tobacco in myanmarMillions of people worldwide use tobacco every day. Though tobacco usage has decreased in some countries, it still remains a significant public health concern for various populations. This is especially true for lower-income countries all over the globe. Myanmar is no exception. With the highest rate of tobacco usage in Southeast Asia, tobacco in Myanmar runs rampant with limited regulation.

The Feedback Loop: Tobacco and Poverty

Worldwide, 1.8 billion people smoke, with 84% of smokers from underdeveloped countries. The world’s poor are prone to spending their limited income on tobacco. However, smoking comes at a high opportunity cost. Money spent on tobacco could instead go toward food, education and health care. In countries such as Bangladesh, the poorest households spend 10 times more on tobacco than they would on education. In Mexico, the poorest 20% of households spend at least 11% of their income on tobacco. Overall, the world’s poor sacrifice significantly more of their income to satiate tobacco addiction than do richer households.

In addition to being a financial drain, tobacco also presents numerous health risks. Users of tobacco are at risk for cancer, respiratory diseases and heart problems. These illnesses create higher medical and insurance costs, which could cause households to spiral deeper into poverty.

Tobacco in Myanmar

Currently, around 1.6 million people in Southeast Asia die from tobacco-related illnesses each year. Myanmar currently has the region’s highest prevalence of tobacco use. Approximately 80% of men use tobacco in Myanmar. In this country alone, over 65,600 people die from tobacco-related diseases annually. Regardless of this risk, more than 5 million adults in Myanmar continue to use tobacco every day.

The lack of regulation of tobacco in Myanmar puts millions of individuals at risk of exposure to secondhand smoke. Currently, 13.3 million smokers and individuals exposed to secondhand smoke are at risk of developing tobacco-related diseases such as CVD (cerebrovascular disease). CVDs are one of the most common ways tobacco claims lives. They are also the leading cause of death in the country, contributing to 32% of all deaths.

Premature deaths have also greatly affected Myanmar’s economic growth, severely limiting income opportunities for the nation’s poor and middle-class families. In 2016, economic losses due to tobacco-related mortality were estimated at MMK 1.32 trillion. Overall, the economic loss caused by tobacco-related health complications places a huge strain on Myanmar. Most importantly, without explicit programming efforts, very few users have successfully quit tobacco in Myanmar.

So, What’s Next?

A number of efforts are looking to minimize the harmful effects of tobacco in Myanmar. For example, Myanmar’s government created various changes to its Tobacco Control Laws upon joining the World Health Organization’s FCTC (Framework Convention on Tobacco Control) in 2005. Despite these changes to the law, however, there are insufficient funds for smoke-free enforcement in public spaces. Currently, smoking remains legal in pubs and bars, indoor offices and public transportation.

A comprehensive tobacco control program is therefore necessary to limit the prevalence of tobacco in Myanmar. Luckily, many organizations are willing to assist in this fight. The World Health Organization released plans for its Tobacco Control 2030 campaign, which includes Myanmar. It will be one of the 15 countries chosen to receive aid from the U.N. to support its battle against tobacco.

In 2019, the People’s Health Foundation also implemented a four-year plan to turn Yangon, the largest city in Myanmar, completely smoke-free. This organization plans to raise public awareness of the dangers of smoking and passive smoking on various media platforms. The People’s Health Foundation also partnered with the Ministry of Health and Sports to minimize smoking and overall tobacco usage in the country. Already, the organization has converted regions including Ayeyarwady, Bago and Mon into smoking-free zones. While much work still remains, Myanmar these efforts to minimize the use of tobacco among its citizens are showing some signs of success. This provides hope that the epidemic of tobacco in Myanmar may soon end.

Vanna Figueroa
Photo: Flickr

Health and Human Rights of RefugeesOne of the most important factors in beating the coronavirus is ensuring that everybody has access to public health. According to The New Humanitarian, this has pushed numerous governments to double down on their efforts to protect the health and human rights of refugees, migrant workers and asylum seekers who may have not been able to afford access to these services pre-COVID.

In March as the worldwide outbreaks quadrupled and human rights organizations around the world urged governments the dangers the coronavirus would impose on refugees and asylum seekers. The World Health Organization, the UNHCR and several other organizations put out a joint press release that pressured governments to release migrants and undocumented individuals from immigration detention centers as well as include them in public health relief efforts. Here are three countries that have prioritized protecting the health and human rights of refugees during COVID-19. They show that these policies could be sustained even beyond the crisis.

