Does HIV/AIDS Affect Civil Servants in Africa?

  1. The disease affects the productivity of the military and its ability to respond to armed conflicts. In 2003, the Zimbabwe Human Development Report estimated that the Zimbabwe Defense Forces had an HIV prevalence rate of 55%. With such a high rate of illness, the military has high training and recruitment costs, as soldiers get sick and are unable to work. In addition to this, HIV can transmit through sexual contact. It disproportionately affects younger populations which typically make up the bulk of the armed forces.
  2. The HIV/AIDS epidemic breaks down political institutions by limiting their capacity to govern. According to former president Robert Mugabe in 2001, AIDS had a significant presence in his cabinet, killing three of his cabinet ministers in the span of a few years and infecting many more. The disease wipes out workers essential to the function of a state, like policymakers, police officers and judicial employees.
  3. HIV/AIDS threatens the quality and accessibility of education. A UNICEF report found that more than 30% of educators in Malawi were HIV positive. If children cannot receive a quality primary education, they are less likely to receive secondary education and start professional careers. Instead, crime may open up opportunities for security that education could not provide. With increased antiretroviral use and awareness of the disease, HIV rates and deaths among educators have likely dropped along with overall rates in the last decade.

Civil Servants

The impact of HIV/AIDS on civil servants in Africa has been immense. The disease affects vulnerable populations such as gay men, sex workers and young women disproportionately. However, it has also affected those who work as civil servants. Civil servants are integral to the functioning of governments. Without them, countries are vulnerable to conflict and violence. Furthermore, HIV/AIDS prolongs conflict in countries already experiencing it.

While there are many other causes of violent conflict, the breakdown of political and social institutions fueled by HIV/AIDS only exacerbates conflict. War can also be a vector for the further spread of the disease. According to UNHCR, both consensual and non-consensual sexual encounters happen more often during the conflict. Rape has been a weapon of war in conflicts in Rwanda, the Democratic Republic of Congo (DRC) and Liberia in recent years and has likely contributed to the spread of HIV.

Solutions

Combating HIV and AIDS is a very important step in stabilizing economic, political and social structures across Africa. USAID programs like PEPFAR have had a significant role in combating HIV and AIDS. PEPFAR has invested nearly $100 billion in the global AIDS response in various ways. Most notably, it has provided 18.96 million people with much-needed antiretroviral treatment.

PEPFAR also aids in prevention care. For example, it has supported more than 27 million voluntary medical male circumcisions as well as testing services for 63.4 million people. In 2012, there was a government campaign in Zimbabwe to promote circumcision, in which at least 10 members of parliament participated.

These campaigns and USAID programs have had tangible results. In 2013, a study by the South African National Defense Forces showed an 8.5% HIV prevalence rate among its soldiers, much lower than the 19% prevalence in the general population. Given the successes in decreasing HIV/AIDS infections across Africa, perhaps economic, political and social stability is to follow.

– Emma Tkacz
Photo: Flickr

Mental Health in Guatemala 
Between 1960 and 1996, Guatemala fought in a civil war between the government of Guatemala and several leftist rebel groups, resulting in many deaths due to the destructive violence. This caused many mental health conditions and problems to arise in the people residing in the country. Unfortunately, violence and public security continue to be a concern in Guatemala, deteriorating Guatemalan’s mental health. 

What Does Mental Health Mean and Why is it Important?

The Centers for Disease Control and Prevention (CDC) defines mental health as someone’s emotional, psychological and social well-being, affecting how they experience and perform in their daily lives. To add, it can help determine how people cope with stress and make choices. Mental health is significant for one’s physical health because poor mental health can lead to diseases, such as diabetes, heart disease and stroke.

The Number of People in Guatemala that Have a Mental Health Disorder

More than 3,250,000 people in Guatemala could experience a mental health illness in their lifetime. However, unfortunately, many of them do not seek the help they need. In fact, one in four people between the ages of 18 and 65 have suffered or continue to suffer from a mental health disorder, but only 2.3% took the initiative to consult a psychiatrist to address their mental health issues. Commonly, people do not want to talk about their mental health. The reason is the lack of knowledge and the stigma around mental health in Guatemala.

Furthermore, Guatemala’s poverty rate increased from 45.6% to 47% in 2020. As a result, Guatemalans are at greater risk to develop mental health disorders because they endure more difficulties in their daily lives. The limited mental health sources available to them are insufficient to help alleviate the stress that socioeconomic disadvantages cause.

In the United States, most health care providers do not cover expenses for mental health care. Interestingly, Guatemala does not have a universal health care system, let alone dedicated mental health legislation. As a result, Guatemalans have difficulty seeking help because there is “0.54 psychiatrist available per 100,000 inhabitants,” according to American Psychological Association. Only five of them are outside of the main cities. Guatemala is a low-income country that does not have the resources to make mental health data available to the public. That is why there are not many studies or public data regarding this issue.

