Inflammation and stories on healthcare

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 Singapore
The healthcare system in Singapore is globally renowned for its compelling design, which satisfies both conservatives and liberals. The universal healthcare system provides economically efficient and high-quality medical care in both private and public facilities.

Objectives of Healthcare

According to the Affordable Healthcare passage from Singapore’s Ministry of Health, the five fundamental objectives of the healthcare system include:

  • To nurture a healthy nation by promoting good health;

  • To promote personal responsibility for one’s health and avoid over-reliance on state welfare and medical insurance;

  • To provide good and affordable basic medical services to all Singaporeans;

  • To rely on competition and market forces to improve service and raise efficiency; and

  • To intervene directly in the health care sector; when necessary, where the market fails to keep health care costs down.

To summarize, the government acknowledges the strengths and limitations of the public and private sectors in health. Overall, healthcare in Singapore has a multipayer financing structure, where a “single treatment episode might be covered by multiple schemes and payers, often overlapping.”

Specifics of Singapore’s Success

The system is known as the 3Ms, which consists of:

  • MediShield Life – a universal basic health care insurance that is mandatory for citizens and permanent residents and provides lifelong security against large hospital bills and specific costly outpatient treatments.

  • MediSave – a mandatory savings plan consumes between 7 and 9.5% of worker’s wages, helping cover out-of-pocket payments. These tax-exempt, interest-bearing accounts can be used to pay for family members’ health care expenses or routine care.

  • MediFund – the government’s safety net for Singaporeans who cannot cover their out-of-pocket costs, even with MediSave.

Healthcare in Singapore is ranked among the best healthcare systems in the world, according to the World Health Organization (ranked 6th in 2010) and Bloomberg’s list, “These Are the Economies With the Most (and Least) Efficient Health Care.”

However, several factors beyond its structure contribute to Singapore’s successful healthcare system. Singapore is a small island city-state with a population of 5.6 million. Singapore’s physicians per 1,000 people ratio is 2.294, compared to the U.S’s, 1.565. Additionally, rates of smoking, alcoholism and drug abuse are relatively low, as well as the obesity rate. The healthier population predisposes “the country to … lower health spending.”

Limitations of Healthcare in Singapore

Although healthcare in Singapore receives acclaim for its ability to fund its systems through private markets, there are several limitations to consider, especially concerning Singapore’s underserved population. The lack of hospital beds in the emergency section of public hospitals causes patients with basic insurance plans to have limited financial protection. Since the spending on healthcare in Singapore is one of the lowest in the world (SGD 9.8 million out of SGD 400 billion), subsidies for patients are substantially limited.

Additionally, Singapore prides itself on its multipayer financial system; however, patients pay more than 60% of healthcare costs out-of-pocket. Thus, as Rachel Ngu, a writer for Mims Today (healthcare news across Asia), explains, “patients will need to pay an initial amount based on a subsidized class, as well as co-pay the rest of the bill. Aside from that, they will have to pay 10% of the rest of the bill for Integrated Plans.” Therefore, patients with basic coverage are not able to afford urgent medical attention because of the financial strain of medical bills, notably those without add-on integrated plans for more expensive hospital procedures.

Healthcare in Singapore is effective because of the efforts of the government and the people. Singapore has created a functioning healthcare system that regulates the supply and prices of healthcare services. Also, the system seeks to provide its citizen with security in the face of large medical bills. Though healthcare in Singapore is replicable on some levels, the system tailors to the specific needs of the economy and the demands of the people.

Mia Mendez
Photo: Flickr

Healthcare in YemenMany consider Yemen, a country located in the Middle East, to currently be undergoing the worst humanitarian disaster in the present time. Before the start of the war, which broke out in 2015, Yemen was already struggling to control the health crises that were plaguing the country. Violence and other aspects of war resulted in an emergence of even greater needs for healthcare in Yemen. An estimated 100,000 Yemeni people died due to war violence alone. Conflict and war have killed 100,00 people in Yemen while “indirect causes such as starvation and disease” have resulted in the deaths of an additional 131,000. Here are four facts about healthcare in Yemen.

