Information and stories on health topics.

Healthcare in HaitiHaiti has a population of 11 million people and shares the Caribbean island of Hispaniola with its neighbor, the Dominican Republic. Coverage of Haiti’s poverty was launched into world news after the 2010 earthquake. The country is still recovering from this natural disaster which has had detrimental effects on every sector of the economy including healthcare. Here are five facts about healthcare in Haiti.

5 Facts About Healthcare in Haiti

  1. Haiti is the poorest country in the Western Hemisphere ranking 169 /189 countries according to the Human Development Index. The life expectancy for males is 61 years of age compared to 66 years for females. Haiti has one of the world’s most unequal income distributions, and with 6 million Haitians living on less than $2 a day affording healthcare is a challenge. In 2012, only one-third of the population was financially stable enough to access healthcare in Haiti.
  2. Little government funding causes low public investment in healthcare in Haiti. The World Bank deems the government’s finances should invest in preventing diseases rather than creating more hospital buildings. Unfortunately, the Haitian government has largely decreased its investment in healthcare and in 2017 only 4.4% of Haiti’s budget was spent on public health.
  3. The Hospital of the State University of Haiti is still not constructed following the devastating 2010 earthquake. This planned 534-bed infirmary was set to become the newest general hospital, but the project has come to a halt as $27 million is still needed for completion. Issues about which type of healthcare system to use, political problems and a poor economy bring about questions when this building will be finished.
  4. Around 96% of the Haitian population is exposed to natural disasters that hinder advancement in society. For example, the 2010 earthquake destroyed the capital city of Port-au-Prince, where more than 25% of the country lives. This earthquake killed 150,000 people and destroyed 60% of the healthcare system in Haiti. The highest rates of cholera in the Western Hemisphere are in Haiti. The cholera epidemic entered Haiti’s rivers in 2010 which infected 800,000 people and killed 10,000. In 2014 drought caused millions of people to become food insecure which created the problem of malnourishment.
  5. The current political conflict is putting a strain on access to healthcare in Haiti. In an attempt to force the Haitian President to resign, the country participated in a lockdown known as “Peyi Lock.” Due to the lockdown, patients were unable to travel to hospitals and major shortages of medical supplies such as drugs and oxygen occurred. Inflation caused the price of medicines to increase by 35%. International medical assistance groups have begun to leave the island which will harm those in poverty who cannot afford healthcare.

Political conflict and poverty create difficulties when accessing healthcare in Haiti. Though the current pandemic presents new challenges, the World Bank created a $20 million COVID-19 Response Project for Haiti to help address the most pressing concerns. Aside from emergency health funding, the World Bank is also addressing gaps in other sectors such as WASH and food security which all relate to ensuring resilience in the health of as many Haitians as possible.

– Hannah Nelson
Photo: Unsplash

PIVOT Data in Madagascar Is Improving HealthcareBABSON PARK, FL Madagascar has one of the poorest healthcare systems in the world, spending $14 USD on healthcare per capita. This is well below the average of $94 USD per capita spending on healthcare in the Sub-Saharan region. The PIVOT organization has taken a data focussed approach to help improve the healthcare systems in Madagascar.

After working in Rwanda with Partners In Health, PIVOT founder Matt Bond saw the importance of statistical analysis when it comes to long term change within a healthcare system. Bond aspires to have a lasting impact on Madagascar’s health system. In addition, he develops interventions that can be implemented across the world to help improve health conditions. With the support of the Harvard Medical School, PIVOT focusses its efforts towards interventions that have significant statistical results within Madagascar’s medical system.

Madagascar’s Healthcare Challenges

PIVOT has established its goal to improve accessibility to healthcare facilities. Around 60% of the population lives more than three miles away from a medical facility. Additionally, many communities are unable to access medical treatments due to the uneven distribution of medical professionals and supplies. This issue is highlighted with the current COVID-19 pandemic. As of May 19, 2020 Madagascar has confirmed 322 cases of COVID-19. Madagascar has a Healthcare Access and Quality index rating of 29.6 out of 100This is well below the sub-Saharan average rating of 40 out of 100. A healthcare system with such a low rating may struggle with the increased demand for medical attention. Madagascar’s government has set a strict curfew in order to reduce the spread of COVID-19, however, the healthcare system will still be challenged by the pandemic.

The Data

The initial studies conducted by PIVOT began in 2014, with 8000 subjects to be followed up with every 2 years. The study collected data on over 840 variables, from basic demographics to access to healthcare. The long term studies aim to identify changes in mortality rates and access to medical resources. In addition, this extensive study required collaboration with the National Institute of Statistics of Madagascar. The results indicated maternal mortality rates to be one in 14, twice the estimated previous national Madagascar health predictions.