The Main Cause of Poor Mental Health in Guatemalan Children

A study that Rosalba Company-Cordoba and Diego Gomez-Baya conducted includes the issue of mental health of children in Guatemala. Interestingly, 50% of Guatemala’s total population is under 18 years old, making it a country with one of the youngest populations. A child’s mental health is valuable because it can have positive or negative long-lasting effects on their development.

Unfortunately, Guatemala’s high poverty rate has led to increased levels of violence because of the struggle to live in desperate conditions in the community. Exposure to violence showed significant effects on a child’s mental health, such as depression and anxiety. Although childhood poverty is prevalent in many areas of Guatemala, the quality of life showed little significance in the study. These symptoms were more common in adolescents than in children because they are more aware of their surroundings and environment. On the other hand, children exposed to low violence from urban areas with educated parents described higher qualities of life.

Violence rates have continued to increase with assaults, shootings, threats and robberies, causing many children to be afraid to go to school. Almost 60% of Guatemalan students would prefer not to go to school due to fear. Many students and teachers have received threats and experienced robberies or know someone who has been a victim of violence. Guatemala remains one of the poorest countries with high rates of violence, causing a higher risk of a child developing mental health disorders.

Living in these socioeconomic disadvantaged areas can cause children to become part of the gangs because there is no other option. The previously mentioned study showed the association between greater parental education level and higher income with lower food insecurity. However, many children do not attend higher education schooling because they have to help their families with household expenses. The number of children living in urban areas is increasing. This leads to more children in unsanitary conditions and a high cost of living. Almost all children attend primary school. However, the completion rate is 15%, which leads to low enrollment rates for secondary school.

Solutions for Mental Health in Guatemala

Many people have taken action to improve the state of mental health in Guatemala, especially for children. First, many citizens are taking to the streets to protest against the continuation of violence. The implementation of the International Commission Against Impunity (CICIG) resulted in reductions in homicide rates. For example, there were fewer homicides per 100,000 each year. The CICIG provided Guatemala with $150 million in international support to help reform their justice system, but President Jimmy Morales thought this violated Guatemalan authority. As a result, he removed the CICIG mandate in 2019, causing a setback.

Next, people are beginning to seek support for their mental health in Guatemala due to more specialized centers offering psycho-emotional support services to the public, such as Federico Mora National Hospital for Mental Health, for a low cost. According to American Psychological Association, there are about seven psychologists for every 100,000 people, which is a number that continues to increase.

Lastly, schools are doing their part in fighting against gang violence to make children safer in Guatemala and other countries. With support from UNICEF and the Ministry of Education, the schools created a Peace and Coexistence Committee. The idea is to promote an environment where they do not tolerate violence, as Theirworld reported. The schools are trying to lead by example and show their students that violence is not always the answer. They found over the years that there are fewer arguments between the children because they have conversions to handle any dispute.

As Guatemala continues to be a low-income country, crime rates and violence will increase, leading to mental health problems. Mental health in Guatemala will suffer the consequences of the stigma and the lack of resources. The country is working toward a better future by spreading awareness about mental health and fighting violent trends.

– Kayla De Alba
Photo: Unsplash

Fight Against Malaria
According to the World Health Organization (WHO) in 2019, malaria infections stood at almost 230 million globally. Of these malaria incidents, 409,000 cases led to fatalities. These are the striking and often overlooked numbers encasing the global fight against malaria. Malaria, a parasitic infection that mosquito varieties ruthlessly spread, is an ancient disease plaguing regions across the globe, particularly within the warmer climates of the tropical and subtropical areas of the world.

The cyclical nature of the disease from uninfected mosquitoes to infected hosts then infected mosquitoes to uninfected hosts, is in part the reason this disease is difficult to counteract outside of preventive measures, such as traditional nets, drugs and various forms of insecticides. However, these methods have limitations. The insidious nature of repeat infections adds insult to injury, with reports indicating up to six malaria infections annually among some children. Now, the dawn of a malaria vaccine hopes to make strides in the fight against malaria.

The Dawn of a Malaria Vaccine

The daunting reality and statistics on malaria illustrate only one side of the story on emerging aid over the last three decades. After years of research and trials by the manufacturer, on October 6, 2021, WHO officially authorized the widespread use of a malaria vaccine that GlaxoSmithKline created called Mosquirix. This is not only a win in the fight against malaria. Mosquirix is “also the first vaccine ever recommended for use by WHO to combat a parasitic disease in humans.”

