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healthcare in kiribati
The Republic of Kiribati, better known as just Kiribati, is an Oceanic country formed by 33 unique islands, of which 20 are inhabited. The majority of Kiribati’s population is located on the Eastern Gilbert islands, while many islands located in the center function without a permanent population. Healthcare in Kiribati has been a committed work-in-progress, especially after the notification in the late 20th century that its population was at one of the lowest standards of living in Oceania. The disjointedness of the islands and a lack of cohesive national health policy has significantly impacted Kiribati’s ability to effectively provide national healthcare services to all that need it.

In fact, as recently as 2012, there was not an official agency for national health policy, regulation of health standards, assessment of health technology, or management of health technology. However, despite this glaring lack of infrastructure, Kiribati has instituted projects at the national level to improve its primary level of healthcare. The government, along with partnerships from international health organizations, is working to invest in Kiribati’s health infrastructure.

The following five facts about healthcare in Kiribati are integral to understanding the country’s changing health structures and transition out of poverty.

5 Facts About Healthcare in Kiribati

  1. Around 22% of the Kiribati population is living under the “basic needs” threshold, according to the Department of Foreign Affairs and Trade. However, the traditional definition of poverty is not used in Kiribati, as much of the population believes that as long as one can maintain subsistence living, they are not poor. Instead, poverty is related to meet their basic expenses on a daily or weekly basis. This culture has made it so that many residents in Kiribati live in housing without access to clean water, sanitation or other basic hygiene utilities.
  2. Kiribati is at an elevated risk for infant mortality, consistently ranking as the highest country in Oceania by the estimated absolute number of incident cases, with approximately five times the number of cases as Australia. In 2012, the rate of infant mortality stood at 60 deaths per 1,000 individuals. While this statistic was significantly reduced from years past, there is no reason for such a high percentage of the population to suffer from infant mortality. The most common causes of infant mortality in Kiribati are perinatal diseases, diarrhoeal diseases and pneumonia. As a result of inadequate water supply and poor sanitation, water and food-borne illnesses can also contribute to the incidence of infant mortality.
  3. Kiribati also suffers from its lack of developed healthcare infrastructure. Hospital facilities, doctors to assist the population, and trained nurses are all hard to come by in Kiribati. Though they meet standards for routine care, the scarce availability of such facilities makes them hard to access for the general population. With only three district-level hospitals and one referral level hospital, patients often must be sent overseas if serious conditions arise. This remote level of treatment can often make timely access to medicines an issue as well.
  4. In Kiribati, there is a low number of doctors and nurses relative to the population overall. This low number contributes to the relatively high infant and maternal mortality rates of Kiribati. Recently, the government has worked with smaller groups around Kiribati to train more healthcare professionals. By holding orientation courses for all health staff and developing long-term courses for primary care staff, communities on many of Kiribati’s islands could tackle the lack of healthcare personnel issues. As a result of these programs and increased training, the number of individuals that are able to assist with healthcare is rising, and the rates of morbidity from common diseases have been reduced.
  5. Water supply is an issue in Kiribati that most don’t directly associate with healthcare and disease, but can have a significant impact on the health of the population. Outdoor defecation is said to be prevalent in Kiribati, which can lead to contamination of the water supply. Groundwater contamination is often related to a higher incidence of diarrheal diseases. However, outdoor defecation is not entirely the result of a lack of other options, but education is necessary to help the population of Kiribati understand the risks associated with it.

In the fight against poverty and for a healthcare system that can serve its entire population, Kiribati has much work to do. Progress has been made in developing training for healthcare professionals and educational programs for communities, but many services such as sanitation and clean water supply still aren’t up to standards. Still, with a government committed to increasing the healthcare provisions for its people, Kiribati is sure to develop into a country that can provide for its growing population.

Pratik Samir Koppikar
Photo: Pixabay

Building Sustainable Healthcare

Qualified and experienced medical professionals traveling to developing countries and providing necessary healthcare may seem not only harmless but sensible for communities in need. However, if the ultimate goal is to improve sustainable healthcare in these countries in the long-term, the benefits of professional volunteers can be short-lived.