4 Facts About Healthcare in Yemen

  1. Civil War: Yemen’s healthcare system was already in a fragile state before the civil war and ultimately collapsed as a result of the war. The collapse of the healthcare system left the country in a state of desperation for humanitarian aid. There are an estimated 24 million people out of a population of 29 million that are in need of some sort of medical aid. Another 14.4 million people are in an acute need for aid. The failed system resulted in a major decline in the number of operable facilities for healthcare in Yemen, with less than half of the previously functioning facilities still operating. This, in combination with extensive damage to the country’s infrastructure, has left 80% of the Yemen population without sufficient access to healthcare services.
  2. Malnourishment: Yemen’s already existing struggle to fight malnourishment became an even greater challenge due to the war, which has worsened the food insecurity crisis. About 56% of Yemen’s population is currently experiencing crisis-level food insecurity. Thus, malnourishment is one of the biggest health issues plaguing the country, creating an even greater need for access to healthcare in Yemen. Children are by far the most vulnerable to suffering from malnourishment. In fact, 2 million Yemeni children, all less than 5 years old, suffer from acute malnourishment.
  3. Disease: In 2017, Yemen experienced the largest cholera outbreak in recent history. Cholera is a bacterial infection that emerges from people ingesting water or food that the feces of an infected person has contaminated. The spread of this disease occurs more rapidly in areas without access to adequate sewage systems and sources of clean drinking water. Since 18 million people in Yemen are unable to access clean water and sanitization services, they face an increased vulnerability to contracting and spreading cholera. As a result of this heightened risk, reports estimated that there were one million cases of the disease in the country in 2017 alone. An additional estimated 991,000 cases occurred between January 2018 and September 2019. The lack of access to healthcare in Yemen further exacerbated the outbreak, resulting in thousands of deaths, despite cholera being an infection that is easy to treat. On top of the cholera outbreak, the COVID-19 pandemic has become another threat to healthcare in Yemen with a reported 260 cases and 54 deaths.
  4. Outreach: Due to the government’s inability to support the system, healthcare in Yemen relies on outside aid. The International Organization for Migration is working to reopen and restore 86 healthcare facilities people initially deemed inoperable. The IOM also manages “nine mobile health teams” to provide healthcare to those unable to get to operable facilities, with four of those teams providing emergency health services to migrants arriving on the coast of Yemen. Another organization, The International Committee of the Red Cross, provided medical facilities with medication and emergency supplies, resulting in medical relief of 500,000 people in the first half of 2018 alone. The International Medical Corps is another organization contributing to aid by providing health professionals with training and supplies, in addition to supporting 56 health centers across Yemen. Through that support, the organization provides adequate outpatient care to malnourished children, in addition to mental health services such as counseling. In response to the COVID-19 pandemic and already at-risk population, the Yemen Humanitarian Response Plan received an extension from June to December 2020. The U.N. and its partners are seeking $2.41 billion solely for fighting COVID-19 while continuing to provide aid for those that the country’s ongoing humanitarian emergency has affected.

Despite barriers to outreach, such as inadequate funding, there is an ongoing effort to stabilize and improve the state of healthcare in Yemen amid the violence of civil war. Efforts by the United Nations and numerous other humanitarian organizations are occurring to combat health issues related to circumstances of war, malnutrition and disease, while also providing Yemeni people with tools and training to treat and prevent further health complications.

– Emily Butler
Photo: Flickr

Healthcare in JapanHealthcare in Japan is both universal and low-cost. The country provides healthcare to every Japanese citizen and non-Japanese citizen who stays in Japan for more than one year. Japan’s healthcare system is uniform and equitable, providing equal medical services regardless of a person’s income. Here are five facts about healthcare in Japan.

5 Facts About Healthcare in Japan

  1. Everyone has health coverage. Established in 1961, Japan’s universal health insurance sought to provide people with equal access to “necessary and adequate” medical care at low costs. Two key characteristics of Japan’s healthcare are that medical care is affordable and equally accessible to everyone. Citizens can either receive coverage through social insurance if they work for a corporation or through national medical insurance if they are self-employed. Patients and physicians have great freedom in their choices. Patients can choose their own physicians, and physicians are able to freely choose the best procedures, tests and medications they see fit for their patients.
  2. Insurance plans vary for individuals. Japan has three main forms of health insurance. The first insurance system covers employees who work at companies. Companies deduct insurance premiums for healthcare from employees’ paychecks. The second insurance system covers citizens who are self-employed. Factors such as the individual’s income, the number of people living in the household and any assets determine premiums. The third system is a pooling fund, with premiums coming from the previous two plans for medical costs of people 70 years or older. The three medical plans cover citizens from all backgrounds, ensuring that everyone has access to healthcare. Because everyone has coverage, there are seldom issues of people in low-income households or poverty lacking medical care.
  3. Payment is through a fee schedule. Patients pay for their medical care through a national fee-for-service schedule. The government sets the schedule, which includes both primary and specialist care fees. Since the fee schedule is uniform and applies to everyone, all providers “share the same prices for medicines, devices and services.” The poor and the elderly also receive government subsidies to pay for their health insurance. This ensures that the poor do not have any disadvantages in receiving medical care.
  4. Japan’s healthcare plans provide various medical services. The insurance plans include primary and specialty care, visits to hospitals, mental health care and most dental care. Plans also cover prescription drugs that physicians and hospice care approve for the elderly. For pregnant women, the local governments often subsidize check-ups, making it easier for women to access adequate medical care. People with disabilities also get aid from the government. They receive government subsidies to pay for any equipment such as wheelchairs or hearing aids. By making medical care both comprehensive and accessible to disadvantaged groups, healthcare in Japan looks out for the poor.
  5. Japan’s healthcare is extremely equitable. An individual’s income makes less of an impact in influencing the quality of care in Japan in comparison with many other countries. Because the fee schedule for medical care is uniform across the nation, everyone pays the same prices. Furthermore, physicians receive the same fee from patients with or without government assistance due to government subsidies for low-income people. Therefore, Japan’s healthcare system provides no incentives for physicians to treat patients differently. Everyone receives equal treatment and equal access to medical resources, regardless of their social class. This allows the disadvantaged and people living in poverty in Japan to receive the “necessary and adequate” care that the country’s universal health insurance pledges.