Dr. Pedro Alonso, director of WHO’s global malaria program, says in a press release that “[i]t’s a huge jump from the science perspective to have a first-generation vaccine against a human parasite.” The vaccine, which targets children, has the potential to prevent “23,000 deaths in children younger than 5 each year.” As it stands, the vaccine manufacturer has “committed to producing 15 million doses of Mosquirix annually” until 2028.

Development in Tandem With the Global Health Order

This trend toward vaccination campaigns, development and authorization does not of course appear in a vacuum. After decades of stalling efforts on malaria prevention, a new global health order has ushered in a recent admiration for the efficacy of vaccine funding, research and implementation on the back of the global struggle against COVID-19. Organizations championing the global vaccine battle against COVID-19, such as GAVI, the Vaccine Alliance, “likely play a crucial role in negotiating the financing, procurement and delivery of” the Mosquirix vaccine.

Other major players in the fight against COVID-19 are also entering the ring. BioNTech recently launched a malaria project in July 2021. Its intentions are the use of mRNA technology, which has proven highly effective in COVID-19 vaccines, in the fight against the malaria parasite. Clinical trials of the world’s “first mRNA-based vaccine for malaria prevention” will begin at the close of 2022. These new multilateral and multi-agency relationships in health care, which the pandemic brought about, could be the stepping stones for future breakthroughs in global health.

Looking Ahead

Spurred on by new movements in global health, the malaria vaccine will make strides within infant and youth populations across at-risk regions like Africa and beyond. Mosquirix pilot programs in Kenya, Malawi and Ghana “found that the vaccine is safe. There is community demand for it and it is a cost-effective prevention method.” While perhaps not intrinsically linked to the new global health order, the world is making strides in combating an ancient and sometimes overlooked disease through emerging technologies, monetary funding and intellectual endorsements. It is safe to say that the new malaria vaccine could set new precedents as to the way the world cooperates on matters of global health security so that the international community can develop long-lasting strategies to keep at-risk regions safe, productive and healthy.

– Aidan Swayne
Photo: Flickr

Mental Health in Norway
Mental health is a disease that affects an estimated 792 million people worldwide. Yet when people live in poverty and lack the money to attain basic needs, mental health often falls on the back burner. This is especially true in Norway. Though the country has a low poverty rate coupled with substantial efforts to improve access to and quality of mental health care, about half of all people in Norway experience a mental health disorder at some point in their life, and these numbers are rising in the wake of COVID-19.

Health Care in Norway

Norway offers universal health care coverage to all of its citizens and extends this service to all citizens from the European Union. It receives funding through general taxes and payroll contributions by employees, and provides a variety of services, with mental health being one of them. In 1956, this system, called the National Insurance Scheme, became a right for all Norway citizens. Though it ensures access to local municipalities and general practitioners, patients that require long-term or outpatient care must pay a fraction of it, making services unattainable for some poorer citizens.

How Does Economic Status Influence Mental Health?

 Mental health problems can arise in anyone, regardless of age, socioeconomic status or demographic group. The ways these disorders affect the individual vary. However, people in poverty are more susceptible, as a large factor fueling these disorders is one’s life situation. In fact, life factors like disability, unemployment, sicknesses and others drive common mental illnesses like depression and anxiety.

A study that the International Journal for Equity in Health published found “the prevalence of psychological distress increasing by decreasing social status,” and noted economic problems as a major factor of it. Life factors, like living in poverty, have proven to increase levels of mental health disorders, but so do perceived living situations. Another study, published in Science Direct, investigated Norwegian adolescents’ view of living status. It found that if people felt they were impoverished or living in a low-income household, they had higher instances of mental health disorders. This perception, it found, might even be more influential than actual living conditions.

Impact of Mental Health Disorders on Norwegians

Estimates have determined that nearly 15% of children worldwide suffer from a mental health disorder. In 2018, 16.5% of  Norwegians 15 to 24 years old reported experiencing “severe psychological distress.” Typically, mental disorders manifest as early as 14 years of age, with personality and anxiety disorders developing as early as 11 years old. The Organisation for Economic Co-operation and Development said that “without early and effective treatment and inclusion in society, young people with mental disorders risk becoming lifetime users of adult mental health services.” On top of this, instances of mental illness in children and young adults are particularly concerning since they lead to poorer education and difficulty transitioning into the workplace. Consequently, affected individuals earn lower incomes as adults if not treated properly at a young age.

Concerningly, in the last decade, Norway experienced an increase in permanent poverty among children, a factor that directly relates to mental health. Oslo, the country’s capital, has notable disparities in income throughout the city’s districts. This impacts mental health in Norway since living in city districts with high-income inequality, like in much of Oslo, lowers the probability of accessing mental health services, according to a study by Jon Finnvold of Oslo Metropolitan University. The study also highlighted that kids living in lower-income households experienced a higher risk of behavioral, or mental, problems.