Nurses International

Nurses International is a non-profit organization that aims to build sustainable healthcare in developing nations by providing resources and education to local nurses in order to become qualified healthcare workers. Some of its work includes:

  • Ameliorating programs that are already in existence by providing necessary courses to complete the nurses’ training
  • Setting up new programs where they are non-existent
  • Removing obstacles, such as affordability, for students
  • Applying a curriculum that utilizes technology to increase productivity and efficiency
  • Educating nurses on their influence on community development
  • Multiple consultation efforts, such as reviewing curriculum, mentoring staff and aiding in policy development

Open Access

Nurses International also provides online courses intended to magnify the instruction for students in nursing programs. The courses may also act as preparation for those entering a nursing program. The online programs have been made available worldwide and include lectures, references for educators and students, assignments and assessments.

With all current courses relocated online due to COVID-19, there is a new course available for students to enroll in that discusses all aspects of the COVID-19 including testing, treatment and trajectory of the disease. Nurses International is also currently developing a teacher’s guide for Open Access and has the “worlds first Open Access BSN.”

Nurses International endeavors to do its work honing an anthropological perspective. Understanding and respecting the beliefs, values, traditions, and language of the patients and the community is at the heart of the organization’s work. Nurses International “respects and values multiple perspectives and finds that diversity allows them to their best work” towards building sustainable healthcare.

Nurses International’s productive efforts can be seen in Burundi, where volunteers teach students and develop learning materials while a new hospital is being built. Nurses International is making a teacher handbook and providing health checkups for women partaking in the program. In China, they are educating clinical instructors in the city of Quijing from 3 different nursing schools. In Egypt, Nurses International is providing a residency program for nurses to help them transition into clinical practice.

Challenges of Medical Tourism

Nurses International has an understanding that the demands of a developing country go far beyond the need for provisional healthcare. There is a growing interest from clinicians and medical students to travel to and temporarily practice in developing nations. The consequences of these visits can be damaging in multiple ways. For instance, countries hosting these international visitors must adapt resources that are already insufficient for their stay. Visitors often bring along supplies that are unnecessary or inapplicable. There is no evidence these missions create a stable healthcare model. By the end of their visits, substantial amounts of materials and money have been dedicated to solutions that are only temporary.

The Best of Both Worlds

Of course, volunteers can be helpful in developing countries. There is still a high demand for medical professionals and urgent care. The best solutions can come from an approach that is conscious of the community’s needs in both the short-term and the long-term. The Project Health Opportunities for People Everywhere (HOPE) and the Ghana Emergency Medicine Collaborative (GEMC) united in 2011 to accomplish this objective.

GEMC recognized the crucial need for specialization in emergency medicine since almost 6 million deaths around the world occur from injuries and acute illnesses. The collaborative realized that sending students away to developed countries for their training was ineffective in sustaining healthcare in the community because many students would remain in the developed countries that they were trained in, instead of returning home. To prevent such issues, GEMC brought emergency medicine specialists from the U.S and U.K. to Komfo Arioke Teaching Hospital (KATH) in Kumasi, Ghana.

The faculty coming from developed countries advise and train students who eventually graduate from the program and become qualified clinicians and instructors, allowing graduates from the local community to then lead the programs. Project Hope joined forces with GEMC’s methods by providing volunteers to perform direct and immediate health care services as needed at KATH, and also to strengthen a program with transitory medical volunteers. These programs work together to form an initiative to build sustainable healthcare in the community.

— Amy Schlagel
Photo: Pixabay

 

Life Expectancy in RwandaAs life expectancy in Rwanda has doubled in the past 20 years, the efforts that helped to achieve this goal are closely tied with efforts to combat poverty. If people are sick but cannot access healthcare, they cannot contribute to the economy. Conversely, if people are living in poverty, they often cannot afford to access healthcare. Ending poverty and providing medical care are closely tied, and Rwanda has made excellent progress on both fronts.

Life Expectancy in Rwanda

In the early 1990s, Rwanda was the site of a 100-day genocide, during which a million Tutsis and Hutus were killed. The genocide decimated the country, destroyed infrastructure and cast millions into poverty. Life expectancy in Rwanda reached a low of 26.2 years in 1993 at the height of the genocide, but by 2018, it had risen to 68.7 years. Furthermore, life expectancy is projected to increase to 71.4 years by 2032.