Astrophysicist Jim Herrnstein, helped Bond found PIVOT and their data focussed approach to healthcare in Madagascar. Herrnstein believes that the scientific method used to back PIVOT’s interventions highlights which projects are beneficial to the overall health of Madagascar’s population. The data suggest that single-layered interventions such as providing mosquito nets are important. However, it does not offer widespread and long term solutions. Initiatives such as hiring and training healthcare workers have decreased maternal mortality rates and increased delivery care accessibility by 20%.

The data collected is not just based on Madagascar’s population; PIVOT also researches and tracks environmental factors that can affect health and well-being. These studies focus on the environmental factors that contribute to malaria rates, childhood diarrhea and access to healthcare. The environmental terrain is an obstacle itself when it comes to healthcare access. Between 60-70% of Madagascar’s people will travel between three to six miles by foot to reach medical facilities. Additionally, only 34% of the population has access to clean water, which contributes to the rates of communicable diseases.

The Results

Within the first two years of operation, PIVOT has made a substantial impact on Madagascar’s healthcare system. The data suggests that access to healthcare for fever-related symptoms has increased by over 25 percent in areas where PIVOT has established interventions. The use of maternal health services has increased by 63 percent, and the overall use of healthcare facilities by Madagascar’s population has tripled.

PIVOT has proven the importance of using data to support healthcare interventions in Madagascar. The organization’s scientific approach has allowed them to target specific elements within Madagascar’s healthcare system to most effectively improve the medical environment. PIVOT continues to track the population’s well-being and use of medical facilities to ensure their programs continue to benefit the health of Madagascar’s population. 

Laura Embry

Photo: Flickr

Healthcare in Pakistan
In a study that The Lancet conducted, healthcare in Pakistan currently ranks 154th out of 195 countries in terms of overall system performance. As a developing country with a mere 2% of its GDP allocated for total health expenditures, Pakistan struggles to maintain a proper healthcare system with regard to quality and accessibility.

Pakistan’s numerous cases of communicable and vaccine-preventable diseases highlight its struggling healthcare system. Viral hepatitis, dengue, tuberculosis, malaria, typhoid, HIV and cholera have long been leading causes of death. They are the result of overpopulated cities, poor sanitation, unsafe drinking water and inadequate socioeconomic conditions.

Pakistan has one of the lowest amounts of immunized children, with overall vaccination coverage of just 60%. The result is a high newborn mortality rate: 69.3 deaths per 1,000 live births. Moreover, while the rest of the world is free from polio, experts still consider the disease as an endemic in Pakistan. Documentations determined that there were nearly 150 polio cases in 2019. With these alarming statistics in mind, here are six facts about healthcare in Pakistan.

6 Facts About Healthcare in Pakistan

  1. Healthcare in Pakistan includes both private and public sectors. The private sector serves approximately 70% of the population. Private hospitals and healthcare institutions consistently outperform their public counterparts, as measured by the overall quality of healthcare and patient satisfaction.
  2. A common misconception is that healthcare services in the public sector are free of charge to Pakistani citizens. This is not the case, as 78% of the population continues to pay for healthcare out of their own pockets.
  3. Healthcare in Pakistan has been a focal point after the country signed the U.N. Millennium Development Goals (MDGs). Pakistan began to initiate healthcare programs, establishing both Basic Health Units as well as Rural Health Units. Basic Health Units are assigned to NGOs, who manage the day-to-day operations, administer medicine and overlook the facilities.
  4. Reports estimate that there are roughly 175,000 doctors registered to serve the population. However, many Pakistani doctors choose to practice abroad due to poor service structure, increased workload, lack of funding and a rise in hostility by some. Moreover, many female doctors have stopped practicing due to family and social compulsions. Taking into account all these factors,  the doctor to population ratio stands at one doctor for every 1,764 persons. For adequate population coverage, Pakistan needs at least two doctors for every 1,000 persons.
  5. Healthcare in Pakistan has gradually improved over time. Currently, 92% of the rural population and 100% of the urban population have access to health services. Such improvement has been a direct result of Pakistan meeting the MDGs. Despite measures to increase the quality of healthcare facilities, most of the population prefers to consult private doctors and practitioners.
  6. Pakistan continues to commit to the MDGs in order to eradicate a multitude of preventable diseases. The introduction of immunization programs, such as the Expanded Program on Immunization (EPI), has increased vaccination coverage in Pakistan from 5% to 84%. EPI partnered with the Global Alliance for Vaccines and Immunization (GAVI), a global health organization dedicated to increasing immunization in low- and middle-income countries. With this partnership, countless people are working to eradicate vaccine-preventable diseases, such as measles, polio and neonatal tetanus.