What is Norway Doing to Improve Mental Health Services?

Notably, in the past few decades, there has been substantial investment in mental health services in Norway. Between 1999 and 2008, it invested NOK 6.3 billion ($735, 739, 200) into the Escalation Plan for Mental Health. This investment lowered suicide rates and helped improve services already provided by municipalities and increased access to children.

However, there are still discrepancies in access to care for mental health in Norway, largely based on socioeconomic status. Any problems Norway faced with its mental health care system only became more pronounced during the pandemic: like all countries, it saw an increase in patients requesting mental health assistance, especially in early 2020, the onset of the pandemic. A lot of these increases, as scientists speculate in a study that VOX EU published, come from the effects of lockdown and movement restrictions. Scientists are looking to policymakers, as they enforced said lockdowns, and draw on this evidence to show the harm isolation has on people’s overall mental health.

In no way do mental health problems only affect Norway; they also affect the entire world without discrimination, planting its seeds in the minds of the richest and the poorest of citizens belonging to any race, ethnicity or income level. Yet, people with lower incomes and of a minority ethnicity are particularly vulnerable to feeling the weight of these illnesses, as they have less access to services.

In Norway, the government’s universal health care system calls for equal access to all health services, including mental health, but it is just not the case. Those needing more comprehensive care still must pay a portion out of pocket, a bill that not everyone can afford to pay. Oslo specifically is home to unequal access, a direct result of the stark income discrepancies throughout the city. Norway has made substantial progress through mental health investment, but there is always a need to reach more people, to focus on the vulnerable populations to ensure they have the same opportunity for care as everyone else. There are still people not receiving care, as costs remain a barrier for those needing extensive treatment.

– Cameryn Cass
Photo: Unsplash

Sanitation Facilities Empower Girls
About 2.3 billion people around the world lack access to basic sanitation facilities, according to UNICEF. A lack of sanitation facilities in schools can discourage girls from attending school. When girls have access to clean, enclosed sanitation facilities during their menstrual periods and potential pregnancies, they are less likely to skip school or drop out entirely. Sanitation facilities empower girls to attend school by allowing them to feel safer and more comfortable with access to adequate facilities to properly manage their menstruation. In turn, dropout rates decrease and girls’ education completion rates increase.

Private Changing Rooms

Private changing rooms for girls to bathe and change in can help girls feel more comfortable attending school and participating in lessons. Changing facilities with water supplies offer girls a place to change, wash and dry menstrual supplies during the school day. Some changing rooms may also provide students with free menstrual supplies, which is essential for impoverished girls who lack access to these products outside of school.

Without private changing rooms, female students may feel embarrassed to come to school during their periods, especially in countries where people stigmatize menstruation. According to a World Bank study in India, 80% of girls from rural areas in India thought menstrual blood carried harmful substances and 60% believed menstruation is a topic that people should discuss openly.

The availability of changing rooms in schools is also important for pregnant students who require privacy and good-quality sanitation. A lack of proper sanitation facilities stands as a barrier for many pregnant students who feel discouraged and uncomfortable coming to school otherwise. Hygienic sanitation facilities empower girls by helping them feel comfortable at school, even during menstruation or pregnancy.

Private Bathrooms

Much like changing rooms, private bathrooms in schools with modern urinals or toilets can benefit girls’ education. Private bathrooms may include menstrual supplies and waste disposal, which encourages girls to come to school even during their periods. In cultures that stigmatize menstruation, some girls pretend to be ill or come up with other excuses to avoid attending school during their periods due to shame or embarrassment. Many girls do not attend classes during their periods because their schools lack toilets with water facilities as well as discreet sanitary waste disposal areas. Enclosed and gender-specific bathrooms can also improve girls’ safety by giving them privacy when using the bathroom, which protects them from sexual assault and natural dangers such as snake attacks. Private bathrooms and sanitation facilities empower girls by increasing school attendance rates during menstruation.

Organizations Making a Difference

Many organizations around the world are helping girls remain in school during their menstrual periods by providing clean sanitation facilities and free menstrual hygiene products. For example, ZanaAfrica is a social enterprise that works in Kenya to provide girls with reproductive health education and sanitary pads. The enterprise also leads policy and advocacy programs to help break the silence and shame surrounding menstruation.

In Kenya, estimates indicate that 1 million Kenyan girls miss out on education every month due to a lack of menstrual products and sanitation facilities. ZanaAfrica’s approach to supporting girls in school consists of three key steps: integrating health education into schools, collaborating with local partners to provide sanitary pads and education and leading with advocacy and policy. Since 2013, ZanaAfrica has provided more than 50,000 Kenyan girls “with health education, sanitary pads, underwear and mentors.”