Japan’s healthcare system operates on a national fee schedule and is universal in nature. The fee schedule allows healthcare in Japan to be equitable as well as cost-efficient, ensuring that medical care is available to everyone. It also keeps total health expenditures at a minimum due to its set, uniform fees. Healthcare in Japan demonstrates how people in poverty do not experience exclusion from or have difficulties finding medical care, but rather enjoy equal access to healthcare like everyone else.

– Silvia Huang
Photo: Flickr

Healthcare in Burundi
Burundi is a landlocked country in East Africa with a dense population of 11.89 million people. Due to overpopulation, an ongoing humanitarian crisis and more than 73% of the population in poverty, healthcare in Burundi is unstable, and the people of Burundi are highly susceptible to the wide variety of diseases that are plaguing the country. 

Current Health Risks in Burundi

Accessibility to healthcare in Burundi continues to be an issue for civilians, shown through the rise in deaths that diseases and epidemics caused. COVID-19 has affected the country as a whole and posed a threat to the already fragile healthcare system with records of 104 cases and one death as of June 16, 2020, although the need for more resources and vaccines was already in question long before this specific virus. Without proper treatment or preventative care, diseases like measles, malaria and many other infectious diseases put the population at risk.

In April 2019, the number of measles cases increased to 857 and refugees were reportedly spreading it to communities from refugee camps. Meanwhile, there were 504 cases as of March 2020. Out of the 18 provinces of Burundi, 63% of those districts face a high risk of infection. Low immunity and vaccination rates are two factors putting communities in compromising positions.

Malaria is an ongoing epidemic in Burundi that has claimed the lives of more than 3,170 people, and it continues to spread. Reports determine that the number of cases is 1.2 million, showing a slight decline in cases in comparison to the 1.7 million in 2019. Malaria is treatable and preventable through vaccination and the proper medication; however, access to these supplies and resources is scarce.

Focusing on the Issue  

The numbers on infection and mortality rates of treatable and preventable diseases in Burundi show a need for redirection. Seeing this need, various organizations have proposed ways to put a spotlight on the lack of funding for healthcare systems and supplies and provide the funding necessary to see progress. Here are a few ways organizations are addressing this:

  • In April of 2020, the World Bank and International Development Association (IDA) put into motion a $5 million grant to prevent and counter the spread of COVID-19 and reinforce the preparedness of the health care system of Burundi as a whole. These funds will assist the country’s healthcare system in receiving necessary testing and treatments for existing diseases and epidemics. In coordination with this, the World Bank will disburse $160 billion over the span of 15 months to “protect the poor and vulnerable, support businesses and bolster economic recovery.
  • Dr. Norbert Mugabo, a medical officer from Cibitoke province, set out to vaccinate more than 17,000 children as part of a measles vaccination initiative in April of 2020. Dr. Mugabo hopes to reach children between the ages of 9 months and 15 years in light of the outbreak in November 2019.
  • The International Rescue Committee (IRC) set many goals to aid Burundi in 2020. It determined that its main avenue for providing all-around better healthcare is starting with the basics. For example, the IRC intends to rebuild hand washing stations, boosting hygiene and addressing sanitation issues. These small steps forward have the ability to make a big difference long term.

The healthcare system in Burundi lacks the resources and funding needed to help the overall population thrive. However, with the help of dedicated professionals such as Dr. Mugabo and organizations such as the World Bank and the IRC, change in a positive direction is right around the corner.