With the arrival of COVID-19, Pakistan’s healthcare system is under immense pressure and is struggling to deal with the thousands of cases arriving each day. Frontline workers are taking the brunt of the virus. An estimated 3% of the total cases in the country consist of healthcare workers. Medical professionals are resorting to strikes and protests over the lack of protective gear necessary to safely treat patients.

In light of the unrest, Prime Minister Imran Khan announced new healthcare reforms to fix the faults of the health sector. The reforms allocate $300 million to pay for additional ventilators and other medical equipment. Additionally, major cities are setting up isolation centers to increase hospital capacity for infected patients.

These six facts about healthcare in Pakistan determine that the country will need to radically transform its health system performance in the following years in order to confront outbreaks that continue to threaten the population. The World Health Organization has recommended that Pakistan’s Ministry of Health increase healthcare expenditures to 5% of its GDP. Doing so would not only put an end to controllable diseases, but it will also ensure that the healthcare system will be able to deal with dangerous outbreaks in the future.

–  Abbas Raza
Photo: Flickr

 

Healthcare in ArgentinaThe system used today for providing healthcare in Argentina was developed during a period of economic glory for the country. This economic reform was achieved throughout the 1940-50s period of urbanization, industrialization and labor movements. Since then, healthcare in Argentina has been largely decentralized and privatized to provincial-level support. Healthcare services and resources are divided across three sectors. The public sector offers all services free of charge and is used primarily by those without social security. The Obras Sociales sector, which is funded by compulsory social security, is used primarily by workers. The private sector, which users pay for entirely out of pocket, is the most exclusive. On average across sectors, a ratio of 3.6 physicians treats 1,000 people.

5 Important Facts Related to Healthcare in Argentina

  1. The gross domestic product (GDP) expenditure for healthcare in Argentina is high. According to World Bank statistics from 2017 for Argentina’s current health expenditure, health services contribute to 9.12% of the annual GDP of the country. This percentage is significantly higher than that of 2016, which was 7.54% of GDP. Argentina’s health expenditure is also 1.1% higher than the average for its Latin American regional context. Argentina can still make improvements by creating universal health services across the country, but since the introduction of a Universal Health Plan in 2016, Argentina’s health expenditure has risen. Because of the shift from state to provincial-level control of healthcare in Argentina, there are inconsistencies between the provincial-level distribution of funds toward the healthcare system. The physician to population ratio between the autonomous city of Buenos Aires and the Misiones province can trace the inconsistency of healthcare access across provinces. In Buenos Aires, 10.2 physicians serve a population of 1,000, while in Misiones there are just 1.2 physicians to every 1,000 people.
  2. Argentina has successfully lowered rates of poverty-linked communicable diseases, like Chagas. Chagas, which is a vector-borne disease, has seen lower rates of transmission within eight out of the 19 endemic provinces of Argentina that it has previously been found. The interruption of vector and congenital transmission of the Chagas disease achieved these lowered rates. The development of strategies to combat other communicable diseases within Argentina, like HIV/AIDS and tuberculosis (TB), are still in dire need of support. One organization, called Mundo Sano, is working on strategies to interrupt the transmission of congenital HIV/AIDS between mother and child as of 2020. Statistics from United Nations AIDS (UNAIDS) research shows that as of 2016, 91% of women living with HIV/AIDS were already seeking out either antiretroviral or prophylaxes treatment to prevent vertical transmission. As a result, an estimated less than 100 children contracted the disease. With support from Mundo Sano, vertical transmission rates of HIV/AIDS could decrease even further.
  3. Argentina has developed action plans to combat the prevalence of multiple non-communicable diseases. As of 2014, metabolic diseases accounted for 4% of all deaths and cancers accounted for 20% of deaths. Most notably, 28% of all deaths in the country were attributed to diseases of the circulatory system. Once implemented, policies will be used to regulate food advertising, fiscal policies and front-of-package labeling. With funding to support the implementation of these policies, the incidence of certain non-communicable diseases could decrease significantly in Argentina.
  4. Natural disaster relief is available to all 23 provinces of Argentina. Instances of climatic stress to the diverse terrain of the country emerge most commonly as volcanic eruptions, floods, earthquakes, landslides, mudslides, tornados, storms, heatwaves and wildfires. The Argentine government established the National Directorate of Health Emergencies agency to prevent and mitigate the effects of a disaster. Environmental threats to public health across Argentina are combatted locally by provincial disaster response teams that operate under the national level agency.
  5. The aging population has free healthcare in Argentina. The National Institute of Social Services for Retirees and Pensioners (PAMI) in Argentina was created in 1971 to provide comprehensive healthcare and support to the country’s aging population. Since its beginnings, PAMI has implemented multiple programs for the betterment of health for Argentina’s elderly. Among the services available through PAMI are free healthcare for those 65 or more years old, along with preventative care resources like immunization and support networks. According to 2018 data from the World Bank, the average life expectancy across the Argentine population from birth is 76.52 years old, which has been steadily increasing since the creation of PAMI.

