Health in Southern Africa
HIV
South Africa:
South Africa is home to 17% of the people living with HIV/AIDS worldwide. Even though the country has the largest antiretroviral program, not even half of those who are eligible actually receive the treatment. (Benatar, 2013) Botswana: As of 2011, 25% of the population over age 15 live with HIV. (HIV & AIDS in Botswana, 2012) Swaziland: 31% of people aged 18-49 have HIV. HIV prevalence among women in their low 30's is at 54%. With the help of the President's Emergency Plan for AIDS Relief, Swaziland provides ART for 91% of HIV+ pregnant women. (US Relations with Swaziland, 2014) Lesotho: With the third highest prevalence in the world, almost one in four people have HIV. Everyone--even those not infected--are affected by HIV in some way. For example, many children have to run the household after the death of their parents due to AIDS. Only 58% of people in need of treatment are actually getting it. The government has done what it can to help by launching a program for free ART. However, there just aren't enough health workers for everyone to be treated. (HIV & AIDS in Lesotho, 2012) Malawi: AIDS is the leading cause of death for adults and plays a large role in Malawi's low life expectancy (HIV & AIDS in Malawi, 2012). Zambia: More than one in every seven adults has HIV. In 2011, there were around 115 new infections a day. (HIV & AIDS in Zambia, 2012) For more information, the Food and Agriculture Organization of the United Nations elaborates on the impact of HIV/AIDS, including the underlying causes and the relationship between HIV and poverty. |
What this means: HIV/AIDS continues to be a problem for countries in Southern Africa. Madagascar is the only country in the area with a prevalence below 10-15%. In some countries, the prevalence could actually be lower than it is because even though treatment is available, many people are left untreated. Other countries don't even have easy access to treatment because of poor government leadership, which was the case in South Africa before 2008. Other factors that can contribute to such high prevalence rates include poverty, lack of HIV education, and lack of access to health care (or not enough workers).
The table below provides HIV-related statistics for Zambia, Zimbabwe, Mozambique, Namibia, and Malawi.
The table below provides HIV-related statistics for Zambia, Zimbabwe, Mozambique, Namibia, and Malawi.
TuberculosisTB is particularly bad in the southern part of Africa with high prevalence rates, epidemics, and an increasing number of drug resistant cases.
South Africa: With one of the worst TB epidemics in the world, South Africa reports the most extensively drug-resistant tuberculosis cases in the world (Mayosi & Benatar, 2014). Namibia: In 2009, there were 400 cases of drug-resistant TB, including both multi-drug resistant and extensively drug resistant TB (Namibia Country Cooperation Strategy 2010-2015, 2010). Swaziland: The country has the highest TB incidence rate in the world. TB is one of the leading causes of death in adults. (Intensifying TB Case Detection--Swaziland, 2012) -Co-infection with HIV: In southern Africa, HIV infections have led to higher counts of drug-resistant TB. A 2004 study also showed higher mortality rates associated with co-infections than for those with TB only. (The Emerging Threat of Drug-Resistant Tuberculosis, 2011) Lesotho and Swaziland both have high co-infection rates with 77% of TB patients having HIV as well. (DTBE in Lesotho) and (Intensifying TB Case Detection--Swaziland, 2012) Botswana has a slightly lower rate at 65% (DTBE in Botswana) -Mining Mining in southern Africa is one cause of the HIV and TB epidemics. Poor ventilation in the mines has enabled TB to spread. The South African Health Minister describes HIV and TB as a snake in southern Africa, and the head is in South Africa (where the majority of the mining is). Therefore, South Africa is where the focus on controlling these diseases should be because miners come from Lesotho, Swaziland, Botswana, Mozambique, and Zimbabwe. The miners carry HIV and TB back to their home country and spread them, causing more than just South Africa to be affected. (Stuckler, Basu, & McKee, 2010) The video to the right describes the situation regarding TB in mine workers. To learn more about TB and mining in Southern Africa, click here. What this means: TB and HIV seem to go hand in hand for around 60-80% of the people with TB. This co-infection results in more deaths and more drug resistance. As a result of drug resistance, TB is becoming more difficult and expensive to treat. In addition, mining--and the lack of regulation policies--have increased the spread of TB. MalariaMalaria is a very seasonal disease that occurs more frequently during the rainy season, which can be up to nine months in some areas.