Katie Mote-Preuss
Photo: Flickr

Healthcare in the Russian Federation
The Russian Federation is the biggest country in the world, covering more than 6.6 million square miles. It is also the ninth most populated country with almost 146 million citizens. Despite Russia having universal healthcare, most people are unable to obtain an adequate form of it. After the fall of the Soviet Union in 1991, healthcare conditions have not improved and many expect it will worsen due to government corruption, consequences of COVID-19 and a lack of government funding for medical supplies. Here are 10 facts about healthcare in the Russian Federation.

10 Facts About Healthcare in the Russian Federation

  1. Life expectancy increased by eight years over the past 20 years but still remains lower in males than in females. In 2000, estimates determined that the average lifespan of both genders was 65 years old, but in 2018, the number increased to 73 years old. In 2020, estimates identified that females live to 77.8 years old, while males only live to an average of 66.3 years.
  2. The Russian Federation provides its citizens with compulsory insurance, known as OMC, or free universal healthcare. Russia also allows its citizens to purchase privately-owned insurance or DMC. People who are on the OMC do not receive coverage for the majority of vital treatments and everyone has to pay in full for the provided medical services. Poor healthcare in the Russian Federation stems from a lack of governmental funding, hence more than 17,500 Russian villages and towns have no medical infrastructure and salaries for doctors and nurses are often as low as $250 a month.
  3. In 2019, a large number of imported medicines disappeared from Russian pharmacies and the sanctions against Russia further escalated the drug shortage problem. The Russian government failed to supply basic drugs like glucose, Prednisone and Lamivudine to its hospitals. There is also a painkiller deficit for terminally ill patients which is linked to the suicides of 40 terminally ill cancer patients in Russia in 2014. The problem with drug shortages and low wages has escalated in the previous years because Russia has implemented policies that not only cut spending on imported Western products but also only promote domestic businesses.
  4. The Russian government plans to cut its healthcare budget by 33% in the near future, bringing it down to $5.8 billion a year. Russia’s current health expenditure from GDP is only 5.3%, which is less than Guatemala and Madagascar’s annual GDP healthcare spending. The current global average health expenditure is at 10%. According to a 2014 Bloomberg report, healthcare in the Russian Federation placed last out of 55 developed nations.
  5. Moscow, the capital of the Russian Federation, has the best hospitals in the country, some of which have national rankings. Moscow’s Children Hospital ranks 250th in the world, while the Bakulev Center for Cardiovascular Surgery ranks 291st. Despite dire shortages of medicine, both hospitals operate at a national level. Russia also has more than 17,000 pharmacies and 17% of them are privately owned, while the rest either belong to the city’s authorities or regional governments.
  6. In Russia, 98% of children between the ages of 12-23 months receive vaccinations for measles and skilled health staff attend 99% of all births. However, the general rate of vaccinated children has recently declined because not only did the parents receive the option to not vaccinate their children, but many citizens noticed that their children get ill more frequently after receiving the vaccines. Because the measles vaccine became widespread since 1993, cases in Russia have drastically decreased, dropping from almost 80,000 to only 2,539 in 2018. In addition, there were 51 births per 1,000 women between the ages of 15-19 in 1990, but in 2018, it has decreased to 20 births per 1,000 women. Russia’s teenage pregnancy rate is decreasing because of an increase in contraceptive counseling and laws, one of which stipulates young women older than 15 years old to receive sexual health consultations without their parents’ permission.
  7. Only 5% of people hold private medical insurance or use private healthcare in the Russian Federation because many are unable to afford it. The cost of private health insurance in Russia can vary from 10,000 to 45,000 rubles per year, and on average, a living wage family has an income of 23,700 rubles per month. There were no governmental attempts to make insurance more affordable and the Russian Federation will cut its health expenditure next year by 33%. In addition, many Russian citizens have to seek appropriate healthcare in neighboring countries.
  8. There are only 8.4 psychiatrists, 2.4 social workers and 4.6 psychologists per 100,000 people. Despite the Russian law guaranteeing psychiatric care to its citizens as a civil right, Russia underfunds medical programs due to its corruption. The Corruption Perceptions Index ranks Russia 137th out of 180 countries worldwide, and the Global Corruption Barometer also estimates that 27% of public service users paid a bribe in 2016. In 2018, the Russian government added new amendments to its Administrative Code, which allows courts to freeze one’s assets if they are under investigation for bribery. It also exempts businesses from liability if they are willing to cooperate with the authorities to uncover other criminal schemes. Both actions are promising in terms of battling corruption. Unlike the seeming battle with corruption, Russian psychiatric hospitals have been struggling immensely from governmental underfunding. Psychologists and social workers are unavailable in 13 territories within Russia, and findings determined that one-third of Russian in-patient psychiatric hospitals have unsanitary conditions. It has been numerously reported that Russian psychiatric hospitals have 15 people in one room, which has bars on all windows and no partitions or toilet access.
  9. In 2017, the seven leading causes of death were ischemic heart disease, stroke, Alzheimer’s disease, cardiomyopathy, Cirrhosis and lung cancer. Many of them decreased in frequency since 2007. Only Alzheimer’s has increased by 34% between 2007-2017, while strokes have decreased by 19.2% and cardiomyopathy by 29.5%, despite the lack of improvements in Russia’s medical system.
  10. Small Russian nonprofit organizations and civil societies like Patient Control, Eurasian Women’s Network on AIDS and the EVA Association have been fighting an uphill battle with the Russian government. The EVA Association is a nonprofit organization that helps women with HIV or any other immunodeficiency disorder, by bringing together a network of activists, 72 medical specialists and eight other nonprofits from more than 39 cities in Russia. Patient Control, on the other hand, advocates for citizens who have not received the necessary medication for tuberculosis, Hepatitis C and HIV due to significant healthcare budget cuts in Russia. In 2016, the Russian Red Cross branch also worked closely with the Regional Health Initiative, a Red Cross program, and it worked to supply civilians, particularly in Sochi, Irkutsk, Belorechensk and Tula, with food parcels and tuberculosis screenings.