Many factors have contributed to the dramatic increase in life expectancy and overall social welfare. The Rwandan constitution secured citizens’ right to health in 2003. Accordingly, the government has invested in healthcare systems including primary healthcare systems, HIV/AIDS healthcare systems, oncology services, community-based health insurance and medical education. A dramatic increase in vaccination rates has been crucial in improving Rwandans’ health. After the genocide, fewer than 25% of children had been vaccinated against measles and polio, but today, 97% of Rwandan infants have received vaccinations against 10 diseases.

There have also been declines in deaths from tuberculosis and malaria. There has been a similar decline in maternal and child mortality: after the genocide, Rwanda had the world’s highest rate of child mortality, but today, Rwanda has caught up with the global average. Furthermore, the HIV/AIDS case and death rates have decreased. In 1996, antiretroviral therapy became available, and in the last 10 years, Rwanda’s death rate from AIDS fell faster than it did in the U.S. and Western Europe.

External investment and an increase in foreign aid have also improved Rwandans’ health. In 1995, Rwanda received only $0.50 per person for health, less than any other country in Africa. NGOs like Partners In Health (PIH) have helped increase the population’s access to healthcare and have supported efforts to rebuild public and community health systems.

Poverty in Rwanda

The percentage of people living in poverty declined by 5.8%, from 44.9% to 39.1%, between 2011 and 2014 alone. Factors contributing to the decrease in poverty include:

  • The improved health of the people of Rwanda. Strong healthcare systems can work to combat poverty, because when people are in good health and can access medical care, they are able to work and be more economically productive.
  • The government’s Vision 2020 anti-poverty objective, which fosters privatization and liberalization with the goal of promoting economic growth.
  • A thriving banking system.
  • The expansion of the service sector.
  • Entry into the East African Community, an economic bloc whose other members are Uganda, Kenya, Tanzania and Burundi.

Poverty and Life Expectancy in Rwanda

There is a substantial intersection between Rwanda’s efforts to increase its citizens’ life expectancy and its efforts to pull them out of poverty. The efforts to ameliorate both problems of poverty and life expectancy in Rwanda are linked through public health, and each is improving because the other is. In the words of one public health expert, Rwanda demonstrates that “a nation’s most precious resource is its people.”

Isabelle Breier
Photo: Wikimedia

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

Lack of Testing

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

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

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

A Resistant Population

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

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

Weak Healthcare Systems

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

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

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

Economic and Psychological Factors

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

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

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

Beti Sharew
Photo: Flickr

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

COVID-19 and the Venezuelan crisisOf all households in Venezuela, 35% depend on financial support from family members working overseas. According to local economic researcher Asdrúbal Oliveros, remittances to Venezuela will suffer a heavy blow as a result of the COVID-19 pandemic and its severe effect on the global economy. With an estimated $2 billion decrease in remittances, the health of millions of Venezuelans is in serious danger due to the combined effects of COVID-19 and the Venezuelan Crisis.

The World Bank believes the pandemic will cause a 20% decrease in global remittances, the biggest drop in recent years. With 90% of citizens in Venezuela living in poverty, the drastic fall in remittances and oil prices spell trouble for countless people. Furthermore, the unprepared Venezuelan healthcare system has struggled to control the pandemic.

Despite numerous U.N. groups imploring for money-transfer businesses to make international transfers cheaper, Venezuela’s foreign exchange policy and volatile economic system are difficult to reform. “Venezuelan remitters” are instead left using unnecessarily complex methods to send money back home.

The Venezuelan Government Under Nicolás Maduro

In 2019, the Venezuelan government politicized humanitarian aid when it vilified the U.S. government’s foreign aid as the beginning stage of a U.S. invasion. However, the government has finally acknowledged the long-denied humanitarian crisis in Venezuela. President Nicolas Maduro has accepted the deliverance of aid after negotiations with the International Federation of Red Cross and Red Crescent Societies (IFRC). Subsequently, the United Nations declared it was increasing its efforts to aid Venezuela.