Countries Protecting the Health and Human Rights of Refugees During COVID-19

  1. Italy: Italy has one of the highest infection rates with 238,159 confirmed cases and 34,514 deaths. Italy’s fields have also attracted migrant workers from Eastern Europe. On May 13, the Italian government passed an amnesty law allowing around 200,000 migrant workers and undocumented refugees to apply for healthcare and 6-month legal residency permits. The downside of this new step is that the bill only applies to agricultural workers, leaving out many of the workers in the informal sector who perform labor in construction or food services.
  2. Portugal: Migrants and asylum seekers in Portugal with applications that are still in process are now being granted early access to public services that include welfare, rental contracts, bank accounts and national health service. Claudia Veloso, the spokesperson for Portugal’s chapter of the Ministry of International Affairs, told Reuters that “people should not be deprived of their rights to health and public service just because their application has not been processed yet.”
  3. Brazil: Brazil has the highest rate of outbreaks second to the United States, and President Jair Bolsonaro has continuously dismissed the severity of the virus and failed to respond effectively to outbreaks. So, it has fallen to local community organizations, donors and local authorities to enforce these regulations and double down on the effort to get everybody treated. The Paraisópolis community group started running a quarantine center in partnership with health workers, NGOs and medical centers. The center has around 240 volunteers monitoring the health of at least 50 families at a time. It acquired sanitation supplies and personal protection equipment through crowdfunding. The group is providing food and medical aid to undocumented migrants.

Amnesty International stated that in order to fix the refugee crisis “the world urgently needs a new, global plan based on genuine international cooperation and a meaningful and fair sharing of responsibilities.” Policy experts are hopeful that these new policies will help governments to consider new possibilities for a more humane approach to helping displaced migrants and asylum seekers in the future. The health and human rights of refugees need to be protected.

Isabel Corp
Photo: Flickr

Psychiatric hospital Skopje, Macedonia
Healthcare in Macedonia utilizes a mixture of a public and private healthcare system. All residents are eligible to receive free state-funded healthcare and have the option of receiving private healthcare for treatments that the public system does not cover. Public healthcare in Macedonia often comes with long wait times and although public hospitals have basic medical supplies, they do not have specialized treatments. For these specialized treatments, residents typically seek private treatment where they must pay out of pocket or buy private insurance on top of their free healthcare.

Improvements in Overall Health

North Macedonia did not become a part of NATO until 2019, and still has not received admission into the E.U. As a result, its healthcare system has developed slower than member countries. Despite this, North Macedonia has shown growth in overall health. The introduction of private healthcare allowed residents to seek a wider range of treatments and cut down wait times. Life expectancy has grown from 71.7 years in 1991 to 75.1 years in 2010. However, this is still lower than the E.U.’s average life expectancy which is 80.2.  Although life expectancy has grown, North Macedonia’s infant mortality rate is still above average.

North Macedonia reached a European record of 14.3 deaths per 1,000 live births in 2015. To compare, the average mortality rate in Europe for 2015 was 5.2 deaths per 1,000 live births. The high infant mortality rate is likely the result of outdated equipment at public health facilities and a shortage of qualified health workers. Only 6.5% of North Macedonia’s GDP goes towards healthcare, and therefore healthcare in Macedonia is often reliant on outside donations. These conditions have caused health workers to leave the Macedonian healthcare system in search of better working conditions. The health ministry has worked to purchase new equipment as well as increase the amount of qualified staff in public hospitals by hiring more workers. Today, the infant mortality rate in North Macedonia is 10.102 deaths per 1,000 births. This is an improvement, and hopefully, with continued programs, the numbers will continue to decrease. Organizations such as Project HOPE and WHO have already made a direct impact on Macedonia’s healthcare system.

Organizations Combating Infant Mortality

Project HOPE has donated over $80 million worth of medicines, medical supplies and medical equipment to hospitals throughout North Macedonia since 2007. Starting in 2017, most of these donations went to hospitals specializing in infant care. Project HOPE also provides training for healthcare workers so they can adapt to the updated equipment. The current drop in the infant mortality rate is due to these donations that allow hospitals to buy updated equipment and retain healthcare workers through training. There is only one hospital in North Macedonia that accepts low birth-rate and premature babies, University Clinical Center at Mother Theresa. Therefore, Project HOPE’s donation has greatly lessened the burden on this hospital to care for infants. Since Project HOPE implemented this program, the number of deliveries at Mother Theresa has increased by 40%.