Since the 1940-50s economic reform in Argentina, the healthcare system has grown fragmented across the public, social security and private sectors. Healthcare sectors depend on the autonomous power of provincial-level governments and are therefore divided from one another.

In 2016, the government of Argentina responded to the fragmented nature of the system and introduced a Universal Health Plan. This plan is meant to increase the efficiency of coverage by compiling national health records into a single system, making patient identification more accessible across sectors. With cross-sector recognition and agreement for universalizing healthcare in Argentina, along with financial support for the cause, the country could achieve a healthier population overall.

Lilia Wilson
Photo: Flickr

Healthcare in UruguayWhen people think of the small South American nation of Uruguay, its healthcare system is probably not the first thing that comes to mind. Despite its obscurity, Uruguay has played a pioneering role in the development of South American medical standards and other countries have followed the example set by its exemplary healthcare system. What is this system, and why do many think it works so well?

Private and Public Care

Healthcare in Uruguay consists of two main systems: private hospitals run by private enterprises, and public hospitals run by government organizations.

In choosing their healthcare provider, many Uruguayans opt for one of the private Mutualista plans, which function like a membership to a private hospital. With Mutualista plans, a person might pay around $100 monthly to have access to the services of a private hospital.

 The Mutualista system of healthcare in Uruguay differs from many healthcare systems in other countries because it does not operate as health insurance, but rather as a membership plan to a hospital that has neither deductibles nor a lifetime cap.

Uruguay also has a public healthcare system, which is most often referred to as the Administración de Los Servicios de Salud del Estado, or the ASSE. The ASSE healthcare plans work similarly to Mutualista plans, but with one crucial difference: for poor and low-income patients, medical care costs nothing.

Uruguay’s public health system provides broad access to older individuals and those with pre-existing conditions. As long as an individual has an Uruguayan ID card, they can access the public healthcare system in Uruguay.

Who Chooses Which Plan?

Wealthier individuals tend to choose the Mutualista plans of private hospitals over the coverage of public hospitals because public hospitals have “generally lower” service standards. However, this in no way signifies that Uruguay’s public hospitals provide poor care. In fact, many public hospitals operate through universities that employ expert clinicians, allowing those hospitals to provide specialized treatments.

Together, the combination of public and private healthcare systems provides a large variety of care options for Uruguayan citizens and allows them to choose the system that best suits their medical needs and economic status.

Care for Uruguay’s Poor

As it provides free care to low-income patients, Uruguay’s public health system ensures that all citizens receive care. By providing universal care, Uruguay dramatically improves the health of the nation by making sure that no individual goes without necessary medical treatment simply because they cannot afford it.

For most low-income individuals, healthcare in Uruguay comes at little to no cost. Because of this, Uruguay’s public ASSE healthcare functions as a “safety net” for low-income individuals who cannot afford the luxury of private health services. This expansion of care to all may explain why life expectancy is steadily increasing, currently standing at 73.2 years and 80.2 years for men and women respectively, an uptick from 70.4 years and 78.4 years respectively between 1996 and 2000.

Of note, the country has made considerable strides in attacking poverty, as measured by income, which fell from 39.9% in 2004 to 9.7% in 2014. Likewise, extreme poverty declined from 4.7% to 0.3% during the same decade.

High Quality

Many consider Uruguay’s healthcare system to be among the best because it employs 5.08 physicians per 1,000 people, which makes it one of the most well-staffed systems in the entire world. Uruguayan hospitals also offer a good variety of medical drugs and make it easy for patients to get the medications they need. Besides this, the Uruguayan healthcare system even offers mobile medical services to provide care to those who may have difficulty leaving the house.

