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Follow the Money

A Lesson of the Ebola Epidemic


One of the lessons of the fast spreading Ebola epidemic is the need to improve African countries’ public health services, which have suffered the consequences of decades of neglect. Africa now needs rapidly upgrading those services, as well as improving the capacity of its medical and para-medical work force.

The high cost of treating certain diseases, most notably HIV/AIDS, when coupled with the indirect costs resulting from lost worker productivity, is having a serious negative impact on African economies. More effort needs to be made to increase primary health care, especially in rural areas, accompanied by health promotion, disease prevention and improved education for all ages.

The African continent is the region of the world most affected by the HIV/AIDS pandemic. This is reversing decades of improvement in life expectancy, educational progress, and economic growth. For example, in Lesotho, where life expectancy was 60 years in 1995, life expectancy had plummeted to 35 years in 2010. In Sub-Saharan Africa, where life expectancy was 62, because of HIV/AIDS it is now 47.

Because teachers in rural areas in developing countries have better salaries than the local population they travel more and tend to develop sexual relationships with students and local women, some of whom are already HIV infected. As a result, HIV/AIDS is killing teachers at a faster rate than replacements can be trained.

A study in Zambia found that two teachers die for every one that graduates from training school. The pandemic affects not only the supply of teachers but the quality and management of education at local, regional and national levels.

A World Bank report estimates that HIV/AIDS may reduce growth in GDP by 1% a year in some sub-Saharan African countries, due to the continuing loss of skilled and unskilled workers in the prime of life. In South Africa HIV/AIDS may depress GDP by as much as 17% over the next decade. In addition, HIV/AIDS is estimated to have decreased agricultural output by as much as 20 percent in several African countries. According to experts’ predictions, by 2015 South Africa will have 50 million fewer people than in a no-HIV/AIDS scenario.

Public health officials still have to deal with the stigma of AIDS that persists in most African countries. Progress in raising AIDS awareness has been slow despite the efforts in education and the work of non-governmental organizations. In addition, progress has been hindered, particularly in rural areas, because health services and infrastructure are inadequate and the lack of trained medical personnel is widespread. If health care systems are to be effective, resources must be redirected from curative care in urban settings with high tech equipment to primary and preventive care.

HIV/AIDS is not the only concern. South Africa has the highest tuberculosis death rate per capita worldwide, followed by Zimbabwe and Mozambique. There is concern about the increasing number of cases of multidrug-resistant tuberculosis (MDR) as well as extensively drug-resistant (XDR) tuberculosis in several countries.

Many diseases affecting both children and adults could be addressed with minimum resources if they were employed strategically. Diarrhea and respiratory infections, measles, malaria and malnutrition represent the greatest threats to children’s health. Malaria is the leading cause of death among African children under five years old. In addition, it is estimated that African women are approximately 175 times more likely to die during childbirth and pregnancy than women in industrialized countries.

Health problems are made worse by the lack of health professionals, which is due in part to the continuing exodus of doctors and nurses to industrialized nations. In addition to problems directly related to the health sector, corruption drains critical resources needed to improve people’s health and education.

It has been estimated that corruption costs the African economies more than 148 billion dollars a year. As a comparison, Sub-Saharan countries received $15 billion in development aid in 2011. The widespread practice of bribing government officials by foreign companies must be curtailed. With this goal in mind, industrialized nations should enforce national and international laws that deal with this issue.

In the last few years, emphasis has been placed on economic aid to Africa. African countries, however, need a different kind of aid. They need their human resources to be trained in their own countries, they need more help in preventing major diseases, they need more education for all age levels, and they need better conditions of trade for their products. African countries do not need more monetary aid given irresponsibly, which ends up in the pockets of government officials and members of the countries’ elites.

Dr. Cesar Chelala is an international public health consultant and the author of “Health of Adolescents and Youth in the Americas”. He is also a winner of an Overseas Press Club of America award.