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naida-adolescent-health-care-in-nigeria
Adolescent health care in Nigeria is a fundamental struggle that the country faces on the path toward a more equitable society. In 2017, the U.N. reported that wealth inequality in Nigeria is extreme, as the five wealthiest people have a combined wealth of $29.9 billion while 60% of Nigerians live on less than $1.25 a day. Nigeria is in a precarious position, as the country has great wealth, yet inequality remains high. The health care sector is one area where inequality is evident.

The Divide

A serious challenge that those seeking to expand adolescent health care in Nigeria have encountered is the divide between youth in schools and those who are not. The World Health Organization (WHO) contends that adolescence is characterized by a significant psychological and physical transition.

Sex education is an integral part of adolescent health care. Sex education can include education in the areas of sexuality, marriage, childbearing and sexually transmitted infections (STIs). However, adolescents who are in school tend to have a different, more formal access to this type of education largely because adolescent health care mainly funnels through in-school programs.

Moreover, adolescents in school are generally more affluent and from either urban or suburban areas. As a result, adolescent health care in Nigeria tends to focus on these segments of the population.

Individuals “out-of-school” are young people who are not in the education system. Education is a major socioeconomic determinant, so because out-of-school adolescents are not in the education system, they tend to be of a lower socioeconomic class or have limitations in the professions they can choose.

Organizations and Support

In September 2021, the World Health Organization (WHO) announced that it is continuing to pledge support to adolescent health care in Nigeria by recognizing that adolescence is an important time in life and development. The WHO program focuses on guidelines and a recommendations-based approach where the program will advise the government on the issue.

Among other organizations working in Nigeria, USAID has decided that improved health care for adolescents “out of school” is a priority, according to The Guardian. USAID launched a five-year (2020-2025) program entitled “YPE4AH” or the “Shine Well Well” Program. Like the WHO program, it seeks to research and outline guidelines and benchmarks for adolescent health in Nigeria. It will work in tandem with the Nigerian government and various other programs such as the Youth Empowerment and Development Initiative and the Women Friendly Initiative to tackle the problem, The Guardian reported.

The program seeks to identify specific benchmarks and important driving factors which determine health care. Additionally, many of these programs strive to reduce the stigma around sex education, which not only includes information about STIs but also topics like vaccines, maternal care and mental health.

Those committed to adolescent health care in Nigeria recognize that a multitude of international organizations have not only recognized the problem but committed support. While those familiar with the issue understand that wealth inequality remains a key barrier to health care equality, they may have the reassurance that the government, NGOs and Nigerian organizations are working in tandem to combat the issue. The first step, which is seeking to identify the problem and quantify it, has already occurred, so hopefully, change will follow.

– Lara Drinan
Photo: Flickr

Foreign Aid to Afghanistan
Some definitions of foreign aid provide a distorted vision of its purpose. This in turn drives citizens, government officials and donors away from supporting it. An accurate definition of foreign aid is one country helping to improve a recipient country’s standard of living through economic, military and various other services. Donors provide this type of support after war or natural disaster. The recent withdrawal of U.S. forces from Afghanistan is slowly concluding more than 40 years of conflict. However, foreign aid to Afghanistan remains necessary.

Afghanistan’s Violent Past

More than half of the population in Afghanistan lives on $1.90 a day. In headlines, history books and news stories, many do not see Afghanistan beyond the label of an economically developing country. This label often comes from a place of unfair judgment.

The longevity of the Afghan crisis is why aid is vital in transforming the country to work toward a better quality of life and future for the younger generations. The detrimental relationship between the state and citizens has damaged every part of what is necessary for a society to flourish. For example, the top-down monopoly with profiteers and warlords on top formed to control economic markets producing bottom-up violence is a significant barrier in the country flourishing. Understanding the nature of the conflict that has created a dystopian climate throughout the country is vital in producing foreign aid to Afghanistan because planning for the long term is what will produce change.

Antony Blinken’s Push for Reform

The U.S. is the world’s largest provider of foreign aid, but reform is necessary for providing quality aid for the future. During secretary of state Antony Blinken’s visit to Afghanistan on April 15, 2021, he spoke on several areas of reform to ensure the foreign aid sector continues to progress and attend to the needs of Afghanistan.

The U.S. is studying previous aid distribution models and methods to ensure that country receives the maximum amount of help. This also promotes other governments to continue the change. The U.S. plans on holding the Afghanistan government accountable to the pledge of acknowledging the basic human rights of their citizens. For example, traveling outside of the country has been nearly impossible for Afghan citizens. The U.S. will also hold the Taliban accountable for using Afghanistan as a base for formulating attacks on other countries. Neutralizing any form of threat prevents damage to other countries that would ultimately produce the need for more foreign aid and will push away allies.