Healthcare in Uruguay not only offers a variety of hospital plans but also fosters improvements in national health. By offering virtually free care to its low-income residents, the healthcare system in Uruguay removes all economic barriers to healthy living. Many individuals commend the system of healthcare in Uruguay because they believe it ensures that all citizens have access to the care they need.

Global Impacts

While many countries around the globe continue to struggle with creating a healthcare system that works for their citizens, Uruguay seems to have found a balanced healthcare system that keeps its citizens both happy and healthy.

In South America, Uruguay’s system has influenced its surrounding nations and provided a model for constructing a healthcare system. One can see this in how countries like Argentina. Similar to the Uruguayan system, the Argentinian healthcare system includes private, social security and public care sectors. The public sector offers mostly free care to many citizens. Akin to the private hospitals in the Uruguayan system, Argentinian private hospitals also tend to provide care to wealthier citizens; both public systems also tend to serve less wealthy individuals.

The multi-tiered care system and the element of free public care suggests a pattern between the Argentine and Uruguayan healthcare systems. Since Argentina adopted many facets of Uruguay’s system, it suggests that the effectiveness of Uruguay’s healthcare system has caused changes in the way other countries thought about and organized their healthcare.

In summary, healthcare in Uruguay presents a success story for the following reasons:

  • Uruguayan hospitals provide high-quality care to their patients and always work to the benefit of the patients

  • Public hospitals and private Mutualista plans provide a variety of healthcare options depending on patient needs

  • Uruguay’s public hospitals often provide free care to low-income patients, and in doing so improve the public health of the nation

Overall, Uruguay’s healthcare system acts as a beacon of progress in South America. Its healthcare system functions to improve public health and ensure care even for its low-income citizens, and for that reason fulfills many humanitarian goals. Because of this, the Uruguayan healthcare system continues to influence its neighboring countries by leading them towards developing high-quality healthcare systems that accommodate the economic needs of citizens.

– Nolan McMahon
Photo: Flickr

Maternal Health in NepalNepal is a landlocked country bordering India and China, with a population of approximately 30 million. With close to 80% of births occurring at home, maternal health in Nepal has become a focal point as mortality rates raised alarmingly.

4 Facts About Maternal Health in Nepal

  1. The maternal mortality rate saw a reduction of about 71% between the years 1990 and 2015. The decline is attributed to free delivery services and transport, access to safe delivery services, and medicines that prevent hemorrhaging.
  2. Midwives are one of the popular professional services for maternal health in Nepal. Fast intervention and postnatal suggestions from a skilled midwife allows for better care for both mother and child after birth. In Nepal, only about 27% of women receive care within 24 hours of giving birth. This makes way for hemorrhaging, heavy-lifting related injuries shortly after giving birth and complications for the baby during and directly after birth.
  3. To ensure that midwives are updated on the most current practices and procedures for successful pregnancy and birthing, midwifery education is imperative. Institutions have partnered with the United Nations Population Fund (UNFPA) to offer combined education for nursing and midwifery. Midwives do not have specific legislation for their work. They are not completely recognized under the law or regulated, creating issues with proper training and resources. Therefore, greater recognition and accessibility will allow midwives the resources, training and encouragement that they need for success.
  4. The National Medical College Teaching Hospital in Nepal published an extensive report of the challenges surrounding maternal health in Nepal. A specific challenge mentioned in this report includes the socio-economic influencers of maternal health. Due to poor nutritional health in women with lower economic status, issues like anemia that cause mortalities. Additionally, rural areas record about 280 birth complications per day.

As maternal health in Nepal becomes more of a focus in the healthcare system, certain policies and programs must be expanded. Midwifery education and access to services are the most important programs for successful maternal health in Nepal. Many experts and those in the field continue to push for individual programs that focus primarily on methods for successful midwives.

– Ashleigh Litcofsky
Photo: Pixnio

Tuberculosis in Lesotho
On May 13, 2020, Lesotho confirmed its first case of COVID-19, making it the last country in Africa to contract the virus. The country now has to make a difficult decision on how to take charge of the situation. In short, the government has its work cut out for it.

But COVID-19 is not the first disease that the country has had to fight off. For years, Lesotho has been at war with tuberculosis, an incredibly infectious disease that acts similarly to COVID-19. Although Lesotho’s fight with TB may not be over, it has certainly made great strides towards ending the epidemic its citizens are living in.

