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Healthcare in South Africa
With a population of 57.78 million people and with approximately 49.2% of the adult population living below the poverty line, AIDS and healthcare in South Africa are two of the country’s main issues. In particular, the unequal distribution of healthcare resources has worsened the country’s fight against HIV and AIDS. During recent years, South Africa has begun to take steps toward change. Here are five facts about the AIDS and healthcare crisis in South Africa.

5 Facts About AIDS and Healthcare in South Africa

  1. Systems of Healthcare in South Africa: South Africa’s healthcare system is severely divided between the public and private sectors. The public sector (the healthcare provided by government funding) covers about 84% of the population. In South Africa, 70% of doctors work in the private sector, as people who can afford private healthcare tend to pay better, and private doctors have access to better resources. Furthermore, per capita expenditure in the private sector, or the cost per person, was about $1,400 in 2014, while per capita expenditure in the public sector was about $140. For comparison, the United States’ per capita healthcare expenditure is about $11,200.
  2. Rural vs. Urban Communities: As in many countries, there is significant inequality in access to healthcare between rural and urban communities. In South Africa, people living in rural areas tend to rely on public healthcare. Unfortunately, there is an inadequate number of trained healthcare professionals in the public sector. A study conducted in 2002 revealed that urban areas of South Africa were more likely to have higher percentages of HIV infections. However, as a result of the inequality of healthcare, people in rural South Africa were two times less likely to receive testing for HIV or AIDs.
  3. AIDS Epidemic: In South Africa, 7.7 million people live with AIDS, the highest case rate in the world. About 20% of the world’s HIV cases are in South Africa, and within the country, about 60% of women have HIV. Even in areas in which testing is available, many choose not to partake, as they are afraid of receiving a positive result. A lack of resources, including education for young people and proper training for healthcare workers, has created issues surrounding awareness of the disease, proper diagnosis and access to PrEP. This drug reduces the possibility of infection by 99%.
  4. ART Program AID: In 2003, South Africa rolled out the largest Antiretroviral Treatment plan (ART) in the world. Offered through the public sector, ART serves as the primary HIV intervention for both children and adults. An important aspect of its implementation was affordability, as only 13.7% of South Africans have medical insurance. With the help of CDC South Africa, government facilities and mission hospitals, more people were able to access and benefit from the program.
  5. The Good News: ART has proved to be successful, as adult HIV deaths peaked in 2006, with 231,000 deaths, and then decreased dramatically. In 2014 there were 95,000 deaths, which was a reduction of 74.7%. In total, from the very beginning of the program in 2003 to 2014, the ART program reduced HIV adult deaths by an estimated 1.72 million, a clear positive trend. Most recently, in 2018, 71,000 people died from AIDs-related illness, which was a 50% decrease from 2010. Furthermore, 62% of people with HIV had access to treatment. 87% of pregnant women with AIDs also received antiretroviral medication, preventing 53,000 HIV infections in newborn babies. These statistics are all improvements from previous years.

While there is still work to be done to improve AIDS and healthcare in South Africa, much progress has been made. Increased funding and support for new programs and access to antiretroviral medication have had a significant impact. Moving forward, it is essential that these programs expand their efforts to further reduce deaths caused by HIV and AIDS.

Alyssa Hogan
Photo: Flickr

Poverty in ChadLocated in Central Africa, the country of Chad is the fifth largest landlocked state and has a poverty rate of 66.2%. With a total population of approximately 15.5 million, a lack of modern medicine, dramatic weather changes and poor education have riddled the country with deadly diseases and resulted in severe poverty in Chad.

Poor Health Conditions in Chad Lead to Disease

The most common types of disease and the primary causes of death include malaria, respiratory infections and HIV/AIDS. Malaria, usually spread through mosquito bites, is a potentially fatal disease and is quite common in the country of Chad. Due to poor sanitation, Chadians are more susceptible to malaria; the most recently estimated number of cases was 500,000 per year.