The U.S. will ensure even aid distribution throughout the country. It will have clear communication with the Taliban in the coming years. The Taliban must allow aid groups to work on uninterrupted terms. Overall, the U.S. is enforcing long-term change through rectifying the relationship between the state and citizens that has been upholding the unlivable climate.

The Future of Foreign Aid to Afghanistan

The narrative of putting a stop to the current war or any war in the future is an unreachable goal. Foreign aid will not go towards a single issue. Instead, it will focus on changing the systemic problems that continue to produce wars. The U.S. often uses a militant approach, however, with the updated forms of foreign aid, it will not be using violence to overcome it. This includes $64 million in new humanitarian assistance which the United Nations High Commissioner for Refugees (UNHCR) and the World Health Organization (WHO) will distribute. This new surge of funding will provide a large range of assistance including shelter, essential health care, sanitation, food aid, hygiene services and more. These are forms of aid that will contribute to the overall building of a better livelihood for Afghan citizens.

The Millennium Challenge Corporation (MCC)

The Millennium Challenge Corporation (MCC), which U.S. Congress introduced in 2004 is an agency separate from the State Department and USAID. It continues to abide by its mission statement of reducing poverty through economic growth by providing aid to countries like Afghanistan. The U.S. has also developed a range of grants and programs to assist Afghan women who the civil upheaval greatly impacted. USAID continues to provide grants in helping Afghan women gain access to universities through the Women’s Scholarship Endowment.

The US State Department’s Bureau of Population, Refugees and Migration (PRM)

The U.S. State Department’s Bureau of Population, Refugees and Migration (PRM) funds several programs for Afghan women refugees and internally displaced persons. The programs include literacy training, gender-based violence prevention and mother-child health care. PRM works with various partners to ensure change including the U.N. High Commissioner for Refugees (UNHCR), the International Committee of the Red Cross (ICRC) and the International Organization for Migration (IOM).

In large groups, varying interests can prevent the proper allocation of funds to aid. However, the government and donors continue to work closely together. The impact that aid has extends beyond providing food and emergency medical assistance. It has the potential to provide a hopeful future for those who have only known living in a war zone. It reconciles individual relationships within the society. As aid strategies are revised to adhere to current needs the long-term quality of life for Afghan citizens will improve.

– Maggie Forte
Photo: Flickr

Fight Against Malaria
According to the World Health Organization (WHO) in 2019, malaria infections stood at almost 230 million globally. Of these malaria incidents, 409,000 cases led to fatalities. These are the striking and often overlooked numbers encasing the global fight against malaria. Malaria, a parasitic infection that mosquito varieties ruthlessly spread, is an ancient disease plaguing regions across the globe, particularly within the warmer climates of the tropical and subtropical areas of the world.

The cyclical nature of the disease from uninfected mosquitoes to infected hosts then infected mosquitoes to uninfected hosts, is in part the reason this disease is difficult to counteract outside of preventive measures, such as traditional nets, drugs and various forms of insecticides. However, these methods have limitations. The insidious nature of repeat infections adds insult to injury, with reports indicating up to six malaria infections annually among some children. Now, the dawn of a malaria vaccine hopes to make strides in the fight against malaria.

The Dawn of a Malaria Vaccine

The daunting reality and statistics on malaria illustrate only one side of the story on emerging aid over the last three decades. After years of research and trials by the manufacturer, on October 6, 2021, WHO officially authorized the widespread use of a malaria vaccine that GlaxoSmithKline created called Mosquirix. This is not only a win in the fight against malaria. Mosquirix is “also the first vaccine ever recommended for use by WHO to combat a parasitic disease in humans.”

Dr. Pedro Alonso, director of WHO’s global malaria program, says in a press release that “[i]t’s a huge jump from the science perspective to have a first-generation vaccine against a human parasite.” The vaccine, which targets children, has the potential to prevent “23,000 deaths in children younger than 5 each year.” As it stands, the vaccine manufacturer has “committed to producing 15 million doses of Mosquirix annually” until 2028.

Development in Tandem With the Global Health Order

This trend toward vaccination campaigns, development and authorization does not of course appear in a vacuum. After decades of stalling efforts on malaria prevention, a new global health order has ushered in a recent admiration for the efficacy of vaccine funding, research and implementation on the back of the global struggle against COVID-19. Organizations championing the global vaccine battle against COVID-19, such as GAVI, the Vaccine Alliance, “likely play a crucial role in negotiating the financing, procurement and delivery of” the Mosquirix vaccine.

