Primary Health Care Strategy
Interventions to improve women’s health that focus solely on public health issues miss the fundamental interconnectedness of health with other factors in society. Recognizing this interconnectedness is the starting point for the multisectoral rethinking of health care strategies that the Commission is calling for in the African Region
Addressing the Challenge of Women’s Health in Africa
Report of the Commission on Women’s Health in the African Region
There are 821 million people living in Sub-Saharan Africa, and it is the region with the highest burden of disease on earth.
Average life expectancy is 53 years of age, only two years longer than life expectancy in 1990.
In 1977, the World Health Assembly set the goal of achieving health for all by the year 2000. A year later, at the conference in Alma Ata (in Kazakhstan, then still part of the USSR) organized by the UN, health care was defined as a fundamental right and the "Strategy for Primary Health Care" was adopted. The role of the state was thus established as being responsible for the welfare of its citizens and for establishing public health services to satisfy basic needs. Thus, in recent decades health care has taken on fundamental importance in the development agenda as one of the major concerns today in the international community. This is reflected in the Millennium Development Goals. Although all of these are related to health, three of them have a direct health care goal:
Goal 4: To reduce child mortality.
Goal 5: To improve maternal health.
Goal 6: To combat HIV/AIDS, malaria and other diseases.
African countries have participated in carrying out this agenda in health care. In its African Charter on Human and People’s Rights, the Organization of African Unity includes the right to health care and the commitment of the states to ensure that this right can be exercised. In 1990, at the organization’s summit, the Bamako Initiative of 1987 was adopted. This aimed to improve the management of primary health care in Sub-Saharan Africa as a whole, but also introduced a cost-covering system that restricted underprivileged people’s access. This, coupled with the economic crisis of the eighties and the resulting Structural Adjustment Plans adopted by African states at the behest of international financial institutions, led to a reduction in public spending and slowed down the development of public health systems.
The impact of the international context on health care in Sub-Saharan Africa
has had mixed effects. The challenges in health care faced by sub-Saharan African peoples now have a clearly historical dimension that can also be seen in the fact that different health systems coexist in the region: biomedicine, traditional African Animist medicine, and medicine in the Arab/Muslim tradition.
In Sub-Saharan Africa, a specific group of diseases account for most health care visits, mainly infectious diseases such as HIV/AIDS, acute respiratory infections, diarrhoeal diseases and malaria. Other diseases such as tuberculosis are on the rise, while others are retreating, such as rubella and leprosy.
The severity of the health care scenario in Sub-Saharan Africa is not only a result of the prevalence rates, but also the side effects these can have, the fact that they are preventable diseases, and the fact that some infections such as HIV/AIDS have no cure.
Access to treatment, in this case antiretroviral treatment, is essential, given that around 68% of the world’s HIV-positive population live in Sub-Saharan Africa (22.9 million people), of which 59% are women. In 2008, AIDS caused 1.4 million deaths in the region, 72% of all the deaths worldwide. On an encouraging note, it is worth mentioning that the region is slightly above the world average in access to antiretroviral treatment.
Diseases such as malaria and tuberculosis also have a strong impact on the region. In Sub-Saharan Africa, malaria causes 90% of the million recorded deaths a year worldwide, whereas 480 cases of tuberculosis per 100,000 inhabitants were recorded in 2008 in the region as a whole.
The region’s population growth rate is 2.5%, which indicates the urgency of tackling these diseases that affect human development, and therefore the development of societies.
Maternal and child health is fundamental in this sense, since it is the critical first step to achieving global improvement in life expectancy. Infant mortality is largely linked to problems of malnutrition, along with diseases such as HIV/AIDS, respiratory infections, diarrhoea, malaria, and measles. Moreover, in Sub-Saharan Africa the maternal mortality rate is 900 per 100,000 live births, arising mainly from the lack of prenatal care and deliveries without skilled health care assistance.
Obstetric fistula, which affects two to three million women on the continent, is in most cases also a result of poor care during delivery. It usually occurs mainly in the first births by adolescent women when labour is halted or blocked, and the required medical or surgical care is not received. Fistula also occurs as a result of sexual violence.
Female genital mutilation is practiced in western, eastern and north-eastern Africa. According to the WHO, in Africa there are 92 million girls and women over 10 years of age who have undergone female genital mutilation, and there are an estimated 3 million girls a year at risk of being mutilated. FGM can cause bleeding, urinary problems, infections, cysts, infertility, birth complications and an increased risk of death for the newborn. Since 1997, work has been done (particularly by the WHO, UNICEF and the UN Population Fund) that has led to a decline in the practice of FGM and an increase in the number of women and men who are in favour eradicating it.
The Millennium Development Goals have improved regional trends in health, although many of the targets set for 2015 will not be met. This will require an increase in public spending on health care, which in 2007 stood at 9.7%, and therefore an increase in the number of doctors, nurses and midwives, with special attention for rural areas.
Author: African Studies Group of the Autonomous University of Madrid