Zambia: Malaria kills more children than any other illness. 50% of all deaths resulting from malaria are children under five years old. (Zambia Malaria, 2011) The video to the right shows how Zambia has responded to the problem of malaria. Mozambique: Malaria is regarded as the most important public health concern with the entire country at risk for infection. (Mozambique Malaria Operational Plan FY 2015) Madagascar: While AIDS is not a major health problem like it is in other southern African countries, malaria is indeed a concern with 90% of the country being endemic. (Madagascar Malaria Operational Plan FY 2015) Other Notable ProblemsZimbabwe's Health Sector
Zimbabwe's health sector almost completely collapsed in 2008 due to infrastructure deterioration, supplies shortage, and low pay for health workers (Zimbabwe Country Cooperation Strategy, 2014). To learn more about Zimbabwe's health crisis, click here. Poverty One of the reasons many of these countries have such poor health is due to poverty. Around 65% of Zambia's population and 75% of Mozambique and Malawi's populations are living on less than $1/day (Zambia Factsheets of Health Statistics, 2010). In addition, 91% of Madagascar's citizens are living in poverty, meaning they can't afford health care or even proper nourishment (Primary health care: back to basics in Madagascar, 2008). As a result, on average 104 children under 5 years old die a day (Madagascar--The issue). To learn more about the poverty problem in Southern Africa, visit the Southern African Development Community's website. |
by Mikael Häggström.,
used under
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Lack of access
Access to health care is a major concern for Namibia due to remote areas. (Namibia Country Cooperation Strategy 2010-2015, 2010)
Madagascar also lacks adequate access to health care for multiple reasons, one of which is poverty as explained above. Like in Namibia, long distances discourage citizens from going to clinics. Only about 60% of Madagascar has access to roads, and even then some have to walk over 10 kilometers to get to a clinic (Primary health care: back to basics in Madagascar, 2008).
What this means: The geography of Southern Africa prevents many southern Africans from getting proper care because of remote areas and long distances. Others aren't receiving care because they just can't afford it; medications and doctor visits are expensive, and the majority of some populations can't even afford food. These two factors cause the problems with diseases to be even worse because instead of going to clinics and getting treated, people are spreading HIV, TB, and other illnesses around.
Access to health care is a major concern for Namibia due to remote areas. (Namibia Country Cooperation Strategy 2010-2015, 2010)
Madagascar also lacks adequate access to health care for multiple reasons, one of which is poverty as explained above. Like in Namibia, long distances discourage citizens from going to clinics. Only about 60% of Madagascar has access to roads, and even then some have to walk over 10 kilometers to get to a clinic (Primary health care: back to basics in Madagascar, 2008).
What this means: The geography of Southern Africa prevents many southern Africans from getting proper care because of remote areas and long distances. Others aren't receiving care because they just can't afford it; medications and doctor visits are expensive, and the majority of some populations can't even afford food. These two factors cause the problems with diseases to be even worse because instead of going to clinics and getting treated, people are spreading HIV, TB, and other illnesses around.
Miscellaneous Statistics
The two tables below detail different statistics for adults and children in Zambia, Zimbabwe, Mozambique, Namibia, and Malawi. Zimbabwe's life expectancy has dropped dramatically, which could be explained by the collapse of the health sector and an HIV epidemic. In addition to TB and HIV, malaria is another disease wreaking havoc on southern African countries.
Organizations Working in Southern Africa
Desmond Tutu HIV Foundation:
The Desmond Tutu HIV Foundation is located in Cape Town, South Africa and focuses on HIV research, treatment, training, and prevention. Desmond Tutu played key role in implementing ART treatment in Cape Town. The Foundation also provides online training courses for doctors and nurses. Another project is the Tutu Tester, which is a mobile unit for free health care (see picture to the left). It has TB screenings, general health screenings, and HIV counseling. 30-50 people visit the Tutu Tester each day, and 40,000 individuals have been helped since the unit's implementation in 2008. To learn more, visit the Foundation's website. (Desmond Tutu HIV Foundation Projects, 2015) |
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IntraHealth International:
IntraHealth's The Southern Africa Human Capacity Development Coalition is addressing the need to improve the health services for HIV/AIDS because there is a lack of workers and training. The Coalition does this by "improving workforce planning and use, enhancing health worker skills, and strengthening systems to support health worker performance" (Southern Africa Human Capacity). The project is helping Botswana, Lesotho, Namibia, Malawi, and Swaziland. For more information about IntraHealth's other programs, visit their website here.