Other major players in the fight against COVID-19 are also entering the ring. BioNTech recently launched a malaria project in July 2021. Its intentions are the use of mRNA technology, which has proven highly effective in COVID-19 vaccines, in the fight against the malaria parasite. Clinical trials of the world’s “first mRNA-based vaccine for malaria prevention” will begin at the close of 2022. These new multilateral and multi-agency relationships in health care, which the pandemic brought about, could be the stepping stones for future breakthroughs in global health.

Looking Ahead

Spurred on by new movements in global health, the malaria vaccine will make strides within infant and youth populations across at-risk regions like Africa and beyond. Mosquirix pilot programs in Kenya, Malawi and Ghana “found that the vaccine is safe. There is community demand for it and it is a cost-effective prevention method.” While perhaps not intrinsically linked to the new global health order, the world is making strides in combating an ancient and sometimes overlooked disease through emerging technologies, monetary funding and intellectual endorsements. It is safe to say that the new malaria vaccine could set new precedents as to the way the world cooperates on matters of global health security so that the international community can develop long-lasting strategies to keep at-risk regions safe, productive and healthy.

– Aidan Swayne
Photo: Flickr

Female Genital Mutilation in Côte d’Ivoire
Female genital mutilation is the process of partially or totally removing the external female genitalia, and is a violation of the human rights of women and girls around the globe. While many strive to ban this non-medical practice, FGM still has a grip on many countries. One such country where FGM is prevalent is Côte d’Ivoire. Here is some information regarding the practice of female genital mutilation in Côte d’Ivoire and the measures to eradicate it.

Female Genital Mutilation in Côte d’Ivoire

Côte d’Ivoire, also known as the Ivory Coast, is a country located along the south coast of West Africa. With a population of about 25 million, FGM practices affect approximately 36.7% of women ages 15-67, the highest prevalence being 60% to 75% among the ethnic groups of the northwest regions of Nord, Nord-Ouest and Ouest. However, girls and women of all ages and from all different regions of Côte d’Ivoire are at risk of FGM.

The prevalence of female genital mutilation in Côte d’Ivoire stems from two reasons, the first being social and cultural traditions. Those who perform the actual cut are typically the older women that make it their living and perform the procedure without anesthesia and the use of medical facilities. Pressure for older girls to undergo FGM often takes place when the prospective husband and his family will not accept a bride that has not experienced it.

The second reason for FGM’s prevalence in Côte d’Ivoire traces back to the large migrant population coming in and out of the country. Many migrants originate from countries where there is little to no legal action against FGM, such as the border nations of Guinea and Mali. The frequent crossing of borders attributes to the high percentages of women and girls who experience FGM in the northwest regions.

Harms of Female Genital Mutilation

Of the four major types of FGM that the World Health Organization (WHO) identified, Côte d’Ivoire practices Type 2. There are no health benefits to any type of FGM, as the non-medical practice mutilates a normal organ of a woman’s body. Instead, FGM harms those who undergo the procedure, and the victims become increasingly at risk to develop health complications in the present moment or in the future. Women and girls who experience FGM largely suffer from the following:

  • Severe pain
  • Infection
  • Urinary and vaginal problems
  • Childbirth complications

Steps Against Female Genital Mutilation

The government of  Côte d’Ivoire created legislation targeting the practice of FGM. Article 5 of the Constitution of Côte d’Ivoire prohibits “female genital mutilation as well as any other forms of degradation of human beings.” Law No. 98-757 of 23 December 1998 criminalized the practice of FGM in all forms, which includes actions by medical professionals and by those who aid in its performance.

Since the creation of Law No. 98-757, few people who practice FGM have experienced prosecution. The Ministry for Women and the Protection of the Child and Solidarity is a major government authority in Côte d’Ivoire. It protects the country’s women and girls and ensures equality in economic, social and cultural areas. From 2008-2012, the government put a National Action Plan in place that protects women and girls from sexual violence, including FGM. Since the National Action Plan’s end, there have been no new talks to implement a new plan.

Looking Ahead

While more work is necessary to completely end female genital mutilation in Côte d’Ivoire and the Ivory Coast, the work of those advocating to end FGM is making a difference in the local communities. Many are starting to see the harms that the practice inflicts. Small steps are still steps toward a brighter future for the women and girls affected.