WHO has also assisted North Macedonia in developing a new 2020 healthcare plan for infants and mothers. This plan would link healthcare facilities in the country and classify them by level of service to ensure everyone is receiving the appropriate care. It should also improve transportation between hospitals to increase the continuity of care between locations. This shared communication and learning between healthcare facilities is imperative since there are only nine hospitals in Macedonia for 2.08 million people and seven of those hospitals are in the country’s capital, Skopje. Increasing transportation and communication will ensure that those living outside of the capital are receiving quality healthcare. Slowly but surely with these new policies in place, North Macedonia’s infant mortality rate will continue to drop.

Rae Brozovich
Photo: Flickr

South African PovertyThe battle against poverty has always been a difficult one, but the novel coronavirus pandemic has presented many new challenges. Actions currently being taken to combat South African poverty and COVID-19 have proven that, with new options and renewed commitments, there is still much that can be done to alleviate poverty. Impoverished people around the world need aid now more than ever.

An Ongoing Struggle

Historically, South Africa has struggled to aid its most economically vulnerable citizens. According to the most recent government analysis, almost half of the adult population is living under the poverty line—an alarming figure. It seems apparent that this South African poverty crisis would be seen on nearly every level of society. Sadly, this widespread poverty has had a notable impact on which necessary resources are available to people. While electricity infrastructure is fairly widespread, between 28% and 30% of poor households lack access to water and sanitation services. As is relatively common in cases of inequality, the most vulnerable frequently lack access to basic necessities, making their struggles far more urgent.

COVID-19 Developments

The 2020 COVID-19 pandemic is poised to exacerbate South African poverty. The World Bank has predicted that while the pandemic will increase poverty worldwide, the hardest-hit region will be Sub-Saharan Africa. Although South Africa has been relatively spared from the worst of COVID-19 on a health level, the poverty-inducing effects of the pandemic are daunting—it is projected that some 23 million South Africans will be pushed into poverty in 2020. Beyond the immediate tragedy, this decline will present new challenges. In order to protect them, governments will need to find new ways to offer meaningful support throughout the crisis.

Innovation Brings Hope

Fortunately, the government of South Africa has begun to take steps to properly aid its impoverished citizens during this time. They have rolled out a new, easily accessible digital tool called HealthCheck in order to provide self-assessment resources. Members of the public can download the program, which will ask them a few simple questions and then provide a COVID-19 risk prediction along with a pertinent guideline and suggested actions.

While HealthCheck is designed to be available to the entirety of the South African populace, it aids low-income South Africans in particular. Although only a third of the population uses smartphones, feature phones enjoy more widespread use, so a lack of hardware is not necessarily an issue. For many impoverished people in South Africa—and across the world—receiving the proper healthcare needed to determine a risk of infection may be difficult or outright impossible.

Partnerships Increase Access

To further alleviate this issue, the South African government has coordinated with network operators MTN, Vodacom and Telekom, to have facilitate free access to the USSD line. This way, South Africans who could not typically afford cellular or wi-fi services can make use of the HealthCheck tool. As a matter of fact, they have—authorities have reported that so far, over one million members of the public have used HealthCheck.

The digital tool has been utilized in conjunction with NGOs like Doctors Without Borders.  The NGO has worked to fill the gap in fighting South African poverty by creating impromptu field hospitals in otherwise-ignored townships. In Khayelitsha, it has opened up 70 additional beds in a basketball arena in order to serve as many people as possible in the area. This was part of a broader government plan to have over 1,400 extra beds ready as needed. Providing aid such as this is an important part of the battle against poverty.

Just a Start

The COVID-19 pandemic has disrupted the growth of the continental African economy, and threatens its growing middle class. Across the entire continent, nearly eight million people are predicted to fall into poverty, in many cases due to the lack of a social safety net. By providing essential resources, NGOs like Doctors Without Borders are working to limit the economic burden that falls on the South African populace.