Despite the progress made, politics continue to negatively affect potential aid. According to Miguel Pizarro, a U.N. Representative, the political influence leaves many without fundamental necessities. Pizarro explains, “If you demonstrate and raise your voice and go to the streets, you do not have food, medicine, water or domestic gas.” Pizarro continues, “Eighty percent of Venezuelan households are supplied with gas by the state. If you become active in the political arena, they take away that right.”

Sharp declines in oil value, numerous embargoes globally and negligent economic policy largely caused the humanitarian emergency in Venezuela. Since 2014, the nation’s GDP has fallen by 88%, with overall inflation rates in the millions. A 2019 paper published by economic researchers at the Center for Economic and Policy Research attributed medicine, food and general supply deficits in 2018 to the deaths of at least 40,000. According to findings from the Coalition of Organizations for the Right to Health and Life, a scarcity in medicine puts over 300,000 Venezuelans in peril.

Dr. Julio Castro, director of Doctors for Health in Venezuela, says “People don’t have money to live. I think it’s probably a worst-case scenario for people in Venezuela.” Despite recent increases in aid and medicine from U.N. operations and the IFRC, the Venezuelan struggle persists.

Venezuelan Healthcare Amid COVID-19

Most of the Venezuelan population can only afford to receive aid from public hospitals. These public hospitals often experience persistent deficits in necessary supplies. A study conducted by Doctors for Health indicated that 60% of public facilities frequently face power outages and water shortages.

In response to this, the Venezuelan government authorized $20 million in healthcare aid, which will be administered by the Pan American Health Organization (PAHO), a territorial agency of the World Health Organization. They will use the capital to develop COVID-19 testing and to obtain personal protective equipment (Ex: masks, gloves, etc).

According to Luis Francisco Cabezas of local healthcare nonprofit Convite, a recent study identified a worrisome struggle. Data indicated that roughly six in 10 people had reported trouble obtaining medication for chronic illnesses. The problem has only worsened since the pandemic.

Local Nonprofits Redirect Efforts Toward Venezuelan Crisis

Numerous nonprofits in the country have responded to COVID-19 and the ongoing Venezuelan crisis by shifting their efforts. A director for Caritas, a Catholic charity, says the ongoing economic disaster compelled his organization to prioritize humanitarian work over its original mission of civil rights advocacy.

Similarly, Robert Patiño leads a nonprofit civil rights group, Mi Convive, which shifted to humanitarian work in 2016. Since its inception, the organization has directed its efforts to child nutrition. Through the group Alimenta La Solidaridad, Mi Convive has opened over 50 community kitchens in Venezuela, feeding over 4,000 kids weekly.

Although the efforts by Venezuelan nonprofits have aided thousands, it is not enough. COVID-19 and the Venezuelan crisis need to be in worldwide focus until the government can reliably provide for its citizens. The work of numerous good samaritans can only reach so many people, and their work is constantly hindered by “Chavistas,” a group of Venezuelans who are loyal to President Nicolas Maduro’s government. Mi Convive’s Robert Patiño claims the radicals have been known to go as far as withholding food boxes from areas where the nonprofit is trying to begin new programs. The humanitarian emergency in Venezuela must be appropriately addressed, for the livelihood of millions of people are at stake.

Carlos Williams
Photo: Flickr

healthcare in the republic of congo
The Republic of Congo, also known as Congo-Brazzaville, is a central African country with about 5.2 million residents. Since most of the country is covered in tropical forests, more than half of the population lives in two large southern cities, Brazzaville and Pointe-Noire. It’s one of Africa’s top 10 oil producers and has extensive untapped mineral resources. Despite this, The Republic of Congo faces high rates of extreme poverty due to economic crises from oil price drops as well as ongoing conflicts since the 1990s. The economic declines have diminished state funds and the conflicts arising from political unrest led to the government no longer prioritizing healthcare in the Republic of Congo.

This has created an inadequate healthcare system characterized by a lack of resources, lack of healthcare professionals, insufficient access to and inability to deliver health services. The Republic of Congo is currently facing high rates of TB, HIV, malaria and maternal mortality.

Steps Forward

Fortunately, despite these earlier challenges, the government began reprioritizing healthcare in the Republic of Congo with the help of various aid organizations. This revamped investment started in 2009 with a partnership with the United Nations Population Fund (UNFPA) to reduce maternal mortality.