– Grace Ingles
Photo: Flickr

AstraZeneca's Role in the Global Vaccination EffortThe Oxford/AstraZeneca vaccine made many controversial headlines in mid-March 2021 because of a suspected link between it and a rare and sometimes fatal blood clot that forms in the brain. However, the AstraZeneca vaccine will be a crucial part of the global vaccine rollout effort. Not only is it a safe and effective vaccine approved by the World Health Organization (WHO), but it may also be the best candidate to vaccinate the world’s most vulnerable populations in developing countries. AstraZeneca’s role in the global vaccination effort is key in ensuring the global eradication of COVID-19.

The Science Behind the AstraZeneca Vaccine

The AstraZeneca vaccine is around 70% effective against COVID-19 with some studies suggesting it can be up to 90% effective. Although it is less effective than the Pfizer and Moderna vaccines, it is still more effective than what many experts anticipated any vaccine would be.

In mid-March, some European countries paused the AstraZeneca vaccine rollout based on claims that it caused a rare blood clot. A lack of evidence led every country to resume production and use of the vaccine. Out of 11 million people who received the AstraZeneca vaccine in the U.K., five people reported developing this blood clot. Though there has been no sufficient data to suggest any correlation, British officials and the European Medicines Agency (EMA) will continue to monitor the vaccine in case of other side effects.

Because of its effectiveness against COVID-19, the AstraZeneca vaccine has joined the ranks of other WHO-approved vaccines, like Pfizer and Moderna. Here are some reasons why AstraZeneca is better than other vaccines in leading global vaccination efforts.

Benefits of AstraZeneca

  • Cost: The AstraZeneca vaccine will not be marked up. This means it will cost less than $5 per dose. By contrast, the Pfizer vaccine is $20 per dose, and the Moderna vaccine is around $35. This makes the Oxford/AstraZeneca vaccine a more feasible option for developing countries with limited funds.
  • Temperature: The AstraZeneca vaccine does not need to remain at the astronomically low temperatures the Moderna and Pfizer vaccines require. Instead, it can stay at standard refrigeration levels for months. Thus, for developing countries, which often lack the distribution infrastructure and/or are very hot, the AstraZeneca vaccine is the ideal option.
  • Commitments: Oxford/AstraZeneca has already promised it will provide the developing world with more than a billion doses of the vaccine. Of that, 300 million vaccines will come through the WHO’s COVAX initiative. While Moderna has recently joined the COVAX initiative, the bulk of its agreement of 500 million doses will not be distributed until 2022. Pfizer has joined Oxford/AstraZeneca in the COVAX initiative.
  • Production: A major barrier to widespread vaccine rollout is that countries and companies often lack the infrastructure or ability to produce the vaccines fast enough. The solution would be for vaccine companies to relinquish intellectual property (like patents) to let others produce generic versions. Unlike other WHO-approved vaccines, AstraZeneca has shared its patent information with manufacturers in some low-income/developing counties that need the vaccine desperately, like India and Brazil.
  • Current events: In mid-February, COVAX supplied 600,000 AstraZeneca vaccines to Ghana. As of the beginning of March, Cote d’Ivoire also received and began rolling out approximately 500,000 vaccines from COVAX. The initiative is using AstraZeneca because it can be kept at a temperature that makes it a simpler vaccine to distribute. The AstraZeneca vaccines given to these two countries came from a factory in India.

Why is it Important to Vaccinate the World?

Developed countries cannot focus only on their own vaccination efforts and neglect the needs of low-to-middle-income countries. If vaccines do not reach developing countries effectively and quickly, these countries will face even more severe economic distress. This will worsen inequality between wealthy and impoverished nations. Until developing countries have significant access to vaccines, the global economy will lose around $150 billion in output every year. AstraZeneca’s role in the global vaccination effort is essential in ensuring this does not happen.

Additionally, many epidemiologists argue that developing countries must receive substantial amounts of the vaccine at the same time as wealthier countries for the global rollout to be the most successful. Otherwise, the virus will continue to spread and mutate, leaving the vaccine efforts in developing countries to be less effective.

President Biden recognizes that the U.S. population will not be safe from the pandemic if people in developing countries are not protected. Following this, Biden has promised that any surplus vaccine doses will go to developing counties. AstraZeneca’s role in the global vaccination effort is essential in ending the global pandemic and ensuring safety for all nations.

– Elyssa Nielsen
Photo: Flickr

foreign aidAs the COVID-19 pandemic spread over the world, so did foreign aid in many forms. Countries were sending masks, money, equipment and even healthcare professionals. Despite suffering from the effects of the pandemic themselves, China, Taiwan and South Korea all contributed to providing 16 countries around the world, including in Europe and Asia.  Even the U.S. became among those who were aid recipients when a shipment of masks and equipment from Russia arrived in April 2020. Perhaps most notably, Italy received foreign assistance from the U.S., China, Cuba and Russia among other countries.