While it’s just a start in terms of supporting the impoverished population, these initiatives have clearly provided accessible ways for low-income citizens to keep themselves and their loved ones safe and healthy. There are still many hurdles to overcome in the fight against South African poverty, but these recent initiatives have shown that we can still work to effectively aid the poor.

Aidan O’Halloran
Photo: Flickr

Healthcare in TunisiaThe North African country of Tunisia is sandwiched by two relatively unstable nations, Algeria and Libya. However, Tunisia has had consistent development in human wellbeing for the past couple of decades, ranking among the best nations in Africa. In part, this success can be attributed to Tunisia’s relatively strong healthcare system. According to a World Health Organization report, Tunisia possesses a “national health strategic plan” as well as a relatively high life expectancy at 75 years. Healthcare in Tunisia is a promising sign that the country can adequately support its population and promote longer, healthier lives for its citizens. Here are six facts about healthcare in Tunisia.

6 Facts About Healthcare in Tunisia

  1. More than 90% of the population is covered by health insurance. While some citizens use private insurance, others are covered by programs in place to assist the most disadvantaged in society. However, Tunisia still lacks truly universal coverage. One of the top complaints about healthcare in Tunisia is gaps in payment for important medical procedures, which can burden families.
  2. Tunisia’s 2014 constitution granted healthcare as a human right. The government is still working to make this a reality and provide universal, effective healthcare in Tunisia. Specifically, the government is trying to improve the dilapidated health infrastructure in the south of the country. This manifested in a 9% increase in the healthcare budget in 2016, which went toward improving infrastructure in remote areas.
  3. Private healthcare in Tunisia is booming. In recent years, before the COVID-19 pandemic, the number of private clinics built in the country was expected to surge. Seventy-five new facilities are set to be completed by 2025, doubling the number of hospital beds in the country. These improvements should help make access to quality healthcare more readily accessible to the general population.
  4. Tunisia successfully combated many diseases in the past. Most importantly, Tunisia has been able to eradicate and control many deadly diseases that put a strain on its healthcare system. Malaria, polio and schistosomiasis are well under control. In addition, Tunisia’s healthcare system has worked to address HIV/AIDS.
  5. During the COVID-19 pandemic, Tunisia has done relatively well. Sitting at 1,327 confirmed cases and 50 deaths as of July 2020, the country is positioned to recover economically from the virus, which is devastating in other parts of the world. Though it is still early in the pandemic, it appears that the healthcare system in Tunisia was able to absorb the influx of cases in order to slow the death rate.
  6. Robust preventative measures enabled Tunisia’s positive response to COVID-19. Seeing the potential for a rise in cases early on, the government, as advised by healthcare experts, quickly went into a rigorous lockdown that lasted for months. This was especially difficult considering that tourism accounts for 10% of the country’s GDP. According to a WHO spokesman, a strong sense of community and respect for the lockdown measures eased the country’s caseload and death toll. Because the Tunisian population was willing to make sacrifices for the broader community, they are now in a comparatively better place than some other nations around the world.

Healthcare is a critical issue for any nation. While there is always room for improvement, Tunisia has succeeded in using its available resources to ensure medical coverage for its people.

Zak Schneider
Photo: Pixabay

Ebola outbreakThe Ebola Virus Disease (EVD) has ravaged countries in sub-Saharan Africa since its identification in 1976. Overall, there have been 34 outbreaks of Ebola in Western Africa, 11 of which have occurred in the Democratic Republic of Congo (DRC). The largest Ebola outbreak, considered a global pandemic, lasted from 2014 to 2016. It mostly affected countries like Sierra Leone, Liberia and Guinea. At the time, a total of 11,310 deaths were reported due to the disease.

The fatality rate for Ebola has ranged between 25% and 90%, depending on the severity of the outbreak and on the healthcare infrastructure of affected countries. The more modern and accessible these systems were, the more efficient the surveillance and treatment options. The second-largest outbreak of Ebola began in the Kivu region of the DRC on Aug. 1, 2018, and was only declared over as recently as June of 2020.

Containment in the DRC

Comparing the 2014 Ebola outbreak with the one that occurred in 2018 reveals a relative improvement. From 2014 to 2016, there were 28,616 EVD cases that resulted in 11,310 deaths. On the other hand, from 2018 to 2020, there were only 3,481 cases and 2,299 deaths reported.