Sanitation facilities empower girls to attend school, dissolving barriers to education so that girls can develop the knowledge and skills necessary to rise out of poverty. Girls’ access to sanitation facilities in schools is a necessary step in fighting gender inequality. With an education, girls in developing countries can access skilled jobs and contribute to the growth of the economy, reducing global poverty overall.

– Cleo Hudson
Photo: Flickr

Diseases in Nigeria
Nigeria ranked 142 out of 195 countries in a 2018 global health access study. However, although Nigeria has a challenging health care system, the country has improved the infrastructure that has helped it fight diseases such as polio, measles and Ebola. Nigeria now has centralized offices called Emergency Operation Centers (EOCs) that serve as a base for government health workers and aid agencies to coordinate immunization programs and collect data. While there is progress, many diseases still plague Nigeria.

Cholera

Cholera is a water-borne disease that results in a quick onset of diarrhea and other symptoms such as nausea, vomiting and weakness. It is one of the many diseases impacting Nigeria in 2021. If people with cholera do not receive treatment, the disease may kill them due to dehydration. A simple oral rehydration solution (ORS) can help most infected people replace electrolytes and fluids. The ORS is available as a powder to mix into hot or cold water. However, without rehydration treatment, about half of those infected with cholera will die, but if treated, the number of deaths decreases to less than 1%.

In August 2021, Nigeria began to see a rise in cholera cases, especially in the north, where the country’s health care systems are the least prepared. The state epidemiologist and deputy director of public health for Kano State, Dr. Bashir Lawan Muhammad, said the rise in cases is due to the rainy season. It is also because authorities have been dealing with Islamist militants in the north. In Nigeria, 22 of the 36 states have suspected cholera cases, which can kill in hours if untreated. According to the Nigeria Center for Disease Control, 186 people from Kano have died of cholera since March 2021, making up most of the country’s 653 deaths.

Malaria

Malaria is another one of the diseases affecting Nigeria. Through the bites of female Anopheles mosquitos, parasites cause malaria and transmit it to humans. Globally, there were 229 million malaria cases in 2019, with 409,000 deaths. Children under the age of 5 years old are the most susceptible group, and in 2019, they accounted for 274,000 or 67% of worldwide malaria deaths. That same year, 94% of malaria cases and deaths occurred in the WHO African Region. Although the disease is preventable and curable, the most prevalent malaria-carrying parasite in Africa, P. Falciparum, can lead to severe illness and death within 24 hours.

The President’s Malaria Initiative (PMI), which USAID and the CDC lead, works with other organizations to help more than 41 million Nigerians. Despite the difficulties that COVID-19 presented in 2020, the PMI was able to assist Nigeria to distribute 14.7 million treatment doses for malaria, 8.2 million of which went to pregnant women and children. Besides that, the “PMI also distributed 7.1 million insecticide-treated mosquito nets (ITNs), provided 7.2 million rapid test kits, and trained 9,300 health workers to diagnose and treat patients” of malaria. Before the PMI, only 23% of Nigerian households had bed nets, but since 2010, that number has risen to 43%. The PMI also aims to improve health systems and the skill of health workers to administer malaria-related services.

HIV

HIV (human immunodeficiency virus) attacks the immune system, leading to AIDS (acquired immunodeficiency syndrome). One can control the virus with proper medical care, but there is no cure. The disease is prevalent in Africa because it originated in chimpanzees in Central Africa. The virus likely spread to humans when the animals’ infected blood came into contact with hunters. Over the years, HIV spread across Africa and other parts of the world, becoming one of the diseases impacting Nigeria today.

The CDC works with the Federal Ministry of Health (FMOH) and other organizations to create and sustain HIV response programs in Nigeria. The CDC’s “data-driven approach” and prevention strategies and treatment strengthen the collaborative system in Nigeria. These include HIV treatment, HIV testing, counseling, services to help prevent mother-to-child transmissions and integrated tuberculosis (TB) and HIV services. TB is the leading cause of death among people living with HIV.

From October 2019 to September 2020, nearly 200,000 Nigerians tested positive for HIV and began treatment. During the same period, over 1 million HIV-positive people tested for TB. More than 5,000 of those individuals tested positive and began treatment for TB. By the end of September 2020, nearly 25,000 orphans and other vulnerable children received HIV/TB services through the CDC. Not only that, but all facilities in Nigeria that the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) supports now use TB BASICS, which is a program that “prevents healthcare-associated TB infection.”