Tuberculosis in Lesotho

Lesotho is a country in Africa that South Africa surrounds on all sides. It is a developing country home to approximately 2.11 million people. Currently, Lesotho ranks second in the world for people with tuberculosis, with an estimated 724 cases per 100,000 people—about 15,276 people in total. In Lesotho, tuberculosis is particularly harmful to those with HIV, as 73% of people who contract tuberculosis also have HIV.

Tuberculosis is the leading fatal infectious disease in the world, and it kills more than 1.6 million people worldwide each year. TB is an airborne disease: it transfers when a person breathes contaminated air droplets from an actively sick person. If untreated, active TB can be lethal. However, 90-95% of infected people do not actually show symptoms. Most tuberculosis is treatable, as the success rate of treatment in Lesotho is around 77%, but the country has seen a rise in MDR-TB or multidrug-resistant tuberculosis. As the name suggests, multidrug-resistant tuberculosis is immune to the common medications for TB. According to the National Center for Infectious Diseases, MDR-TB affects about 10% of people with smear-positive TB or around 1,000 people. The stronger strain of the bacteria requires that doctors develop more creative treatment options.

Treating Tuberculosis

Although the tuberculosis epidemic has significantly impacted life in Lesotho, the country has not stopped its ongoing war with it. Trained community health workers treat and supervise several patients from the patients’ homes. These workers give injections as well as monitor the side effects of treatments. Patients who become dangerously ill go to Botshabelo Hospital, a place that specializes in MDR-TB in the capital of Maseru.

The CDC also partnered with Lesotho in 2007 to help fight the infection. Since then, it has been working diligently to bring peace. The CDC helps the Ministry of Health and Social Welfare’s efforts towards HIV and TB treatment by improving health information systems, preventing transmission of HIV between mother and child, increasing the capacity in laboratories and giving counseling and testing for those HIV has affected. It also works with the ministry on diagnosis and treatment of the many variations of TB infecting the country. Altogether, the CDC has lowered the TB mortality rate to just 46 deaths per 100,000 infected.

Global Resilience

As a whole, the world has made phenomenal progress in its fight against tuberculosis. Global efforts have saved more than 50 million lives since 2000. Furthermore, global aid is actually is one of the best investments in the public health industry, as each dollar that goes towards TB relief yields $43 back.

Even though Lesotho is facing much loss, including those from its new COVID-19 cases, the country has stayed resilient amid hardship. Lesotho continues its ongoing war with TB, and it will not stop until there is no disease left to fight. The people of Lesotho show the world each day what true bravery looks like as they work towards a new, tuberculosis-free era.

John Pacheco
Photo: Flickr

tuberculosis in ZambiaThe South African country of Zambia has a population of around 17 million. Over the last 30 years, it has experienced a rise in tuberculosis cases, an infectious bacterial disease in the lungs. Estimates show the mortality of the disease as approximately 30 deaths due to tuberculosis per 100,000 people. Below are seven important facts about tuberculosis in Zambia.

7 Facts About Tuberculosis in Zambia

  1. Co-infection: HIV patients have a high risk of contracting tuberculosis. In Zambia, 59% of tuberculosis patients have also tested positive for HIV. Though there are healthcare systems for the prevention and treatment of tuberculosis among patients with HIV, overpopulation, poverty, cultural beliefs and sanitation conditions can make a diagnosis of both HIV and tuberculosis a challenge.
  2. Limited Access to Treatment: There is a greater prevalence of tuberculosis mortality in rural areas of Zambia. The commute to a clinic is often greater than a two-hour walk for a person living in a rural home, which puts a strain on those with the disease and on the family or friends who need to take time off of work to travel with their loved one.
  3. Economic Burden: Tuberculosis is extremely costly for individuals and for Zambia as a nation. Medications and other services like x-rays can be expensive for individual families. Furthermore, the overall loss of a workforce can impact the greater economy. This can be seen in mining communities, where tuberculosis is especially prevalent. Because the mining industry plays an important role in Zambia’s economy, there have been negative economic impacts in losing a percentage of the workforce due to tuberculosis. A 2016 study on tuberculosis in Zambian mines advocates for greater regulatory legislation for mining conditions and better health systems to create a healthier population and a more stable economy.
  4. Improving the Cure Rate: Tuberculosis is a serious disease and can be fatal. The Ministry of Health finds that 62,000 Zambians contract tuberculosis and 16,000 people die each year from the disease. Though there are still many fatalities, there has been great progress in treating the disease. Today, around 88% of people treated are cured, exceeding the WHO recommended cure rate of 85%, and the pooled cure rate of between 55% and 73% for Africa.
  5. Better Management: World Tuberculosis Day, observed each year on March 24, commemorates the discovery of the bacteria that causes tuberculosis in 1882. During the 2019 World Tuberculosis Day, the Ministry of Health Announced the new guidelines for “Management of Latent Tuberculosis Infection.” This was the launch of greater efforts towards the elimination of tuberculosis and emphasizes early detection.
  6. Improved Surveillance: Though tuberculosis is a severe health issue, there have been limited health surveys to find an accurate prevalence of the disease. In 2013, the Government of the Republic of Zambia (GRZ) through the Ministry of Health (MoH) and USAID conducted a survey on the tuberculosis rate in Zambian regions. The surveys showed a higher prevalence of tuberculosis than estimated. They also revealed improved techniques for tuberculosis detection. For example, the use of digital systems and the integration of HIV testing in tuberculosis surveys (HIV is common comorbidity) can help estimate the rate of incidence and help improve the efficiency of tuberculosis healthcare.
  7. More Accurate Diagnoses: Founded in 2006, the Center For Infectious Disease Research in Zambia (CIDRZ) has provided many services for combating tuberculosis in Zambia including research on diagnostic techniques. CIDRZ tested some novel techniques of tuberculosis diagnosis such as LED fluorescence microscopes and computer-assisted digital x-ray interpretation technology. CIDRZ helps mobilize these techniques and train community members in the identification of tuberculosis.