DRC’s commendable public health response to the 2018 Ebola outbreak led to this outcome. Pre-existing infrastructural inadequacies and a lack of trust in health care officials have been the major challenges faced during Ebola occurrences. Though many of these problems continue, the better use of surveillance, contact tracing, prevention strategies and safe burial practices have greatly shaped how the most recent outbreak developed. Additionally, the global health community has made strides in vaccine development and treatment programs, making the defeat and containment of this epidemic possible.

Safe and Dignified Burials

Because the virus is transmitted through direct contact with an infected individual (living or deceased), traditional burial practices that require family members to wash the body pose a significant risk to communities during Ebola outbreaks.

In 2014, rural populations of Sierra Leone experienced surges in reported Ebola cases as a direct result of community members’ attending funerals and touching infected corpses. Since then, the CDC, the Sierra Leone Ministry of Health and Sanitation and the WHO have provided guidelines for safe protocols when handling potentially infected corpses. These protocols involve trained personnel and extensive personal protective equipment (PPE). During the recent contained Ebola outbreak, 88% of funerals utilized safe and dignified burial practices.

Vaccination Efforts

As a result of the most recent epidemic, 16,000 local responders and 1,500 WHO health workers collaborated to provide effective vaccines to 303,000 people. Individuals were considered eligible for vaccination if they had previous contact with an infected individual or were a frontline worker in an affected or at-risk area. Treatment centers, field laboratories and an Ebola national care program were also set up to care for patients, providing weekly test samples and follow-up with survivors.

EVD versus COVID-19

The world has seen other deadly viruses before COVID-19. SARS, Ebola and even the annual flu are some examples. COVID-19 stands out because it is easily spreadable and the rate of asymptomatic transmission is high. Asymptomatic transmission occurs when individuals don’t know they are infected and, as a result, spread the virus without knowing. Even though Ebola is highly contagious toward the end of the infection period, infected individuals show intense symptoms, so it is not easy for the virus to fly under the radar as COVID-19 tends to do.

Moreover, while health responses against Ebola are significant in fighting the spread of the virus, the vaccine and treatments are the real superheroes in protecting large populations and infected patients from the virus. As the world witnessed in the 2014 outbreak, Ebola left a devastating death toll in its wake without a vaccine. There are currently no viable vaccine or treatment options for the coronavirus, although development is currently in progress.

Moving Forward

Because preparedness plays a large role in within-country health responses, it is hopeful that future Ebola outbreaks will be contained. The health responses, vaccination programs and treatment options utilized by the DRC are applicable to other countries as well. Aid from WHO and other health agencies will lessen the threat of Ebola in Western Africa and the world.

– Nye Day
Photo: Flickr

Healthcare in SpainSpain is a beautiful country with exquisite landscapes and a rich culture. This country is known for its delicious, elaborate dishes such as paella. Healthcare is usually not the first thing that comes to mind when typically thinking about Spain but it definitely should be. Spain is world-renowned for its amazing healthcare coverage and for the way the Spanish citizens are usually able to stay healthy throughout their life.

5 Facts About Healthcare in Spain

  1. Spain is the healthiest country in the world. In 2019, the Bloomberg Healthiest Country Index evaluated and ranked over 150 nations based on their life expectancy, environmental factors (ex: access to fresh, clean water) and health risks (ex: obesity). This study gave Spain a grade of 92.75 based on the aforementioned criteria and ranked the Iberian country first out of the listed countries.
  2.  Spain has a free, public healthcare system. Spain’s healthcare system is financed by taxes which means that residents have access to free or very low-cost healthcare, provided they pay for social security. According to HealthManagement.org, 99.7% of the Spanish population takes advantage of the public healthcare system, and only 3% of the population decides to go with the private sector. This is indicative of the Spanish healthcare system’s high quality, as the vast majority of the country decides to be covered by it.
  3. Cancer and circulatory system diseases are among the most common causes of death in Spain. The data found at statistica.com attests that “diseases related to the circulatory system and neoplasms (cancer) ranked as the main causes of death, both with over 100 thousand cases in 2017.” In addition to this, Spaniards also suffer from chronic respiratory diseases such as asthma and COPD (chronic obstructive pulmonary disease).
  4. Mental health is taken very seriously in Spain. Taking care of one’s mental health has become a major topic recently, but Spain has always valued the mental health of its citizens. Spain started to realize the importance of mental health in 2006 and has since worked to assist Spaniards with that issue. Spain offers amenities and services including free prescription drugs and has dedicated a portion of its health budget to mental health. For example, according to the WHO, Spain dedicated 5% of its total healthcare budget (6 million euros) to mental health expenditures in the year 2011.
  5. Child healthcare in Spain is taken equally seriously. Along with Spain’s amazing healthcare coverage for adults, this country also offers equally superb healthcare opportunities to children. According to expatica.com, “the healthcare offered to children in Spain includes prenatal and postnatal care, pediatric care up until age 15 (and standard care from a general practitioner afterwards), free vaccinations until age 14, dental care until age 15, access to 23 different types of speciality practitioners, prolonged benefits for children with physical or mental disabilities and free emergency services”.  Evidently, children are taken care of very well in Spain and have access to many amenities and medical opportunities throughout their entire life.