Concerns About Aid Effectiveness

A common misconception regarding aid is that developed countries rarely benefit from foreign aid. Studies have shown that most Americans think the U.S. spends too much on foreign aid. Moreover, many aid opponents argue that aid is ineffective, costly and creates dependence.

Even Africans, who receive 20% of U.S. aid, have raised concerns about aid effectiveness. In 2002, Senegalese President, Abdoulaye Wade, said “I’ve never seen a country develop itself through aid or credit. Countries that have developed—in Europe, America, Japan, Asian countries like Taiwan, Korea and Singapore—have all believed in free markets. There is no mystery there. Africa took the wrong road after independence.”

Foreign Aid to Developed Countries

The pandemic has shown that strong relations and aid are necessary for countries to overcome economic and healthcare challenges. Foreign aid has a complicated history, but many developed countries were recipients of aid in the past and still benefit from it in many ways.

Italy received around $240 billion in aid from the E.U. during the pandemic. If a similar aid package was given to Sub-Saharan Africa, it could provide primary healthcare to every African. If used to relieve food insecurity, $240 billion could end world hunger by 2030. That is not to say that foreign aid to developing countries should come at the expense of the recovery of developed countries. But contextualizing the funding helps demonstrate what foreign aid could do if distributed equally.

During the destruction of Notre Dame in Paris, France received $950 million in total from donations globally. The White House also pledged to help rebuild France, a year after announcing a reduction to the foreign aid budget. When it comes to aid, the question is not whether to provide it or not—it is about who to provide it to.

Foreign Aid to Developing Countries

Contrary to popular belief, the developing world does not receive nearly enough aid. The average Sub-Saharan African country receives less than $1 billion in aid annually. Following the Ebola outbreak in 2013 – a crisis that is most notably remembered for U.S. involvement – the WHO received around $460 million to help affected West African countries. The World Bank estimated that the outbreak cost $2.2 billion for these countries.

As African and Latin American countries see their first huge waves of the COVID-19 pandemic, it is now crucial that the U.S. and other countries continue to increase their foreign aid budget to help these nations recover. In addition to the pandemic, most developing countries are dealing with food insecurity as well as continuing political and civil unrest. Although aid alone will not resolve all these issues, it can alleviate the impact of the crisis. By being aid recipients themselves, Western and European countries can understand the importance of foreign assistance and take the necessary steps to help those in need.

– Beti Sharew
Photo: Flickr

Human trafficking in BangladeshHuman trafficking is defined by the United Nations as “the recruitment, transportation, transfer, harboring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception.” Put simply, it is the sale of human beings for labor, sexual abuse or forced prostitution. Trafficking affects people across almost every nation, but the U.N. has seen recent trends that show developing nations are a breeding ground for human trafficking. These nations generally have a higher percentage of people who are at risk of human trafficking. This is because there are many vulnerable impoverished people and undocumented immigrants who can be easily manipulated.

The most common tactic used by traffickers to attract men and women for illegal labor is the promise of a better life, better pay to feed their families and security from the violence and war in their nations. This is often due to a lack of support, opportunities and help from their own governments, which make it tantalizing for people to accept all offers of better wages and a new life.

Human Trafficking in Bangladesh

In Bangladesh, the majority of traffickers look for Rohingya migrants from Myanmar, promising them asylum and work in Europe. This is the result of a large influx of Burmese migrants in 2017 due to violence and discrimination. Approximately one million Rohingya are undocumented in Bangladeshi refugee camps, meaning they are desperate for work, homes and support. Traffickers prey on undocumented immigrants because they are invisible to their communities and to the government. Thus, their disappearances go unreported due to the families of victims fearing deportation or imprisonment.

Rohingya women and children are the most vulnerable for human trafficking in Bangladesh. They are often promised housekeeping and nanny work in private homes and hotels. However, this is only to have their passports and identification stolen and to be sold into sex trafficking. Girls are sold into prostitution as young as 10 years old. It is also worth noting that Bangladesh has the highest rate of child marriage under age 15, although a 1929 doctrine outlawed marriage under age 18. In Bangladesh, 59% of girls are married before age 18, and 22% are married before age 15. Girls trafficked in Bangladesh are often forced to marry, another tactic used by traffickers to create bonds with their victims.