In 2021, Nigeria will face many diseases. On the other hand, great strides are occurring to educate the Nigerian population on diseases like HIV, malaria and cholera. Despite efforts, there is still much more necessary work to reduce illness in Nigeria.

– Trystin Baker
Photo: Flickr

Low Health Literacy in Developing Countries
While developing countries often face pressing issues such as inadequate health care, a less obvious but equally threatening problem is low health literacy rates. In comparison to developed nations, health literacy rates in developing nations are significantly low. However, if society as a whole works to educate and empower individuals to make better choices regarding their health, low health literacy, also known as the “silent killer,” will see a drastic reduction. Here is some information about low health literacy in developing countries.

Defining Health Literacy

The World Health Organization (WHO) defines health literacy as an individual’s ability to adequately comprehend health information and to implement this knowledge into their everyday life in order to “maintain or improve quality of life.” An individual with lower health literacy is more likely to make questionable health choices and is less likely to take preventative action against manageable diseases.

Limited health literacy also correlates with unhealthy lifestyle choices, increased hospitalization rates and higher mortality rates. These impacts make it clear to understand how inadequate health literacy serves as a “silent killer,” especially within developing nations where these rates are prominently low.

The Situation in Developing Countries

Low health literacy rates link to inadequate education systems and health systems because these structures hold the responsibility of relaying health information to the general public. Thus, nations that lack these proper systems are more likely to have insufficient health education levels.

A survey of adult citizens in Isfahan, Iran, indicates that almost 80% of respondents did not have sufficient health literacy. Most of the respondents with inadequate health literacy were females with “low financial status” and limited education. This data suggests that an overwhelming number of individuals in developing nations lack satisfactory health education, particularly women. The reason for this is likely issues of gender equality — women lack access to education, essential services and employment opportunities. Furthermore, poverty disproportionately impacts women all over the world.

Taking Action

There are several ways to improve health literacy rates, and therefore, improve global health. It is crucial to educate the population on their health and to empower them to effectively manage their well-being. Several interventions have proven effective. In South Africa, providing individuals with informative yet easy-to-read pamphlets that include graphics is improving health education in the country. Meanwhile, in China, findings determined that “periodic training of health educators is essential for improving health knowledge” among the general public.

Media is yet another way to improve health education. In Uganda, “more than one in three used the internet to search for health information.” In Iran, secondary school students cited television as their most helpful source of information on HIV/AIDS. In Israel, “a model of Media Health Literacy (MHL)” showed potential in improving health literacy among younger citizens.

Across Asia, the Asian Health Literacy Association (AHLA) works to understand and improve health literacy rates. This organization aims to raise awareness of this issue “among researchers, officials, healthcare organizations as well as experts in health and education, corporations and media” in order to formulate effective interventions to improve these rates in Asia. AHLA sees this as an essential  part of improving the quality of healthcare “and reducing health disparities between communities, groups and nations.” Ultimately, the AHLA aims to improve global health, starting with Asia.

Moving Forward

Increasing health literacy rates in developing countries is an effective way to improve global health and eliminate inequalities. Through education programs, improved communication and dedicated organizations,  these rates can improve. By educating individuals on matters of health, people all over the world can live an improved quality of life.

– River Simpson
Photo: Flickr

4 Key Facts about Healthcare in Papua New GuineaPapua New Guinea comprises the eastern portion of New Guinea and a plethora of offshore islands. With the highest infant mortality rate in the region, it is evident that the country suffers from poor health outcomes. Here are four key facts to consider to better understand the state of healthcare in Papua New Guinea.

4 Key Facts About Healthcare in Papua New Guinea

  1. Unique Geographical Challenges: Papua New Guinea features mountain ranges on the mainland as well as 600 small islands. This unique geography introduces challenges in delivering adequate healthcare services to the population, as isolated rural and remote communities are often cut off from essential healthcare services. While all countries have particular groups that are geographically isolated, the situation in Papua New Guinea is exacerbated as 80% of the population lives outside of city centers compared to the global average of 54% urbanization.
  2. Hygienic Inefficiencies: Hygenic inefficiencies occur in two ways: education and access. Awareness of proper hygiene and health operating procedures remains low in Papua New Guinea. For example, only 10% of schools in the country promote handwashing. But even if education rates were high, proper infrastructure does not exist in Papua New Guinea. Only 40% of the population has access to clean drinking water, and roughly 28% of schools have access to sanitation.
  3. Scarcity of Doctors and Nurses: For a population of more than nine million, Papua New Guinea has approximately 500 doctors and 400 nurses. The country has 0.1 physicians per 1,000 people, compared to the world average of 1.566 physicians per 1,000 people. The quality of the small healthcare force is further hindered by poor working conditionals, low wages and inadequate infrastructure. These limiting factors, combined with an inefficient training capacity, reduce the scarce healthcare workers’ performance in Papua New Guinea.
  4. Missing Resources: The lack of access to the resources necessary for health care workers to do their jobs serves only to worsen the prospects of an already struggling workforce. Recently, Papua New Guinea could not provide nurses with basic medical supplies resulting in nurses threatening a strike. Concerns regarding COVID-19 served to highlight that the country only possesses 14 ventilators. For reference, the U.S. had 160,000 ventilators before the pandemic. Even if these resources became available, many nurses and healthcare practitioners would use them inefficiently as there is a lack of adequate training regarding equipment and disease control.