Spain is a country that is home to beautiful landscapes, exquisite cuisine, wonderful people and an amazing healthcare system! It truly earns its spot as one of the best healthcare systems in the world. Spain is a great place to live if someone is looking for a free healthcare system that fully covers all aspects of the medical field.

Kate Estevez
Photo: Flickr

Healthcare in Zambia
Zambia, a landlocked country in Southern-Central Africa, faces several ongoing health challenges. In 2017, Zambia’s public health expenditure was 4.47% of the GDP, one of the lowest rates in southern Africa. Two ministries that provide information about health and deliver health services, administer public healthcare in Zambia. These are the Ministry of Health and the Ministry of Community Development, Mother and Child.

Problems in the Healthcare System

As public healthcare in Zambia remains incredibly underfunded, pharmacies in Zambia are not always well-stocked, and many deem emergency services inadequate. Additionally, inequities in public health care service access and utilization exist in the country. While 99% of households in urban areas are within five kilometers of a health facility, this close access occurs in only 50% of rural areas.

As a result of these deficiencies within the system, UNICEF reports that Zambia’s under-5 mortality rate is 57.8 deaths per 1,000 live births. In 2009, 980,000 people lived with HIV/AIDS in Zambia, and 45,000 of those people died the same year due to the disease.

Lack of clean water has resulted in water- and food-borne diseases and epidemics that have been devastating Zambia for decades, including dysentery and cholera. These issues mainly affect impoverished areas, as overcrowding leads to sanitation issues. In the Kanyama slum in Lusaka, 15 households share one latrine when the weather is good. During the rainy season, Kanyama’s high water table causes the filling of 10,000 latrines with water. Areas like Kanyama require long-term infrastructure measures, such as sanitation, sewage lines and piped water.

The Path to Development

Centers for Disease Control and Prevention (CDC) established an office in Zambia in 2000 to address HIV, tuberculosis, malaria and other diseases. CDC support in Zambia includes expanding academic and clinical training programs with advanced technology at the University of Zambia and the University Teaching Hospital, and the development of a National Public Health Institute to strengthen public health surveillance. Moreover, CDC instituted a Field Epidemiology Training Program (FETP) to train a workforce of field epidemiologists to identify and contain disease outbreaks before they become epidemics. Exactly 42 epidemiologists have graduated from the program since December 2018.

In 2018, Zambia presented to the World Health Assembly in Geneva regarding the cholera outbreak by citing its efforts regarding vaccination, water safety and waste management. Additionally, Gavi, the Vaccine Alliance, worked with Zambia to fund and deliver 667,100 oral cholera vaccine doses to Lusaka slums after an outbreak that affected more than 5,700 people.

Looking Ahead

Most recently, Zambia embarked on the first round of its annual Child Health Week campaign from June 22- 26, 2020 to deliver child survival interventions to protect children and adolescents from deadly diseases. Furthermore, to promote fairness and equality, the campaign aims to improve children’s health by ensuring essential services reach children who do not benefit from routine health services. This campaign accelerates the country’s progress toward attaining the U.N. Sustainable Development Goals (SDGs) for reducing child deaths by two-thirds by 2030, improving healthcare in Zambia overall.