These facts show that the health crisis of tuberculosis in Zambia exposes a dire need for increased accessibility of healthcare and better methods of diagnosis and treatment. The recent efforts in management and care of tuberculosis show promise of effective tuberculosis management and an overall healthier population.

– Jennifer Long
Photo: Flickr

Healthcare in SwitzerlandMany know Switzerland for its high standard of living and hail its healthcare system as one of the best in the world—in fact, it often ranks as one of the top 10 healthcare systems worldwide. However, while healthcare in Switzerland is universal, it is not free or public, which makes it very expensive.

How It Works

All residents pay for their own health insurance. Unlike other countries, healthcare does not receive funding from government taxes. Even children and retirees must have their own individual health plan. The Swiss government mandates that health insurance providers cannot reject applicants for any reason and that all insurance providers offer a basic level of healthcare coverage to ensure that all citizens can obtain insurance.

The basic level of health insurance is identical across all Swiss insurance providers, covering expenses such as general check-ups and treatments, prescription costs, vaccinations, hospital visits and more. A basic healthcare plan covers around 80-90% of a person’s medical costs.

Health Insurance Companies

The role of health insurance companies in Switzerland is complicated. As private companies, they are competitive and seek profit. However, since law dictates that they all have to offer the same medical services under the mandatory basic health insurance, companies have limited competition.

Healthcare insurance companies have decreased in number within the past 20 years, from over 1,000 to less than 100. Their influence on political decisions is high since many government officials represent and defend their interests.

Pros and Cons

The Swiss government legally requires anyone staying in Switzerland for over 90 days to acquire health insurance, no matter the total length of stay. Healthcare in Switzerland is expensive, and people pay for most treatments out-of-pocket rather than receiving reimbursement later.

Switzerland’s high healthcare costs partially come from the fact that the government-mandated private insurance premiums largely fund the healthcare system. Healthcare providers charge more money from individuals to cover medical costs and business expenses since the government does not fund healthcare.

However, healthcare standards are high and citizens can receive excellent quality care across the country. Since basic healthcare is mandatory for all residents, every person has an entitlement to the same coverage and standard of care.

Swiss health insurance companies cannot deny insurance or charge inflated insurance rates for those with pre-existing conditions. Depending on customers’ age and insurance package of choice, some health insurance companies also will charge the same fee for the duration of the residency in Switzerland. Insurance rates may not increase even in the event of sickness or injury.

Comparison with Other Countries

The Organization for Economic Co-operation and Development (OECD) compared healthcare in Switzerland with healthcare in the 37 other OECD countries. It found that Switzerland’s model of universal health insurance coverage provides a wide variety of medical services and high patient satisfaction, but the percentage of Switzerland’s GDP that goes towards health is the second-highest in the OECD area.

Other OECD countries perform equally as well or even better in terms of healthcare at a lower cost. Switzerland spends the highest GDP, around 12%, on healthcare in comparison to other European countries. Swiss residents also spend an average of 10% of their salary on health insurance.