The Future of Healthcare in Papua New Guinea

While the current state of healthcare in Papua New Guinea is lacking compared to global standards, there are many plans in place to increase the scope and effectiveness of healthcare efforts. The Provincial Health Authority (PHA), endorsed by Minister for Health Sir Dr. Puka Temu, is a widespread reform movement attempting to revitalize healthcare in Papua New Guinea. According to Dr. Temu, the program “will bring [Papua New Guinea’] district and provincial health systems under one umbrella, and allow [public health officials] to improve planning and funding of primary health care.”

The healthcare situation in Papua New Guinea presents both unique and general challenges. While many countries suffer from under-resourced and staffed facilities, Papua New Guinea has its unique geography to overcome. To address these concerns, the nation is preparing for the future with its Development Strategic Plan 2010-30, which aims to work alongside the National Health Plan to make Papua New Guinea “among the top 50 countries in the U.N. Development Programme’s (UNDP) Human Development Index (HDI) by 2050.” International partnerships and a domestic governmental focus on health outcomes provide hope for the future of healthcare in Papua New Guinea.

– Kendall Carll
Photo: Flickr

Healthcare in Armenia
Armenia is a mountainous nation of nearly 3 million people. It neighbors Iran, Georgia and Turkey. Over the past three decades, healthcare in Armenia has undergone a slow reform. The country is transitioning from an inefficient model of centralized healthcare to a modern system focusing on family medicine. Many Armenians feel dissatisfied regarding their healthcare system. However, organizations like the Health for Armenia Initiative and the World Bank are working with the Armenian government to improve options for Armenians.

Armenia’s Healthcare History

Healthcare in Armenia during the Soviet era was a centralized medical system. Experts state that the Soviet system was technologically underdeveloped and inefficient. The healthcare model focused on centralized care in hospitals and medical professionals were highly specialized.

Armenia declared independence in 1991, and healthcare in Armenia underwent radical changes. Local governments took over primary health care sectors while regional governments gained ownership over hospitals. Armenia’s State Health Agency is now in charge of the healthcare system. The government allocates resources to these publicly owned facilities. Since its independence, Armenia has implemented many healthcare reforms. A major piece of legislation called the “On Medical Aid and Medical Services for The Population” created a system that allows patients to help pay for healthcare services. This development plays a role in why Armenians find themselves funding most healthcare expenditures with out-of-pocket expenses.

Armenians in certain years paid up to 89% of healthcare charges in out-of-pocket expenses. This is incredibly taxing, given that Armenians earn an average per capita household income of around $1,500 USD. Their inefficient and expensive healthcare system places a heavy financial burden on impoverished peoples. Patients are slowly transitioning to primary healthcare providers with financial regulations replacing older regulations. However, a lot of work is still ongoing to improve the healthcare situation in Armenia.

How Armenians Feel About Their Healthcare

A 2018 report outlined a recent picture of healthcare in Armenia. Around 400,000 people in Armenia are poor or near-poor. Meanwhile, at least 233,000 of these people are part of a vulnerable group including the disabled, children and the elderly. In 2014, 31.8% of the poorest of Armenians reported that they were sick for more than three days, but they did not seek treatment because of financial reasons. Only 4.2% of the richest Armenians made the same decision.

A public opinion report that BMC published in 2020 outlined the current feelings the Armenian people have towards their healthcare system. The researchers polled over 500 Armenian citizens about the country’s healthcare system. Nearly half of respondents did not believe that citizens had equal access to healthcare in Armenia. Almost 70% of respondents felt that the government should have a larger responsibility towards an individual’s health which included funding healthcare services.

The Healthcare for Armenia Initiative’s Mission

Armenian natives and internationals formed the Healthcare for Armenia Initiative (HAI) in 2016. The initiative’s team focuses on bottom-up reforms to increase rural Armenians access to the constitutional right to healthcare. HAI’s projects focus on developing and maintaining healthcare professionals that can provide services in high-need areas.