UNFPA worked closely with UNICEF, WHO and the World Bank to help the Republic of Congo government outline a maternal mortality reduction program. This program was boosted by the 6 million dollars that UNFPA made available to the country. In cities, free cesarean sections were made available as well as more family planning resources. This resulted in a 45% decline in maternal mortality from 2005-2012.

This decline was extremely promising; however, there is still much that needs to be done in Congo because its maternal mortality rates are still in line with other less-developed countries. The government acknowledged this and once again partnered with UNFPA in 2019 to further invest in a maternal mortality reduction program.

UNFPA Collaboration

This new program is focused on boosting healthcare infrastructure, facilities and services by utilizing innovative technologies. It is particularly focused on providing women in rural communities the best care possible. Some of the aspects of the program include providing solar power systems to ensure health facilities can function consistently as well as equipping midwives and doctors with portable ultrasounds and other monitoring devices to help handle high-risk pregnancies. Backpack kits filled with childbirth equipment are given to community health workers along with mobile phones to receive technical support if necessary.

While maternal mortality is a targeted intervention, the Republic of Congo has also done extensive work focusing on the healthcare system as a whole. This began in 2012 with the implementation of performance-based financing (PBF) with the help of Cordaid, an international development organization. PBF is a system in which healthcare providers are funded based on their performance and ability to meet specific objectives. It is utilized as a way to help introduce specific ways of purchasing that help health systems move towards universal health coverage.

PBF greatly improved healthcare in the Republic of Congo because it helps incentivize health workers to provide more and better care, such as assisting more births or providing more vaccinations. This, in turn, makes patients feel better and safer because their doctors are working hard, which increases the likelihood of people going in for consultations. More patients mean that rates for services will go down. Overall, with PBF, healthcare workers and facilities function better, and patients are happier and healthier.

While today, healthcare in The Republic of Congo is still facing challenges, it is vital to recognize how the government is investing and prioritizing the lives of its citizens. Creating change for the better is possible, and one must not forget to celebrate the victories.

– Paige Wallace

Photo: UNFPA

dementia in developing countriesThough dementia is traditionally thought of as being prevalent only in the developed world, it is now occurring at higher rates in developing countries. Currently, 67% of people with dementia worldwide reside in low- and middle-income nations, and researchers predict that number will reach 75% by 2050 in tandem with these nations’ aging populations. Because health and social care services in these countries are already strained or non-existent, dementia in developing countries poses a unique set of challenges.

Dementia and Alzheimer’s

The most common cause of dementia is Alzheimer’s Disease. But as with nearly all forms of dementia, there is progressive brain cell death, so as its symptoms progress, cognitive functions become severely impaired. As early as the second stage of mild dementia, individuals may require intensive care and supervision from others with tasks in their daily life. However, healthcare systems are stretched thin in many developing countries. Often, their frontline providers may not be adequately trained in providing the long-term care needed for these conditions. Even when assisted-living arrangements in a medical facility are an option, people with dementia have limited autonomy over their care because there are few systems in place to monitor the quality of dementia care in poorer nations.

Treating Dementia in Developing Countries

Due to the lack of formal care, people with dementia in the developing world tend to rely upon systems of “informal” care by family, friends, or other community members. These support mechanisms are under great strain due to the economic, emotional and physical demands of unpaid, and often unsubsidized, caregiving. Caring for someone with dementia can demand up to 74 hours a week and cost around $4600 a year. Furthermore, symptoms associated with the later stages of dementia, such as aggression, depression and hallucinations can have distressful psychological effects for these caregivers. In fact, 45% of family caregivers report experiencing distress, and 39% have feelings of depression.

Social Stigmas Surrounding Dementia

The social stigma associated with mental health diagnoses as well as general health illiteracy and unfamiliarity with dementia also contributes to inequities within the quality of dementia care. A study conducted in India suggested that 90% of dementia cases in low and middle-income nations go undiagnosed. Even healthcare professionals may lack the awareness to identify early signs of dementia. The wide-spread myth that dementia is not a medical issue in developing countries can mislead providers to dismiss dementia’s symptoms as characteristics indicative of normal aging.