Progress in Ending Human Trafficking in Bangladesh

In 2019, the United States made a major stride in punishing and resolving human trafficking in Bangladesh. USAID’s Bangladesh Counter for Trafficking in Persons partnered with the Forensic Training Institute and the Bangladesh police on a five-day training program on human trafficking. This event was highly successful, and the U.S. continues to work closely with Bangladesh on the issue. Furthermore, the U.S. has invested $8 million in shelters and programs for trafficking victims. The Bangladeshi and American governments also created a program to take place from 2018 to 2022 that works to reform trafficking policies. It creates new standards for officers and works to improve interagency communication through protocol. This partnership has led to a new awareness of human trafficking. Thanks to these new initiatives, Bangladesh has improved from Tier 3 to Tier 2 on the Human Trafficking Watchlist.

Bangladesh, with the assistance of USAID, is making strides in prosecuting traffickers and making resources for victims more accessible, such as taking the mental and physical effects of trafficking more seriously. Hopefully, this new motivation will continue, and Bangladesh will see less trafficking and stricter punishment of traffickers.

Raven Heyne

Photo: Pixabay

Healthcare in BrazilBrazil is the largest country in South America with a population of over 211 million people. The country’s economy has improved greatly in the past few years and is considered an upper-middle-income economy by the World Bank, yet healthcare system in Brazil still has a long way to go to provide equal care for its citizens.

8 Facts about Healthcare in Brazil

  1.  Free Healthcare – Since 1988, Brazil has provided free healthcare for all its citizens. This has improved the overall health and quality of life of the people in Brazil, decreasing the infant mortality rate from 27 per 1,000 live births in 2000 to 12.8 per 1,000 live births in 2018. Life expectancy has also increased from 68.7 in 1996 to 75.7 in 2018.
  2. Low GDP on Health Spending – Total government spending on health increased from 7% to 8.3% between 2000 and 2014. Currently, Brazil has the lowest proportion of public spending on healthcare in Latin America and the Caribbean, but leaders in Brazil are working on increasing that number.
  3. Implementation of ‘More Doctors’ Program – Social inequality in different areas of Brazil serves as a barrier to healthcare for some residents, particularly those in rural areas in Northern Brazil. Moreover, there is a shortage of doctors and other health professionals in Northern Brazil. To fill these gaps in underserved areas, the government created the program More Doctors (Mais Médicos) in 2013 to bring in doctors from other countries, especially Cuba.
  4. Family Health Programme – A huge part of Brazil’s national health system is the Family Health Programme, which gives healthcare to 97 million Brazilians. The program employs more than 30,000 healthcare teams, and its main goal is to extend healthcare to the country’s most impoverished. Along with offering free healthcare services through the Family Health Program, Brazil’s healthcare system also offers hospital services like heart surgery, medical scans, free dental care and government subsidization of 90% of medications.
  5. Threat of Infectious Diseases – Political and economic crises serve as the biggest obstacles to good healthcare in Brazil. From 2014 to 2016, the percent of people in Brazil who were living in poverty increased from 20.4% to 23.5%. Moreover, 2.9 million people also had to give up private medical insurance during the same time period. Infectious disease outbreaks such as dengue, Zika virus and, most recently, COVID-19 increased in the past few years. Some infectious diseases that were perceived to be under control in Brazil had recorded outbreaks such as yellow fever in 2016 and 2018, which officials reported to have likely occurred from a lack of vaccinations in risk regions.
  6. Underfunded Healthcare – Healthcare in Brazil is significantly underfunded. Twelve percent of state governments’ budgets go toward healthcare, with 15% of city governments’ budgets following suit. Although 98% of city governments meet and even exceed that requirement, many state governments fail to do so each year. According to the World Health Organization (WHO), more than half of state governments fail to allocate at least 12% of their budget towards healthcare.
  7. Private Sector Optimization – Much of the healthcare services in Brazil are based in the private sector, with Brazil having the second-biggest private health insurance market in the world. Investments keep the private healthcare sector afloat with more than half the funding originating from out-of-pocket investments, mainly from pharmacies. The private healthcare sector is based primarily on hospitalization and not primary care, so it is a medium to save the injured or the ill rather than provide preventive health measures.
  8. Technology in the Healthcare System – One of Brazil’s main priorities in regard to healthcare is incorporating technology into the healthcare system to extend the benefits of healthcare to poor and remote communities. Most primary care clinics do not have computers while some emergency hospitals lack computers. The Ministry of Health also wants to increase the use of smartphone healthcare apps and technology to improve access to healthcare services in certain communities.

Although Brazil’s healthcare system requires improvement in certain areas, such as the availability of technology and funding, it still serves as a model healthcare system for other countries in South America. With certain improvements, healthcare in Brazil has a promising future.