(The Southern Africa Human Capacity Development Coalition, 2015)
There are many more organizations providing assistance to different countries in Southern Africa. Some focus solely on a certain area such as HIV/AIDS while others are broader in focus and just work to improve health care in general.
IntraHealth's The Southern Africa Human Capacity Development Coalition is addressing the need to improve the health services for HIV/AIDS because there is a lack of workers and training. The Coalition does this by "improving workforce planning and use, enhancing health worker skills, and strengthening systems to support health worker performance" (Southern Africa Human Capacity). The project is helping Botswana, Lesotho, Namibia, Malawi, and Swaziland. For more information about IntraHealth's other programs, visit their website here.
(The Southern Africa Human Capacity Development Coalition, 2015)
There are many more organizations providing assistance to different countries in Southern Africa. Some focus solely on a certain area such as HIV/AIDS while others are broader in focus and just work to improve health care in general.
Health News Stories
South Africa's Response To AIDS
South Africa's AIDS epidemic was out of control until 2008. President Thabo Mbeki's health minister had declared that garlic, beetroot, and lemons could cure AIDS. As a result, he refused to let public hospitals use any AIDS drugs. Since then, South Africa has made positive strides in overcoming the epidemic. For example, the country now has 2.4 million people on ART. In 2008, 490 clinics provided this treatment; in 2013, 3,540.
Right To Care, started completely through PEPFAR funding, provides care for 203,000 patients. These clinics were part of PEPFAR's strategy to help South Africa despite the views of President Mbeki and his health minister.
Despite these improvements, problems loom ahead for South Africa. PEPFAR has provided most of the support in helping South Africa get AIDS under control with $3 billion in funds. Now the US program is shifting gears and looking to support poorer countries. Consequently, South Africa's government has to come up with hundreds of millions of dollars to continue the AIDS support.
(AIDS Progress in South Africa Is in Peril, 2014)
Right To Care, started completely through PEPFAR funding, provides care for 203,000 patients. These clinics were part of PEPFAR's strategy to help South Africa despite the views of President Mbeki and his health minister.
Despite these improvements, problems loom ahead for South Africa. PEPFAR has provided most of the support in helping South Africa get AIDS under control with $3 billion in funds. Now the US program is shifting gears and looking to support poorer countries. Consequently, South Africa's government has to come up with hundreds of millions of dollars to continue the AIDS support.
(AIDS Progress in South Africa Is in Peril, 2014)
Rotary Family Health Days
Rotary Family Health Days offers "free, comprehensive and holistic health care service to people in disadvantaged communities" over a span of three days in South Africa (Over 80,000 reached, 2014).
- Started in 2013 and helped 68,000 people
- 2014: free health screenings for over 80,000 people
- Original goal: alleviate the HIV/AIDS problem
- Services now provided: TB testing, diabetes and blood pressure screening, and measles vaccines
To learn more about other health-related issues for these countries, visit the CDC website.
Works Cited
Abcdion. (2011). Archbishop Desmond Tutu gets an HIV test on The Desmond Tutu HIV Foundation's Tutu Tester, a mobile test unit that brings healthcare right to your doorstep. [Digital Image]. Retrieved from http://en.wikipedia.org/wiki/Desmond_Tutu_HIV_Foundation. Available under Public Domain.