Furthermore, in some parts of Sub-Saharan Africa, such as rural Kenya and Namibia where knowledge of dementia is not widespread, people may associate dementia with witchcraft or punishment for previous wrongdoings. Such beliefs further entrench the stigma surrounding it into the broader culture, discouraging people with dementia from seeking an official diagnosis. Organizations like the Strengthening Responses to Dementia in Developing Countries (STRiDE) Project have worked specifically towards reducing this stigma.

Understanding Poverty and Dementia

The immense prevalence of undiagnosed cases is particularly detrimental, considering poverty may increase one’s risk of dementia. Poverty is linked with many risk factors for dementia — one of which is stressful experiences like financial insecurity and education difficulties. Incidence of dementia has also been linked to lower levels of education since early development of neural networks can help the brain combat damages to its pathology later in life. A study on the rural Chinese island of Kinmen, where the median level of education is one year, showed dementia rates rising as people turned 60. This trend is earlier than in developed nations, and implies that illiteracy and lack of education can bring on dementia sooner.

Looking Forward

It remains unclear whether there is a correlation or direct causation between education level and the likelihood of dementia later in life. But one thing, however, is clear — low education levels serve as a frequent marker for other socioeconomic issues that are more common in developing nations, such as poverty, malnutrition, and toxic environmental exposures. Furthermore, the most commonly recommended strategy for reducing the risk of Alzheimer’s is maintaining overall health, which is more difficult in poorer countries due to malnutrition and unequal access to health care.

Moving forward, we must expand the support available to informal care systems, while ensuring healthcare providers receive dementia-specific training and health literacy. Women often the ones left to provide the majority of dementia care, but their efforts largely go ignored by their governments. Incentives, like universal social pensions, disability benefits and carer’s allowances, could support family and friends who house and care for people with dementia. Still, formal health systems too need to be bolstered to supplement and eventually substitute the role of informal carers. Policy-makers worldwide need to prioritize and anticipate the growing number of people with dementia as it remains the only leading cause of death still on the rise.

– Christine Mui
Photo: Flickr

Healthcare in Central African RepublicViolent conflict that has surged since 2007 in the Central African Republic (CAR) has created challenges for the nation’s healthcare system. Humanitarian organizations, which provide the majority of the health services available, have continued working to provide adequate healthcare despite threats of violence from militia groups.

Providing Healthcare Amid Conflict

The CAR is facing a humanitarian emergency. Even after the introduction of a peace agreement among the 14 armed groups in the country in 2019, attacks against civilians and humanitarian workers persist. It is estimated that out of more than 4.6 million people living in the CAR, 2.9 million people are in need of humanitarian assistance. NGOs have not stopped attempting to provide services to those displaced and hurting from the violence.

There are inadequate numbers of trained health workers in the CAR, as reported by the World Health Organization. Therefore, it has become a primary concern to increase the number of healthcare providers. This year, in addition to providing water, sanitation and hygiene assistance, the Norwegian Refugee Council (NRC) has begun training 500 individuals to respond to the protection and healthcare needs of vulnerable communities in the CAR.

After the conflict damaged or destroyed 34% of the CAR’s healthcare infrastructure, NGOs are focused on supporting the remaining hospitals and clinics. ALIMA, an NGO committed to providing quality healthcare services to those in need, has been working in the CAR since 2013. They have provided nutritional and medical care in the Bimbo and Boda health districts and outside the nation’s capital of Bangui. Pregnant women and children under the age of five have received free healthcare through ALIMA. Just in 2016, the organization carried out more than 17,320 prenatal consultations and treated close to 75,000 children for malaria.

The International Rescue Committee (IRC) began its involvement in CAR in 2006. The health services provided by this organization target the mental health consequences of gender-based violence. Psychosocial support to women survivors of violence has remained a priority. The IRC also implemented discussion groups aimed to expand gender-based violence awareness and share strategies for prevention.

Combating Infectious Disease

Malaria, HIV and tuberculosis are a few of the prominent diseases that require intense prevention and treatment in the CAR. Doctors Without Borders has been one of the principal actors in delivering these services, treating nearly 547,000 malaria cases in 2018. The organization generated community-based groups in multiple cities to pick up antiretroviral medications needed to treat HIV, while also working to decentralize HIV and AIDS treatment in the city of Carnot. UNICEF has given additional HIV screening to pregnant women during prenatal consultations, and those who tested positive were promptly placed on antiretroviral treatment.