– Shveta Shah
Photo: Flickr

Mental Health in AfghanistanDecades of violent civil war and political unrest have debilitated Afghanistan’s healthcare system and led to the populations’ exceedingly high rates of mental illness. In 2004, Afganistan’s Ministry of Public Health (MOPH) declared mental health in Afghanistan a top priority. Today, the National Strategy for Mental Health (NSMH) is taking a multifaceted approach to improving the mental health of Afgan citizens.

The National Strategy for Mental Health aims to provide a “community-based, comprehensive” system with “access to treatment and follow up of mental illness and related conditions.” One of the primary goals of this system is to integrate mental health services into Afghanistan’s Basic Package of Healthcare Services (BPHS). Within the first 10 years of mental health integration into the BPHS, 70% of patients utilizing mental health services reported “significant improvement.” Other developing countries may wish to follow Afghanistan’s lead and to begin implementing their own mental health initiatives.

Women in Taliban-controlled Areas

Mental health surveys of Afgan women in Taliban-controlled areas exemplify the link between stress and mental illness. Women living in these areas report experiencing gender segregation and violent treatment. This includes restricted employment and education as well as domestic abuse and lack of health resources.

A survey of 160 Afghan women during the 1996-2001 Taliban regime showed many Afgan women suffer from mental illness. The survey results displayed that out of the 160 women,

  • 42% had PTSD symptoms

  • 97% had major depression

  • 86% had severe anxiety

Additionally, Afgan women living in Taliban-controlled areas suffered from depression at almost three times the rate of women living in non-Taliban-controlled areas (78 % versus 28 %).

Integration of Mental Health Services

In many countries, mental health support falls under general health funding, which results in very little direct funds for necessary mental health resources. However, as a result of successful integration by the Afghan government and restructuring of its healthcare system, resources for mental health in Afghanistan are available within the national healthcare infrastructure. The critical decision to absorb mental health in Afghanistan into general health has allowed mental health training to become a priority among all general physicians in addition to specialists.

The National Institute of Mental Health reports that people suffering from mental illness can potentially die anywhere from 13 to 30 years before their counterparts with no mental health problems. The integration of mental illness into general health equips primary physicians with the resources and training to diagnose and treat conditions. Transferring training and resources to primary health caregivers makes mental health services more accessible to the general public.

Afghanistan’s NSMH recognized that medication alone cannot fix mental health problems in Afghanistan. Medication treats the symptoms of trauma, not the source. This can lead to social isolation. This research led the NSMH to switch from a strictly medical treatment plan to a biopsychosocial treatment plan. This provides patients with counseling services, including stress management and domestic violence training for community health workers and teachers.

Impact of Mental Health Services

Before 2004, there were no psychiatrists working for the government. Furthermore, mental health receives less than 1% of physician training. After the integration of mental health services into the BPHS, each district hospital in Afghanistan has a full-time mental health physician who has received a two-month training in psychiatric care.

In regions that previously had no access to mental health services, there are now health facilities with health workers trained in identifying mental health disorders and creating treatment plans. These facilities can provide services for up to 60,000 people. Between 2002 and 2012, when mental health service programs were implemented, more than 900 community health workers and hundreds of doctors, nurses and midwives received training in mental health services.

Furthermore, in 2001, only 10% of the Afghan population lived within a one hour walk from a health facility. The BPHS increased the presence and accessibility of health facilities serving mental health in Afghanistan. Afterward, the overall patient visits to health facilities grew from two million to more than 44 million per year, which shows that the facilities were utilized frequently. In 2004, 22% of the health facilities served a minimum of 750 new patients per month. In 2008, 85% did.

Economic Incentive

Especially in developing countries, prioritizing mental health creates a more sustainable economy. According to the World Health Organization, depression and anxiety account for $1 trillion per year of lost or diminished output in the global economy. Additionally, when workplaces do not provide mental health resources, they lose the equivalent of 45 years of work per year. Mental health consequences on the economy and a population’s health are even greater in low-income countries due to the increased prevalence of stigmatization, superstition and treatment inaccessibility.

In addition to ethical incentives, governments have economic incentives to provide mental health services and resources because there is an economic advantage to having a healthy workforce. A failure to recognize and support populations suffering from mental health problems leads to a loss in economic productivity. Globally, every $1 that is invested in mental health disorder treatment translates to $4 in productivity and well-being.