While some are addressing the problems regarding healthcare in Russia, it is impossible to eradicate poor healthcare all at once because of corruption and lack of funds. As of June 2020, the quality of healthcare in the Russian Federation remains low. With anticipated health expenditure budget cuts and consequences of COVID-19, experts do not expect the situation to improve in the near future. However, because the nation’s citizens are staying united and helping one another through various associations and nonprofits, there is hope at the end of a very long tunnel.

– Anna Sharudenko
Photo: Flickr

Healthcare in Rwanda
Rwanda, the small landlocked state with a population of 12.5 million people, has made tremendous strides in the years following the infamous 1994 Rwandan genocide. The fertile and hilly state borders the much larger and wealthier Democratic Republic of the Congo, Tanzania, Uganda and Burundi. Rwanda is currently undergoing a few initiatives that the National Strategies for Transformation plan outlines. For example, Rwanda is presently working towards achieving Middle-Income Country status by 2035 and High-Income Country status by 2050. Among many improvements, many widely consider universal healthcare in Rwanda to be among the highest quality in Africa and the state’s greatest achievement.

Structure of Healthcare in Rwanda

Healthcare in Rwanda includes designed subsidies and a tiered system for users based on socioeconomic status. From 2003 to 2013, healthcare coverage in Rwanda has jumped tenfold, from less than 7% to nearly 74%. The Rwandan system of governance enables this level of widespread coverage. At the district level, funding and healthcare are decentralized to afford specific programs’ autonomy, depending on the needs of individual communities. Policy formulation comes from the central government while districts plan and coordinate public services delivery. In 2005, Rwanda launched a performance-based incentive program, which rewards community healthcare cooperatives based on factors such as women delivering at facilities and children receiving full rounds of immunizations.

Rwanda’s innovative healthcare system does not come without challenges. Nearly 85% of the population seeks health services from centers. Due to such wide use, it often takes long periods of time for health centers to receive reimbursement from the federal government for services rendered.

Improvements in Healthcare Access and Vaccinations

The rate at which Rwandans visit the doctor has also drastically increased. In 1999, Rwandans reportedly visited the doctor every four years. Today, most Rwandans visit the doctor twice a year. In addition, vaccination rates have drastically increased for Rwandans. Over 97% of infants receive vaccinations against diphtheria, tetanus, pertussis, hepatitis B, Haemophilus influenza Type B, polio, measles, rubella, pneumococcus and rotavirus.

Part of the improved healthcare in Rwanda is the state’s fight against cancer. The most common cause of cancer in Africa is human papillomavirus-related cervical cancer. As part of Rwanda’s goal of eliminating cervical cancer by 2020, over 97% of all girls ages 11 to 15 receive vaccinations for HPV. Rwanda is currently developing a National Cancer Control Plan and data registry to help track and combat the spread of cancer. Finally, to improve testing for cancerous markers, the government built the Nucleic Acid Lab as part of the biomedical center in Kigali.

Growing Pains

Despite vast improvements, the country still has a lot to do in regard to healthcare in Rwanda. Over the past two decades, Rwandan healthcare has steadily closed the gap in developed states, such as France and the United States. Life expectancy for Rwandans at birth is 66 and 70 years for males and females respectively.