Along with malaria, lower respiratory diseases contribute to Chad’s high mortality rate – the most common and deadliest of those being meningitis.  Lower respiratory tract infections occur in the lungs and can sometimes affect the brain and spinal cord. A lack of available vaccinations in the country has increased susceptibility to meningitis. Meningitis is most deadly in those under the age of 20, and with a countrywide median age of 16.6 years old, Chad has seen a rise in total meningitis cases and overall deaths.

As of 2015, there were an estimated 210,000 Chadians living with HIV. According to UNAIDS, there were 12,000 AIDS-related deaths just last year, along with 14,000 new cases. Those living with HIV/AIDS are at a higher risk of death with their compromised immune systems. They are unable to fight off diseases and, with the preexisting severe risk of malaria and meningitis, they are more susceptible to death.

Harsh Weather and Its Role in Food Insecurity and Disease

Due to its geography, Chad is one of the countries most severely affected by climate change. Approximately 40% of Chadians live at or below the poverty line, with the majority relying heavily on agricultural production and fishing. The drastic change in rain patterns and the consequent frequency of droughts have placed a significant strain on their food supply. Fishing in particular has been sparse. Lake Chad, the country’s largest lake, has diminished by 90% in the past 50 years. The rising temperatures in Chad have caused a decrease in both crop yields and good pasture conditions, placing more strain on those who depend on Lake Chad for food and the nutrients it adds to farming.

In addition to affecting poverty in Chad, intense weather patterns have also increased the number of infectious diseases. The infrastructure of the country has not been able to keep up with the rapidly growing population in urban areas. This results in poor sanitation. The sanitation services are overwhelmed during floods: which contaminates the water supply.

Lack of Education Affects Poverty in Chad

Despite the relatively large population, less than half of school-aged children are enrolled in school. With attendance rates so low, the literacy rates in individuals between the ages of 15 and 24 fall; currently, they only reach 31%.  According to UNICEF, attendance rates are astonishingly low; 8% for children in upper secondary school and 13% for lower secondary school. With education rates so low, income inequality, infant and maternal deaths and stunting in children continue to rise; as a result, the overall economic growth of the country declines.

Enrollment is low in Chad due to the lack of resources in schools. With the country in severe poverty, schools remain under-resourced, both in access and infrastructure. Some schools have no classrooms and no teaching materials. Furthermore, teachers are often outnumbered 100:1. As a result, the quality of learning decreases, as does the overall attendance rate.

As of now, only 27% of primary-school-age children complete their schooling. According to UNESCO, if adults in low-income countries completed their secondary education, the global poverty rate would be cut in half. Even learning basic reading skills could spare approximately 171 million people from living in extreme poverty. Educated individuals are more likely to develop important skills and abilities needed to help them overcome poverty. Education also decreases an individual’s risk of vulnerability to disease, natural disasters and conflict.

Poverty in Chad is widespread, and the rate of impoverished people will continue to grow if it is not addressed. Poor health conditions and a lack of education are just a few of the many problems people face; while the living conditions may seem dire in Chad, a gradual decrease in overall poverty rates proves that there is hope.

Jacey Reece
Photo: Flickr

Health System in Malawi

The topic of healthcare has become a worldwide focus in recent years. A push toward government-funded health services has indicated a shift towards the mentality that healthcare is a universal human right. Malawi, one of the smaller countries in southeast Africa, has a low gross domestic product, with 51.5 percent of the population living in poverty. With life expectancy at 64.5 years, the health system in Malawi needs improvement.

The Ouagadougou Declaration

In 2008, the Ouagadougou Declaration on Primary Health Care and Health Systems in Africa was adopted by African Region Member states, which includes Malawi. This declaration focused on nine major issues within healthcare: health governance, service delivery, human resources, health financing, health information systems, new technologies, community ownership and participation, partnerships for development and funding for health research. The Ministry of Health in Malawi is responsible for the implementation and the regulation of these health entities.

Health System in Malawi

Currently, Malawi operates a three-tier health system. The first tier is primary healthcare. This sector is in effect to meet the needs of general medical care, which includes community and rural hospitals and maternity units. The second tier consists of district hospitals. These see patients who receive a referral from their primary care physician to receive specialized services. This includes laboratory work and rehabilitation services. The final tier is tertiary care provided by central hospitals. This tier covers extreme conditions that require highly specialized care such as treatment for specific diseases. The linkage for these services comes through an elaborate referral system that trickles down the health system.