Global Investment

Afghanistan’s next goal is to increase access to the BPHS for the remaining quarter of the population who still struggle to acquire health care. The growth of the BPHS and the Afghan government’s promise to expand its services to reach every citizen requires some economic input from international donors; however, the BPHS does not intend to rely on international donors forever. The World Bank, European Union and United States Agency for International Development (USAID) have been the largest donors to Afghanistan’s BPHS since the creation of the BPHS. However, each has diminished their contributions over the years.

Between 2003 and 2009, each of their individual financial contributions funded about one-third of the BPHS resources for mental health in Afghanistan. These contributions also supported technical and infrastructural support by funding construction and renovation of health facilities as well as road work projects to increase accessibility for rural populations. Between 2010 and 2012, USAID cut its contributions from $4.5 billion to $1.8 billion. Until the MOPH finds permanent funding for mental health in Afghanistan, the funding will come from donors, taxation, public spending and out of pocket pay for patients.

To fully universalize accessible and affordable mental health resources, the world, and particularly global leaders such as the United States, must continue to invest in mental health and commit to fighting poverty worldwide. Reducing global poverty reduces civil unrest, which decreases the rate of mental health problems. The World Bank, European Union and United States Agency for International Development (USAID) are the largest donors to Afghanistan’s BPHS. Continuing global support for mental health strategies helps not only poverty-stricken countries address mental health needs, but supports the global economy by increasing each populations’ well-being and productivity.

Nye Day
Photo: Flickr

food safety in el salvadorThe ability to have access to safe and nutritious food is essential to maintaining life and good health. Unsafe food contains harmful parasites, viruses and bacteria that can lead to more than 200 diseases, from diarrhea to forms of cancer. Approximately 600 million people become ill after consuming contaminated food each year, which results in 420,000 deaths and the loss of thirty-three million healthy life hours. Food safety and nutrition are linked to cycles of health. Unsafe food causes disease and malnutrition, especially with at-risk groups.

Education on Food Safety in El Salvador

Women in El Salvador are participating in an educational program supported by the World Health Organization that teaches safe hygiene practices and food safety. The WHO works in collaboration with El Salvador’s government and other United Nations partner organizations like the Food and Agriculture Organization (FAO), United Nations Development Program (UNDP), UNICEF, UNWomen, and the World Food Program (WFP). The program aims to address foodborne illnesses and poor nutrition by educating local women who then pass on their knowledge to other women in the community.

In preparation for the village workshops, there are two ‘train the trainers’ workshops held to train health promoters who can then go on to educate women in other villages. The women teach others how to host their own educational workshops. Women are chosen as leaders since they play a vital role in food preparation and safety.

Teaching Subsistence Farming

In El Salvador 1 in 10 people live on less than $2 U.S. a day, which makes it hard to buy food.  A large sector of the population lacks the proper education about nutrition needed to grow food themselves. This program provides women with education about farming, specifically focusing on five keys to growing safer fruits and vegetables.

  1. Practice good personal hygiene. Good hygiene begins in the home with a clean body, face, and clothes. People must maintain cleanliness to curb the spread of pathogens and prevent food contamination. A toilet or latrine must be used for proper sanitation.
  2. Protect fields from animal fecal contamination. In areas where animals live in close proximity to humans and fields, it is imperative to control the risk of exposure to fecal matter. Exposure to animal feces is correlated with diarrhea, soil-transmitted helminth infection, trachoma, environmental enteric dysfunction and growth faltering.
  3. Use treated fecal waste. Waste may be reused as a fertilizer for agriculture, gardening or horticultural, but must be safely handled, treated, stored and utilized.
  4. Evaluate and manage risks from irrigation water. Be aware of all risks of microbial contamination at all water sources and protect water from fecal matter.
  5. Keep harvest and storage equipment clean and dry. Wash harvest equipment with clean water and store away from animals and children. Remove all visible dirt and debris from all products.

Results

After participating in the program, the women involved began to change their lifestyles and safety habits. Women use mesh to protect fields from contamination from animals and can grow a wide variety of fruits and vegetables while practicing food safety. Foodborne illnesses decreased in households where safety measures were practiced. Families that utilized the five keys at home reduced their chances of getting diarrhea by 60% compared to families in communities where these hygiene and safety measures were not applied. Families that began to practice food safety also had a more diversified crop production that contributes to improved nutrition.

 

Many people in El Salvador live on less than $2 U.S. a day and education on nutrition needed to grow food independently is sometimes lacking. In order to address these issues, The WHO, and other organizations, partnered with El Salvador’s government to host workshops on food safety and hygiene practices. While food safety remains an important issue in El Salvador, the workshops positively impacted food safety in the country by decreasing foodborne illnesses in households that applied the safety measures.

– Anna Brewer
Photo: Flickr