HAI defines its work around six pillars, and among these pillars are education, research and leadership. It focuses on these three by holding workshops. It held a two-day workshop in partnership with the National Institute of Health of Armenia where it “[discussed] how to improve health education and healthcare in Armenia.” Organizations like HAI have helped to inform recent changes in government policy that will hopefully address the healthcare needs of the Armenian people.

Recent Changes for Healthcare in Armenia

The Armenian government in partnership with the World Bank published a guideline for the Health System Modernization Project. The main goal of the partnership is to improve access, quality, efficiency and governance for Armenian healthcare. The project focuses on adopting an efficient family medicine model. The transition to a family medicine model requires training new doctors that are not overspecialized.

A major priority of the project was to train the number of healthcare professionals necessary to run a family medicine-style healthcare system. At a final cost of nearly $6 million USD, this project component costs less than the projected $7 million. This key part of the project trained 980 family medicine doctors and nurses. The World Bank reports that these numbers should support 60% of the country’s needs.

Armenia and the World Bank cooperated on three other major components as part of this modernization project. They optimized and renovated the hospital network. The project reorganized the Armenian Ministry of Health so the agency could better function as a regulator of healthcare. These reforms gave the Ministry of Health many monitoring tools to efficiently implement and regulate the healthcare reforms the country is undergoing. Armenia’s government also established the Health Project Implementing Unit (HPIU). HPIU is a part of the Armenian Health Ministry that monitors, reports on and provides strategic planning for the overall healthcare modernization project. All of these developments cost around $30 million USD to achieve.

Where Healthcare in Armenia Stands

Healthcare in Armenia is an inequitable system in the process of reforms and transition. Armenia with the help of national and international institutions is moving to a family medicine system that meets the financial and medical needs of its people.

Jacob Richard Bergeron
Photo: Flickr

Surjer Hashi NetworkBangladesh is a country in South Asia with a population of 163 million people. As a developing country, Bangladesh struggles to provide adequate healthcare for such a large number of people. The problem particularly brings challenges for people from rural and marginalized communities, who often cannot access quality health services. To combat this issue, the Surjer Hashi Network has been established. Funded by the U.S. Agency for International Development (USAID), it is a network of hundreds of health facilities throughout the country. The facilities bring free or reduced-cost healthcare to low-income populations in Bangladesh while simultaneously bringing the country closer to achieving universal healthcare.

Healthcare in Bangladesh

Despite Bangladesh’s current struggles to provide a reasonable level of healthcare for its citizens, the country has made significant progress over the past few decades. Certain indicators have seen improvements such as maternal and infant mortality. Furthermore, the rate of vaccinations for children has increased dramatically, with the percentage of tuberculosis vaccinations for children under 1 increasing from 2% in 1985 to 99% in 2009. While the developments are a good sign, Bangladesh still faces many challenges in maintaining its healthcare system. For instance, the country suffers from a severe shortage of healthcare workers. As of 2009, only about one-third of the country’s facilities have at least 75% of qualified staff working in healthcare and 36% of health worker positions are vacant.

The ineptitude of Bangladesh’s governmental structure and the inability of its institutions to carry out its policies cause problems. The healthcare system is concentrated in urban areas even though 70% of the population lives in rural areas. Meanwhile, careless management obstructs the allocation of resources. Healthcare workers suffer from high turnover and absenteeism while maintenance of facilities is poor. Meanwhile, rural Bangladeshis often forego formal healthcare due to a lack of access in the communities. As a result, only a quarter of the population uses public healthcare.

The Surjer Hashi Network

USAID backs the Surjer Hashi Network of health clinics aiming at serving low-income and other underserved communities in Bangladesh. With 399 facilities nationwide, the network serves at least 16% of the population. In just a five-year period, USAID helped the Surjer Hashi Network prevent 2,000 maternal deaths and 10,000 child deaths. The facilities provide communities with proper healthcare in remote and underserved areas. Rural women, in particular, have benefited as the Surjer Hashi Network of clinics provides for reproductive health and child care.

Universal Healthcare in Bangladesh

In 2018, USAID started the Advancing Universal Health Coverage (AUHC) program, which has allowed the Surjer Hashi Network to remain operable in the long term. The program has consolidated the hundreds of clinics in the network into a centrally managed organization and it has introduced new business models aimed at keeping costs down and expanding health services. The efforts will ensure that clinics in the Surjer Hashi Network will be financially independent while providing high-quality and affordable healthcare for the disadvantaged.

As its name suggests, the AUHC’s goal is to achieve universal healthcare in Bangladesh. Through the Surjer Hashi Network, USAID is ensuring that Bangladesh can provide healthcare coverage for as many people as possible with healthcare facilities that are accessible in rural areas as well.

Nikhil Khanal
Photo: Flickr