AIDS Progress in South Africa Is in Peril. (2014, August 26). Retrieved April 15, 2015, from New York Times: http://www.nytimes.com/2014/08/26/health/aids-south-africa-success-pepfar.html?_r=1
Benatar, S. (2013). The challenges of health disparities in South Africa. Retrieved April 15, 2015, from The South African Medical Journal: http://www.samj.org.za/index.php/samj/article/view/6622/4918
Desmond Tutu HIV Foundation Projects. (2015). Retrieved April 17, 2015, from Desmond Tutu HIV Foundation: http://desmondtutuhivfoundation.org.za/our-projects/
DTBE in Botswana. (n.d.). Retrieved April 15, 2015, from Centers for Disease Control and Prevention: http://www.cdc.gov/tb/topic/globaltb/botswana.htm
DTBE in Lesotho. (n.d.). Retrieved April 15, 2015, from Centers for Disease Control and Prevention: http://www.cdc.gov/tb/topic/globaltb/lesotho.htm
Energy.gov. (2004). President George W. Bush. [Digital Image]. Retrieved from http://commons.wikimedia.org/wiki/File:President_George_W._Bush_(8003096992).jpg. Available under Public Domain.
Eubulides. (2009). Estimated prevalence of tuberculosis per 100,000 people in 2007, per country. [Digital Image]. Retrieved from http://en.wikipedia.org/wiki/Epidemiology_of_tuberculosis. Available under Public Domain.
Häggström, M. Main Symptoms of Malaria. [Digital Image]. Retrieved from http://en.wikipedia.org/wiki/Malaria. Available under Public Domain.
Hansen, K. (2014). Rotary Family Health Days 2014--getting loud online. [Digital Image]. Retrieved from http://www.slideshare.net/KristiHansen/rfhd-2014-presentation-social-media-kh. Available under Attribution.
HIV & Aids in Botswana. (2012). Retrieved April 15, 2015, from AVERT: http://www.avert.org/hiv-aids-botswana.htm
HIV & AIDS in Lesotho. (2012). Retrieved April 20, 2015, from AVERT: http://www.avert.org/hiv-aids-lesotho.htm
HIV & AIDS in Malawi. (2012). Retrieved April 15, 2015, from AVERT: http://www.avert.org/hiv-aids-malawi.htm
HIV & AIDS in Zambia. (2012). Retrieved April 15, 2015, from AVERT: http://www.avert.org/hiv-aids-zambia.htm
Intensifying TB Case Detection--Swaziland. (2012). Retrieved April 15, 2015, from World Health Organization: http://who.int/tb/Swazilandfactsheet_CIDA_Oct2012.pdf
Madagascar Malaria Operational Plan FY 2015. (n.d.). Retrieved April 20, 2015, from President's Malaria Initiative: http://www.pmi.gov/docs/default-source/default-document-library/malaria-operational-plans/fy-15/fy-2015-madagascar-malaria-operational-plan.pdf?sfvrsn=3
Madagascar--The issue. (n.d.). Retrieved April 15, 2015, from UNICEF: http://www.unicef.org/madagascar/5557.html
Mozambique Malaria Operational Plan FY 2015. (n.d.). Retrieved April 20, 2015, from President's Malaria Initiative: http://www.pmi.gov/docs/default-source/default-document-library/malaria-operational-plans/fy14/mozambique_mop_fy14.pdf?sfvrsn=12
Mayosi, B. M., & Benatar, S. R. (2014, October 2). Health and Health Care in South Africa--20 Years after Mandela. Retrieved April 15, 2015, from The New England Journal of Medicine: http://www.nejm.org/doi/full/10.1056/NEJMsr1405012
Namibia Country Cooperation Strategy 2010-2015. (2010). Retrieved April 15, 2015, from World Health Organization: http://www.afro.who.int/index.php?option=com_docman&task=doc_download&gid=6579
Noyes, S. (2004). Prevalence of HIV/AIDS in adult (ages 15-49) populations (1999-2002). [Digital Image]. Retrieved from http://en.wikipedia.org/wiki/HIV/AIDS_in_Malawi. Available under Attribution-Sharealike.
Over 80,000 reached in a 3 day health screening campaign across South Africa. (2014, May 12). Retrieved April 15, 2015, from Centers for Disease Control and Prevention: http://www.cdc.gov/globalhealth/countries/southafrica/stories/healthscreening.htm
Primary health care: back to basics in Madagascar. (2008, June). Retrieved April 20, 2015, from World Health Organization: http://www.who.int/bulletin/volumes/86/6/08-010608/en/
Roke. The estimated number of people living wtih HIV/AIDS by country as of 2008. [Digital Image]. Retrieved from http://en.wikipedia.org/wiki/Epidemiology_of_HIV/AIDS. Available under Attribution-Sharealike.
