Brahima Ouédraogo
OUAGADOUGOU, Oct 27 2008 (IPS) – None of the 16 nations of West Africa will achieve the Millennium Development Goals (MDG) of reducing child mortality or improving maternal health without serious efforts to improve their health care systems, according to the World Health Organization (WHO).
This assessment came during a WHO meeting in the Burkinabé capital, Ouagadougou, at the start of October which brought together the 15 member countries of the Economic Community of West African States (ECOWAS), as well as Mauritania and Algeria.
The MDGs set targets in eight key development areas to be achieved by 2015. Goal number four is to decrease mortality of children under five by two thirds. Goal number five seeks to diminish maternal mortality by three quarters.
The deadline for reaching the Millennium Development Goals is nearing, yet the trends in health care are not very promising, warned Dr. Matthieu Kamwa, who coordinates the West Africa Intercountry Support Team. Based in Ouagadougou, the IST is one of three clusters of highly-qualified medical professionals deployed to Africa by the WHO to achieve MDGs in the context of the continent s higher disease burden.
According to the WHO, there have been some improvements in the sub-region, where child mortality dropped from 188 to 165 deaths per 1000 births between 1970 and 2005. However, the rate remains high in Algeria, Benin, Cape Verde, Gambia, Ghana, Guinea, Senegal and Togo.
Maternal mortality also remains high ranging between 700 and 2,100 deaths out of 100,000 births for 11 out of the 17 countries: Benin, Ivory Coast, Burkina Faso, Guinea, Guinea-Bissau, Liberia, Mali, Niger, Nigeria, Senegal and Sierra Leone.
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Dr. Denis Porignon, with the WHO in Geneva, explained that despite worldwide progress, indicators remain uneven for developing nations most of which are in Sub-Saharan Africa and lag for MDGs 4 and 5.
There are cases where the security situation (within a country) is at fault. Also, countries suffer from severe human resource shortages: not enough doctors, nurses or midwives to provide care to children or the general population, Porignon told IPS.
The WHO meeting sought to determine the methods for improving primary health care (PHC), the strategy highlighted by the 1978 Alma Ata Declaration to ensure health for all and the path chosen to reach the MDGs. Progress, however, is hampered by the alarming lack of human resources in the region.
Last April the WHO and its partners organised a meeting on primary health care in Ouagadougou. A number of barriers to effective PHC were identified: structural deficiencies, human resource shortages and, in most cases, a lack of political will.
The four-day meeting concluded with a resolution to strengthen leadership and governance in the region and support the elaboration of national strategic plans for developing health care systems.
National health care systems show clear weaknesses when it comes to analysis, policy development and health care regulation and coordination. Management is weak at all levels, which hampers efficient delivery of health care programs and services, Kamwa told IPS.
The WHO announced a support program for centres of excellence in training for health and development that would teach modules on strengthening health care systems. This would help countries overcome the double challenge of lack of personnel and the lack of will needed for good hospital management.
According to the WHO, none of the countries have met the target of 2.5 health care professionals per 10,000. That s the number of registered nurses, certified midwives and doctors required to meet the MDGs. Algeria has rates of 1.13 doctors, 1.99 nurses and 0.24 midwives.
We hope to narrow the human resources gap with better policies, using measures such as training, salary incentives and premiums, explained Dr. Mawuli Rêne Adzodo, who coordinates health care systems at the IST West Africa office.
Dakar s African Centre for Graduate Studies in Management and Benin s Public Health Institute are the first institutions to benefit from this new aid. They will also be teaching the modules before the programme is expanded to include other countries.
According to Adzodo, these funding initiatives should be able to motivate health care workers in remote areas where 70 percent of people without access to hospitals live.
The WHO has vowed to support countries in developing proposals that would allow them to get additional support from institutions such as the Global Fund to Fight AIDS, Tuberculosis and Malaria or the Global Alliance for Vaccines and Immunizations.
Of the countries covered by IST West Africa, only Algeria and Cape Verde are at the prescribed level of 34 dollars of health spending per inhabitant. According to the WHO, only two countries Burkina Faso and Liberia spend 15 perent of the national budget on health care, one of the tenets of the Abuja Declaration.
It was noted that even though they receive 70 percent of the budget, hospitals remain under-funded and fail in their role as reference centres.
As a consquence, only Cape Verde and Algeria have achieved the goal of life expectancy of 60 years at birth by 2000.
The timing was perfect for this meeting, and we will be telling the countries where we operate to respect their commitment to devote 15 percent of their budget to health, said Selassi Amah D Almeida, health and economics advisor for WHO in Ghana.
