ACP Health Report: More problems than progress

In recent years, the progress recorded in developing countries in terms of health makes gloomy reading. There is progress here and there, but the overall results are rather worrying. In this global overview the ACP countries are generally to be found in the low-to-average range, if one is to believe the UN report prepared before the September 2010 summit on the Millennium Development Goals*.

In comparison with the situation in 1990, three of the goals to attain between 2000 and 2015 are health-related: among them a two-thirds reduction in mortality among children under five, a three-quarters reduction in maternal mortality, and an end to the spread of AIDS, malaria and tuberculosis. Infant mortality has experienced a net decrease, but the goal set is still far from being achieved. The number of women dying in childbirth is a more glaring failure, with almost no decline at all. As regards the fight against the three major infectious diseases mentioned above, there have been partial successes.

The disappearance of children:  an avoidable disaster

For developing countries as a whole, mortality among under-fives decreased by 28% between 1990 and 2010. The progress got underway in earnest in 2000, with a fall of 2.3%, compared to 1.4% in the 1990s. Among the countries with notable successes are the Caribbean nations and several African ones, in particular Eritrea and Malawi, with a reduction in recent years of more than 4.5% per year, along with Ethiopia, Mozambique and Niger, where the fall began back in 1990. 

Unfortunately, though, these countries represent the trees that hide the wood, for only 10 of the 67 countries with the highest infant mortality rate can hope to attain the goals set for 2015 in this area. Among the regions with the highest mortality are West and Central Africa, where one child out of six did not reach the age of five in 2008, and where there were 169 deaths for every 1000 births. By comparison, in the second worst-performing region, South Asia, the figures are less than half, with 74 out of 1000. The level considered to be "serious" is around 40 out of 1000. Half of the deaths of children under five take place in sub-Saharan Africa. The four diseases which kill most children are pneumonia, diarrhoea, malaria and AIDS, but these can be treated or prevented with comparatively few resources: antibiotics for respiratory diseases, rehydration for diarrhoea, and, for malaria, vaccination, mosquito nets impregnated with insecticide and appropriate medicines.

Women: the curse of inferior status

Among other unnecessary deaths which remain high are those of women in childbirth. Despite the fact that data is sparse and poorly collated, the report published on the eve of the the MDG summit stated without equivocation that "there are hundreds of thousands of unnecessary deaths each year, a sad reminder of the inferior status of women in many societies". 

Almost all deaths occurring during childbirth are avoidable. While the proportion of deliveries attended by qualified medical staff is up to 99% in developed nations (in 2008), and 86% in the Latin America and Caribbean regions, it only reached 57% in the Pacific Islands, and 46% in sub-Saharan Africa. In these two latter regions too, there has been little progress in this field as compared to the 1990 figures. In developing countries, it is more the social gap between rich and poor than differences between rural and urban areas that constitutes the most glaring injustice as regards maternal mortality. 

It might also be mentioned that teenage pregnancy rates remain high in poor regions, that progress in access to contraception has almost ground to a halt, and that the funding of family planning is described as a "major failure". This is even more the case in certain countries where the tradition of the marriage of very young adolescent girls and violence suffered by women make them more susceptible to AIDS and to other complications. 

Two well-known successes

Two significant successes have been recorded - or at least will be in 2015 – the fight against AIDS and tuberculosis. The AIDS epidemic seems to have become stabilized. Although figures show that the total number of people with the illness continues to rise, this increase is due to prolonged lifespans thanks to treatment. The number of new AIDS cases is actually falling. Mortality rates all over the world reached a peak as early in 2004, with 2.2 million deaths, and this figure fell to 2 million in 2008. This is the good news, but the bad news is that in poor countries the disease is still making more progress than the provision of medicines. 

The fight against the disease is also a question of awareness raising among the population, especially those aged between 15 and 24. Clear progress has been made in this sense in 18 countries, including 12 ACP nations, led by Namibia, and followed by Trinidad and Tobago, Rwanda, Guyana, Sao Tomé and Príncipe, Surinam, the Dominican Republic, Gambia, Tanzania, Haiti, Cameroon, and the Central African Republic. In these countries, the use of condoms in situations of risk has become more common, especially among young women. 

The second killer is tuberculosis, both alone and in association with HIV. Between 1990 and 2008, mortality increased in just one region of the world, sub-Saharan Africa, but even there the rate has been falling since 2003, though it has not yet reached the 1990 figures. 

The veil of life

A simple veil can mean the difference between life and death, when that veil is a mosquito net impregnated with insecticide. The production of nets has exploded in recent years, from 30 million a year in 2004 to five times more in 2009. It is in Rwanda and Sao Tomé and Príncipe that the largest percentage of children (56%) is protected by these nets, 200 million of which are now available in Africa, enough for more than half the population of the continent. Some 350 million more are needed, however, for there to be enough nets for everyone. 

The supply of more effective treatment for malaria, based in particular on artemisinin – the fastest acting drug - ,has also increased in Africa, though there are still notable disparities between different countries.  Funds available from backers have increased, from 0.1 billion dollars in 2003 to 1.5 billion in 2009, and local financing seems not to have fallen, despite the financial crisis. While the resources available are still not enough to defeat malaria completely, there is, according to the UN report, a chance of attaining the goal of "controlling the disease by 2015". 

* Millennium Development Goals Report 2010, United Nations (MDG Report 2010 20100612)

Hegel Goutier