On Jan. 24, 2020, the Ministry of Health declared there to be a measles epidemic in the CAR; cases had been on the rise since the previous year. Between January 2019 and February 2020, there were 7,626 suspected measles cases. A significant public health response has begun to target the spread, including the development of vaccination campaigns, an increase in epidemiological surveillance and the distribution of free medical supplies.

CAR has been impacted by the current coronavirus pandemic, as the country has recorded nearly 4,000 cases as of July 3. UNICEF and partners have been able to provide free essential care, sanitation services and psychological support.

The Need for Humanitarian Assistance

The United States Agency for International Development (USAID) is a major contributor to humanitarian aid in the CAR. It was with the financial assistance of USAID in the 2019 fiscal year that the IRC and the NRC were able to provide healthcare resources for risk prevention. The preservation of humanitarian funding to the CAR has proven to be crucial, as conflict has further weakened the healthcare system.

Humanitarian organizations have made significant progress in recent years to combat the spread of infectious disease and provide more widespread healthcare in the Central African Republic. There is a need to expand these efforts and improve quality of life during the nation’s continued fight for peace.

Ilana Issula
Photo: Flickr

Healthcare Reform in GeorgiaHealthcare reform in Georgia has contributed greatly to its population’s quality of life. Located east of the Black Sea in Europe, the country of Georgia finally gained independence in 1991 from the Soviet Union. In recent centuries, Turkey, Persia and Russia fought over control of its land, and the region still experiences tensions with Russia. The United States’ political and economic involvement with Georgia was a cause of concern to Russia, especially given Georgia’s interest in joining NATO and the EU. The Georgian- and Russian-speaking country has a population of 4.3 million, with a life expectancy of 71 for males and 77 for females.

Privately Funded Healthcare

After making the transition from a communist regime to a market economy, healthcare in Georgia was primarily privately financed. By the year 2002, healthcare spending per capita was $64. Over the period from 2002 to 2013, that figure saw an increase to $350. The country has been alleviating regulations ever since 2003, easing private companies’ entry into the market.

Recently there have been further reforms, such as the government supporting private insurers to invest and operate in 2010. This led to the private ownership of 84.3% of hospital beds by the end of 2014. Additionally, private insurers generated 43.2% of written premiums that same year.

Rising Standards of Health

Ever since its independence, Georgia has been one of the poorer countries of the region, its population subject to mainly noncommunicable diseases. However, the country’s standards have been slowly catching up to the rest of Europe. For example, the poverty rate went from 33.2% in 2005 to 21.3% in 2016.

One issue with healthcare in Georgia, and with the general health of the population, has been the flawed death reporting system. This system has led to an exaggerated rate of illness-induced deaths. It reached 55% in 2010, even though research suggests that a rate higher than 20% should be considered unreliable. While the rate remains high and unreliable, the country made tremendous progress after improving software systems, resulting in a rate of 27.3% in 2015.

A New Universal Healthcare System

Healthcare in Georgia took a big leap in 2013, when the government introduced a universal healthcare system for which the entire population qualified. Healthcare reform in Georgia downsized the role of private insurers and changed the system’s entire financing and funding structure. Instead of supporting private companies, government funds were allocated directly to the healthcare providers. The vast majority – 96.4% – of patients reported satisfaction with the system.

One of the main diseases affecting the country during this century is Hepatitis C. According to the CDC and the NCDC, “in 2015, estimated national seroprevalence of hepatitis C is 7.7% and the prevalence of active disease is 5.4%.” Healthcare reform in Georgia sought to combat the disease through a national program initiated in 2015. This program electronically improved screening and data collection from national and local agencies. From 2015 until 2017, the cure rate reached 98.2% and 38,506 patients were treated.

Healthcare in Georgia has undergone many reforms since 2003. It began with the support of privatization, but eventually the government transitioned to a single-payer universal healthcare system that serves approximately 90% of citizens. The current system also took measures to address the effects of the Hepatitis C disease. Even though the country still lags behind other European countries in poverty and health standards, recent years have seen significant progress.

Fahad Saad
Photo: Pixabay