Although the 2008 doctrine worked to lay out different measures to ensure the quality of health service delivery in Malawi, major health concerns still persist. HIV/AIDS continues to be the number one cause of death in Malawi: 21.7 percent of deaths in 2012 were linked to HIV/ AIDS. Acute Respiratory Infections account for 8.6 percent of deaths, while Malaria accounts for 40 percent of hospitalized individuals.

Issues With Funding

A large cause of a lack of quality health services in Malawi comes down to funding. Approximately $93 is spent on each person in Malawi annually, which is around 11.4 percent of the overall GDP. The U.S. spends around $10,000 on healthcare per capita annually.

Due to these issues, the focus for healthcare in Malawi has been working on minimizing the burden of disease, increasing cost effectiveness, providing more widespread access to the poor and implementing proven successful health intervention. Implementation has been laid out through new quality assurance policies, improving standards and accreditation, and improving performance management with the Health Strategic Plan, which was created in 2011. While the government in Malawi works to assure quality health services in Malawi, non-profit organizations are working to help provide those health services. A few of these organizations include Care, which has provided 30.2 million people in Malawi with sexual and reproductive health resources, and the Fistula Foundation, which has given over $300,000 of funding for physician training.

Work being done by the Malawian government and non-profit organizations around the world is helping to improve the health system in Malawi.

– Claire Bryan
Photo: Flickr

HIV and AIDS in South Africa

South Africa has the largest number of people living with HIV of any country in the world. South Africa comprises of approximately one-fifth of the 37 million people in the world living with HIV, with an estimated 7.2 million people living with HIV in 2017. This translates to a general population in which an estimated 18.8 percent of South Africans are HIV positive.

And yet, the country is making progress in reducing HIV and AIDS. In recent years, efforts to combat HIV and AIDS in South Africa have been ramped up. According to a study by the Human Sciences Research Council (HSRC), the statutory research agency of South Africa, there were 231,000 new HIV infections in 2017, representing a 44 percent decrease since the last major study in 2012.

Largest Antiretroviral Drug Campaign in the World

South Africa has the largest antiretroviral drug campaign in the world, which its own domestic resources largely fund. In 2015, South Africa was investing more than 1.34 billion (US dollars) towards its efforts to combat HIV and AIDS. And yet, it was not always like this; the South African government regarding and treating HIV and AIDS as a major and important public health issue and one to which it allocates resources to is a fairly recent phenomenon.

The government spearheaded this change, at least in part, by the exit of former South African President, Thabo Mbeki, who headed the government between June 14, 1999, and September 24, 2008. He had a track record of aversion to the combating of HIV as a public health issue and largely turned a blind eye to the issue. ‘“Many people do not remember that in 2000 there were only 90 people in South Africa on treatment,” said Michel Sidibé, executive director of UNAIDS.” When Mbeki left office in 2008, a tide turned and HIV and AIDS became to be regarded in the milieu and in public policy as a major and important public health issue, and now approximately four million people are receiving antiretroviral drug treatment in South Africa.

The 90 90 90 Plan

The 90 90 90 Plan summarizes some of the efforts to combat HIV and AIDS in South Africa. This plan aimed to test 90 percent of people so they would know their HIV status, followed by 90 percent of those diagnosed receiving sustained antiretroviral therapy and 90 percent of those receiving antiretroviral therapy to have viral suppression.

South Africa reached the first of the 90-90-90 targets, with 90 percent of people aware of their status, jumping up from only 66.2 percent in 2014. Of the affected, presently 61 percent of adults (people between ages 15-49) and 58 percent of children are on antiretroviral treatment, and so these current numbers are not at target though they are continuing to trend upwards. Life expectancy has seen a significant increase over the past several years, largely due to the efforts launched with antiretroviral therapy. There has been an improvement in life expectancy from 61.2 years in 2010 to 67.7 years in 2015.  With an increase of nearly 10 percent in just five years, one cannot overstate South Africa’s success in reducing HIV and AIDS within the country.

– Lacy Rab
Photo: Flickr