– Kathy Wei
Photo: Unsplash

Sanitation in BotswanaBotswana is a landlocked country in southern Africa. It has actively advocated and improved legislation for water access and sanitation since 1981 and continues to improve its Wash, Sanitation and Hygiene (WASH) conditions. Still, despite its growing economy, the country struggles to provide WASH services for some of its 2 million inhabitants. Here are 10 facts about sanitation in Botswana.

10 Facts About Sanitation in Botswana

  1. Free Feminine Hygiene Products: As of 2017, girls enrolled in both public and private schools have access to free feminine products as part of their school supplies. One in 10 girls reported missing school during their period prior to this initiative. This often led to girls falling behind in their work, and in some cases, dropping out. To combat this problem and encourage more Botswanan girls to finish their education, the government began providing sanitary pads to enrolled students. Similar initiatives throughout Africa have improved school attendance by more than 40%.
  2. Free HIV Treatment: Botswana provides free antiretroviral treatment for HIV and was the first country to do so. Despite the free treatment, Botswana has one of the highest rates of HIV in the world with 20.3% of the population infected according to Avert. Botswana encourages condom use by making 85% of condoms free and by teaching people about their benefits. Botswana has also improved the prevention of Mother to Child Transmission (PMTCT) in all healthcare facilities. The country provides training to employees to combat this issue, decreasing the transmission to 2.1%.
  3. Hygiene in school: A study performed by The University of Botswana concluded many elementary schools have the proper infrastructure for hygiene, such as toilets, sinks and latrines, but they do not always have the resources to ensure that the infrastructure works properly. The study found that 80% of toilets did not flush properly and that there was limited access to handwashing supplies. The Botswanan government is working to ensure these situations are improved through additional funding and newer infrastructure.
  4. Education about hygiene and sanitation: Hygiene is taught to students in elementary schools, but there is still a greater need for implementation and proper hygiene practices. The Okavango Research Institute found only 70% of students said they “always wash their hands,” before eating and after going to the bathroom, if available.
  5. Toilets in Botswana: More than 88% have access to adequate toilets in Botswana in 2020. Most toilets in Botswana are Western flush style, though latrines are also prevalent. However, in rural areas, Western-style toilets are less common, and up to 32.62% of people are practicing open defecation.
  6. Access to water: Clean water in Botswana primarily comes from ground sources, such as rivers and dams. Rates of water access are relatively high in urban areas (99.5%) compared to 84.1% in rural areas. However, limited infrastructure to secure the water forces many women into the laborious and time-consuming task of retrieving the water. Women may spend up to five hours retrieving clean water on a given day.
  7.  Water Demand: With increased access comes increased demand, which is hampered by decreasing rainfall and the high cost of sanitation. This demand also puts pressure on infrastructure systems and threatens access to clean water. To resolve this demand, government agencies and schools have started water recycling facilities. One such facility started by the Ministry of Agriculture recycles water from the Gaborone city sewage. It uses this water for “gardening and brick making,” reducing the need for clean water for these activities.
  8. Disease Implications: Diarrheal diseases remain a prominent concern regarding sanitation in Botswana. Diarrhea is caused by contaminated drinking water, inadequate sanitation services and unsafe storage practices. Through a study published by the Journal of Health, research determined people in rural areas are drinking and using water “unsuitable for domestic use,” despite the apparent availability of clean water. The study also concluded that the lack of proper storage in a person’s home contributes to the contaminants in the water. The prevalence of diarrheal diseases is the third highest killer in Botswana. Such illnesses kill four times as many people as the global median as of 2017.
  9. Healthcare Facilities: A huge factor in improving sanitation in Botswana is healthcare. Botswana has 27 health districts that provide “almost free” healthcare to citizens. Since the Abuja Declaration of 2001, Botswana allocates 17% of its budget to healthcare. Despite this, hospitals struggle with “inexperienced staff” and a lack of bed access. Citizens who can afford it opt for private healthcare to receive better services. However, healthcare and safety are prioritized in Botswana, and because of this, the country has only 49 reported coronavirus cases. This is also due to the government’s early implementation of required masks and social distancing.
  10. Improvement to WASH Services: Botswana has government agencies dedicated to improving WASH conditions: the Ministry of Land Management, Water and Sanitation Services and The Ministry of Health. This Ministry has worked with the U.N. to participate in the Water Global Analysis and Assessment of Sanitation And Drinking Water (GLAAS) survey. Furthermore, since 2000, Botswana has improved basic sanitation by 25% according to UNICEF.

Botswana is continuing to make valiant strides in the public health arena and looks on track to provide a better overall quality of life to its citizens, despite limitations in funding and infrastructure.

Allison Caso
Photo: Flickr