In France and the United States, life expectancy at birth is nearly 15 years more for both males and females. As a percent of GDP (7.5), Rwanda spends nearly 10% less per year on healthcare than the United States and 4% less than France. Malnutrition is rampant in children; 44.2% of all Rwandan children are classified as malnourished. From 2008 to 2010, anemia levels saw large increases. While family planning is more prevalent, access to contraception is not widely, or at all available, in most parts of the country. Despite the decline of child mortality rates, newborn deaths account for 39% of all child deaths.

Moving Forward

Along with the Rwandan state government, organizations such as Partners in Health (PIH) have helped make vast improvements to healthcare in Rwanda. Locally known as Inshuti Mu Buzima, PIH brings healthcare to over 860,000 Rwandans via three hospitals. The crown jewel of PIH is its Butaro District Hospital, which serves a region in Rwanda that previously did not have a hospital. Today, the hospital is well-known for its medical education and training for all of East Africa.

As widespread access to healthcare continues to spread and immunization efforts increase, healthcare in Rwanda has the potential to lead the way for additional state-wide improvements. Through such efforts, Rwanda’s target goal of Middle-Income Country status by 2035 is creeping further into reach.

Max Lang
Photo: Flickr

Healthcare in Guatemala
For far too many citizens living in Guatemala, healthcare is not feasible and the results of this are catastrophic. Guatemala has the fourth-highest rate of malnutrition, and although the Guatemalan constitution guarantees healthcare, many fail to access the care that they need. Here are five facts about healthcare in Guatemala.

5 Facts About Healthcare in Guatemala

  1. The Guatemalan government spends very little money on healthcare. In fact, Guatemala only spends about $97 per person on healthcare. Comparatively, the United States spends $7,825 per person, and healthcare is not even an explicit “right” under the U.S. constitution. This leads to an underfunded, understaffed and underpaid system that oftentimes does not have the resources necessary to deal with complex diseases. According to a 2017 Health Policy Plus report, the Guatemalan government simply does not have the economic ability to fully fund its healthcare system. The report states that “Limited public resources have inhibited the Government of Guatemala’s ability to meet the health needs of the growing population and comply with its constitutional obligation to provide health services as a public good.”
  2. If a person wants specialists, they have to travel. About 80% of doctors in Guatemala work in Guatemala City. As a result, rural and poorer areas of Guatemala lack the resources they need to get the proper care. Subsequently, in order to receive certain tests, people living in rural areas often have to travel long distances, sometimes taking a day or two off of work. In many cases, people live paycheck to paycheck and cannot afford to miss out on a day of pay.
  3. There is a language barrier. Medicine is complex, and trying to explain medical treatment to someone who does not speak the same language is oftentimes impossible. Guatemala possesses a whopping 25 languages. In Guatemala City, where the specialty doctors are located, the primary language is Spanish. As a result, a person who does not speak Spanish and needs special treatment may have serious challenges.
  4. Rural areas are less advanced. As previously mentioned, the overwhelming majority of doctors work in Guatemala City. For those living in rural areas, access to care is often non-existent. This can lead to a slew of medical ailments, but it also means that these people practice a less advanced version of medicine. For example, in 2009 only 46% of rural Guatemalans utilized modern contraceptives.
  5. Maternal mortality is higher among minorities. Despite making up 43% of the population, more indigenous people suffer from maternal mortality than any other group. Of the 452 maternal deaths in 2013, 68% were indigenous women. In addition, the indigenous maternal mortality ratio was 159 per 100,000 and only 70 per 100,000 for non-indigenous women. One possible explanation is the language barrier. Most doctors work in Guatemala City with a primary language of Spanish. In cases where an indigenous person speaks one of the other 24 languages, it can be difficult for doctors and patients to communicate.

Looking Forward

Although the Guatemalan government considers healthcare in Guatemala a right, for a large fraction of the population it is not. People simply do not have the means to travel or take a day off of work just go see a specialist. Thankfully NGOs are stepping up. One NGO, The GOD’S CHILD Project, is currently fundraising to fight malnourishment in Guatemala. This NGO claims to have helped 4,000 orphaned and impoverished children, as well as 7,000 widowed, abandoned and single mothers and their dependents across Guatemala.

Another NGO named Wings fights exclusively for issues relating to Guatemalan healthcare. Wings’ subsidizes things like contraception and education in rural areas with patients who have serious medical conditions. In 2018 alone, this group helped 3,658 adolescents and young adults with contraceptive access and education. With the help of these NGOs, improved healthcare for Guatemala is on the horizon.