The infrastructure for healthcare in Zambia is overall poor due to a lack of funding, poorly maintained facilities and supply shortages of medications and medical equipment. However, one step to a better healthcare system is to ensure equitable access to health services, especially for those who live in rural areas or slums. To reduce inequities, Zambia must strengthen primary facilities that serve the people who live in these regions and dismantle the existing barriers.

Isabella Thorpe
Photo: Flickr

Kazakhstan’s Healthcare System
In the midst of a global health crisis, easy access to healthcare is more important than ever. Unfortunately, most people in Kazakhstan were already struggling with limited healthcare funding, high levels of chronic disease and restricted access to care prior to the COVID-19 pandemic. While the country’s daily new COVID-19 case numbers approached 2,000 in early July 2020, social reforms and organizations like the World Bank have worked to combat this crisis and improve healthcare in Kazakhstan.

Background

Kazakhstan is a country in Central Asia that Russia, China, the Caspian Sea and a number of former Soviet republics border. Once a member of the former Soviet Union, the world around Kazakhstan has shaped both it and its culture. The exploitation of its natural resources and the migration of surrounding peoples into the country have influenced its development and geography. A new movement to reinstate traditional Kazakh culture has resulted in various reforms in both its society and government, including reforms in healthcare.

Health and Kazakhstan’s Population

Poor diet, pollution and inadequate healthcare negatively affect the health of Kazakhstan’s population. Compared with the countries surrounding it, Kazakhstan’s infant mortality rate is one of the highest at 17.9 deaths per 1,000 live births. Additionally, Kazakhstan’s average life expectancy is at 72 years. Moreover, access to healthcare in rural areas has limitations. According to IntegratedCare4People, a website that the World Health Organization manages, the northern, rural region of Kostanay has 266 physicians per 100,000 people, while the rest of the country has, on average, 388 physicians per 100,000 people.

The Current Healthcare System

In the past, the healthcare system has failed to focus on the significance of chronic diseases, such as diabetes and cancer, and blood pressure issues, focusing more on transmissible diseases. Recently, the government has expanded primary-care services (generalized care aiming to improve the life expectancy of a population) to combat the growing chronic disease mortality. The ultimate goal of Kazakhstan’s reforms is to transition to a universal healthcare system with greater cost transparency and a better quality of life. Over the years, the government has steadily increased healthcare funding and reduced the influence of private insurance.

The Shift Toward Universal Healthcare

The newest reform, the Compulsory Social and Medical Insurance (CSMI) program, which went into effect in January 2020, aims to create a single-payer healthcare system. The intent is for public insurance to pay for certain medical expenses and regulate healthcare quality. The goal of the program is to reduce out-of-pocket expenses (the cost of care that patients are responsible for), which made up 45.14% of Kazakhstan’s total health spending in 2014. However, despite steady growth in funding, healthcare financing in Kazakhstan is still very limited. Health spending makes up 3.1% of the GDP, in comparison with the global average of 9.89%, as of 2017. With an average yearly income of $26,300 per capita, Kazakhstan cannot achieve widespread public insurance without stimulating its economy.

The World Bank and Kazakhstan

In 2019, economic expansion caused wages in Kazakhstan to increase by 8.9% and poverty to decrease to 8.5%. Though the quick spread of COVID-19 in the country will likely backtrack some of these achievements, the World Bank has set up the Country Partnership Framework, a strategy for increasing economic support for Kazakhstan from 2020 until 2025. The goals of this framework are to expand economic diversity, minimize the healthcare gap between rural and urban areas, decrease carbon usage and increase energy efficiency. Part of the World Bank’s work in Kazakhstan includes offering grants to businesses to improve health and economic outcomes. The World Bank has sponsored and commercialized inventions like X-matrix (a wound dressing for burns) and invested in agricultural technology to boost Kazakhstan’s economy.

Healthcare in Kazakhstan is majorly dependent on its economy. While government funding for healthcare is far behind similar countries, the steady growth of business and investment will allow it to slowly increase. The effects of COVID-19 in Kazakhstan are meeting with productive and long-term funding from organizations like the World Bank. With steady growth and progress, Kazakhstan’s healthcare system and overall health should be able to improve over time.

Ann Marie Vanderveen
Photo: Pixabay

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

10 Apps That Aid Healthcare in Developing Countries

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

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

– Catherine Lin
Photo: Flickr