– Tyler Piekarski 
Photo: Flickr

Healthcare in Jamaica
In the tourist’s eye, Jamaica is an enticing island with constant summer sun and alluring beaches. However, behind this guise, Jamaicans face a complicated reality. Healthcare in Jamaica is in desperate need of improvement. There is an increasing obligation to balance public access to health services with the practitioners’ ability to keep up with the enlarged workload.

Health Problems in Jamaica

Jamaica has many health issues that require an effective healthcare system. The top health issues that lead to premature death in Jamaica include stroke, diabetes, neonatal disorders, Ischemic heart disease and HIV/AIDS. Along with these issues, mental illness and STDs disproportionately affect Jamaica’s youth, and these often correlate with social and economic factors. The 2017 Global School Health Survey found that 24.8% of students seriously considered suicide and 18.5% of students attempted suicide over a 12 month period. In terms of STDs, only 31% of Jamaicans over the age of 15 and 51% of Jamaicans under 15 living with HIV were receiving treatment in 2018.

In order to try to make healthcare accessible to all Jamaica introduced free public health services to its citizens in 2008 by removing user fees. On the surface, this appears to be a positive step in removing the economic barrier that prevents the poor from receiving adequate healthcare. However, this has revealed deeper issues for healthcare in Jamaica.

Issues with Free Public Health Services

With the increase in patients, health practitioners have found themselves experiencing overwork and extreme stress. This shift has negatively affected the performance of these practitioners as patient demand has increased, but facilities remain understaffed. In 2016, researchers evaluated how the removal of charges has directly affected the workload. The study found that before the instigation of the free services, 50% of health practitioners had satisfaction with their workload. By 2016, eight years after the introduction of free healthcare, only 14% had satisfaction with their workload.

Some doctors interviewed for the study indicated that both the clinics and hospitals were seeing more patients daily after the elimination of charges. The quality of care worsened as medical professionals did not account for waiting times and availability of resources. The size of health clinics and the number of staff pale in comparison to the number of Jamaicans seeking care.

Along with the insufficient number of health practitioners, Jamaica’s medical infrastructures often do not match the demand of patients. Those in rural areas especially must travel long distances to access health care. The expansion of health facilities is extremely expensive. With Jamaica’s financial debt, this is not a project that it can take on lightly.

Also revealed in this situation is the scarcity of resources available to health clinics. The flood of patients has caused issues such as a delay of bloodwork and a shortage of medication. There have even been situations where patients had to purchase the medical supplies necessary for their surgery, costing an extreme amount that counteracts the efforts of free healthcare.

Upgrading Health Facilities

However, the failings of healthcare in Jamaica does not mean that the country is beyond help. In fact, the Minister of Health and Wellness announced in 2019 that over the next five years, Jamaica will be upgrading public health facilities with the funds of $200 million. The Minister plans to upgrade nine public health centers and six hospitals, one of which is the Cornwall Regional Hospital, which will benefit more than 400,000 residents. The Minister also plans to build a new Western Child and Adolescent Hospital, in addition to developing more sophisticated healthcare technology.

NGOs such as UNICEF are also doing work. The agency has established a Health Promotion program that works to provide quality health services to babies, adolescents and young mothers. The two goals of this program are to enhance institutional capacity to deliver effective health services and to boost the access of adolescents to these health services. By partnering with groups such as the Word Health Organization and Jamaica’s Ministry of Health and Wellness, UNICEF is carrying out its Baby-Friendly Hospitals Initiative, Adolescent-Friendly Services and Empowerment of Girls and Young Mothers.

Healthcare in Jamaica is lacking in many areas, but the country is doing continuous work to enhance health facilities and services. This progress shows that the country should see improvement in the future.

– Natascha Holenstein
Photo: Pixabay

Healthcare in Sierra LeoneSierra Leone is a small nation located on the coast of West Africa. While the country boasts an abundance of natural resources, it is also a poor nation, with a healthcare system in dire need of improvement. Here are 9 facts about healthcare in Sierra Leone.

9 Facts About Healthcare in Sierra Leone

  1. Sierra Leone has one of the lowest life expectancies on the globe. In 2018, the average life expectancy in Sierra Leone was 54.3 years. This places the nation among the bottom five in the entire world. In comparison, the average global life expectancy is 72.6 years.

  2. Sierra Leone faces high rates of infant and maternal mortality. Similar to life expectancy, infant and maternal fatality rates help gauge the quality of a nation’s health care system. In 2015, 87.1 infants died per 1,000 births in Sierra Leone, while 1,360 mothers died per 100,000 births. In the U.S., just 5.4 infants died per 1,000 births, and only 14 mothers died for every 100,000 births. Birth-related deaths generally occur when there are delays in women seeking, reaching and receiving care.

  3. All people living in Sierra Leone are at risk of malaria. Malaria is endemic to the nation, and poses a great health risk. In fact, four out of every ten hospital visits in Sierra Leone are due to malaria. Children are at particular risk, and the disease contributes to the nation’s high number of child fatalities. However, rates of the illness are falling across the country due to preventative practices such as sleeping under insecticide treated nets. Earlier diagnoses and treatments also contribute to the lowered rates of illness. By the end of 2020, the Ministry of Health and Sanitation in Sierra Leone hopes to have decreased cases by 40 percent.

  4. The Ebola outbreak of 2014 hit Sierra Leone particularly hard. Despite its relatively small population, there were more cases of Ebola in Sierra Leone than any other country. To be exact, there were a total of 14,124 cases in the country, including nearly 4,000 deaths. The first case was reported in May 2014, and Sierra Leone was not declared Ebola-free until February 2016. According to the World Health Organization, the virus was able to spread so widely due to the weaknesses of the healthcare in Sierra Leone. These weaknesses included too few healthcare workers, not enough oversight and a lack of resources.

  5. Disabled residents face tough conditions. Approximately 450,000 disabled people live in Sierra Leone, including those who were maimed in the decade-long civil war that ended in 2002. The government does not currently provide any assistance to the disabled. Those with disabilities resort to begging on the streets of Freetown, the nation’s capital. Disabled youth turned away from their families (due to the family’s inability to support the youth) often form their own communities on the streets. Employment can also be hard to achieve due to discrimination. Julius Cuffie, a member of Parliament who suffers from polio, brings awareness to the disabled’s struggles. Hoping to bring the disabled’s issues to the forefront, Cuffie pushes for the Persons with Disabilities Act.

  6. Corruption exists in Sierra Leone’s healthcare system. According to a 2015 survey, 84 percent of Sierra Leoneans have paid a bribe just to use government services. Additionally, about a third of the funds given to fight the Ebola crisis are not accounted for. This translates to roughly 11 million pounds, or almost 14 million dollars. Sierra Leone has a literacy rate of about 40 percent. As a result, many health care services overcharge unknowing residents for basic services. A new initiative, put together by the nation’s Anti-Corruption Commission, advises residents to report cases of bribery.

  7. In 2010, Sierra Leone began offering free health care. The Free Healthcare Initiative (FHCI) aims to decrease the nation’s high maternal, infant and child mortality rate. The government also hopes the initiative improves general health across the country. The ordinance provides a package of free services for pregnant women, lactating mothers and children under the age of five. The program has not been without its challenges, however, due to the aforementioned weaknesses of previous systems of health care in Sierra Leone. That said, the initiative has resulted in a number of positive changes. For example, there has been an increase in the number of healthcare staff, a larger willingness for parents to seek care for their children and a reduction in mortality for those under five.

  8. There has been an increase in efforts to strengthen emergency medical response in Sierra Leone. Road accidents kill thousands each year in the country. In response to this, the First Responder Coalition of Sierra Leone (FRCSL) was created in 2019 to improve the state of urgent medical care. Five national and international groups in Makeni, a city in northern Sierra Leone, founded the coalition. The group aims to provide emergency care, treat the high numbers of injuries and resolve the low amount of pre-hospital treatment in Sierra Leone. In its first two months, the FRSCL trained 1,000 Makeni residents, equipping each one with a first aid kit. The coalition hopes to train 3,500 more in the next six months. It also plans on expanding out of the northern province in the next five years. Hopefully, the FRCSL’s efforts will save thousands of lives from vehicle accidents in the coming years.

  9. CARE is working to improve sexual and reproductive health for women and girls in Sierra Leone. The humanitarian agency began working in the country in 1961. Goals of the organization include providing medical supplies and contraceptives, giving training to healthcare workers and working with the community to eliminate attitudes that prevent women from discovering their rights to sexual and reproductive health. CARE is currently present in approximately 30 percent of the country’s communities, particularly in areas that have high rates of HIV infection and teenage pregnancy. One Sierra Leonean mother, named Fanta, credits CARE with educating her about proper breastfeeding and health practices, leading to the survival and continued health of her daughter.

Healthcare in Sierra Leone is an issue that is complicated by the nation’s high rates of poverty, many endemic diseases and tumultuous political history. While shocking statistics, such as the country’s low life expectancy and high maternal and infant mortality rates paint a grim picture, there are signs of progress being made, and there is potential for much more change on the horizon.

– Joshua Roberts

Photo: Flickr