Sbw01f. Map of World Poverty by Country. [Digital Image]. Retrieved from http://en.wikipedia.org/wiki/Measuring_poverty. Available under Attribution-Sharealike.
Stuckler, D., Basu, S., & McKee, M. (2010). Governance of Mining, HIV and Tuberculosis in Southern. Retrieved April 20, 2015, from Global Health Governance: http://www.ghgj.org/Stuckler_final.pdf
The Emerging Threat of Drug-Resistant Tuberculosis in Southern Africa: Global and Local Challenges and Solutions. (2011). Retrieved April 20, 2015, from National Center for Biotechnology Information: http://www.ncbi.nlm.nih.gov/books/NBK55577/
The Southern Africa Human Capacity Development Coalition. (2015). Retrieved April 17, 2015, from IntraHealth International: http://www.intrahealth.org/page/the-southern-africa-human-capacity-development-coalition
USAID U.S. Agency for International Development. Workshop on HIV/AIDS and Tuberculosis in South Africa. [Digital Image] Retrieved from http://en.wikipedia.org/wiki/HIV/AIDS_in_Africa. Available under Attribution.
US Relations With Swaziland. (2014, February). Retrieved April 15, 2015, from US Department of State: http://www.state.gov/r/pa/ei/bgn/2841.htm
Zambia Factsheets of Health Statistics. (2010, December). Retrieved April 15, 2015, from World Health Organization: http://www.aho.afro.who.int/profiles_information/images/7/70/Zambia-Statistical_Factsheet.pdf
Zambia Malaria. (2011). Retrieved April 20, 2015, from UNICEF: http://www.unicef.org/zambia/5109_8454.html
Zimbabwe Country Cooperation Strategy. (2014, May). Retrieved April 15, 2015, from World Health Organization: https://extranet.who.int/iris/restricted/bitstream/10665/136992/1/ccsbrief_zwe_en.pdf
AIDS Progress in South Africa Is in Peril. (2014, August 26). Retrieved April 15, 2015, from New York Times: http://www.nytimes.com/2014/08/26/health/aids-south-africa-success-pepfar.html?_r=1
Benatar, S. (2013). The challenges of health disparities in South Africa. Retrieved April 15, 2015, from The South African Medical Journal: http://www.samj.org.za/index.php/samj/article/view/6622/4918
Desmond Tutu HIV Foundation Projects. (2015). Retrieved April 17, 2015, from Desmond Tutu HIV Foundation: http://desmondtutuhivfoundation.org.za/our-projects/
DTBE in Botswana. (n.d.). Retrieved April 15, 2015, from Centers for Disease Control and Prevention: http://www.cdc.gov/tb/topic/globaltb/botswana.htm
DTBE in Lesotho. (n.d.). Retrieved April 15, 2015, from Centers for Disease Control and Prevention: http://www.cdc.gov/tb/topic/globaltb/lesotho.htm
Energy.gov. (2004). President George W. Bush. [Digital Image]. Retrieved from http://commons.wikimedia.org/wiki/File:President_George_W._Bush_(8003096992).jpg. Available under Public Domain.
Eubulides. (2009). Estimated prevalence of tuberculosis per 100,000 people in 2007, per country. [Digital Image]. Retrieved from http://en.wikipedia.org/wiki/Epidemiology_of_tuberculosis. Available under Public Domain.
Häggström, M. Main Symptoms of Malaria. [Digital Image]. Retrieved from http://en.wikipedia.org/wiki/Malaria. Available under Public Domain.
Hansen, K. (2014). Rotary Family Health Days 2014--getting loud online. [Digital Image]. Retrieved from http://www.slideshare.net/KristiHansen/rfhd-2014-presentation-social-media-kh. Available under Attribution.
HIV & Aids in Botswana. (2012). Retrieved April 15, 2015, from AVERT: http://www.avert.org/hiv-aids-botswana.htm
HIV & AIDS in Lesotho. (2012). Retrieved April 20, 2015, from AVERT: http://www.avert.org/hiv-aids-lesotho.htm
HIV & AIDS in Malawi. (2012). Retrieved April 15, 2015, from AVERT: http://www.avert.org/hiv-aids-malawi.htm
HIV & AIDS in Zambia. (2012). Retrieved April 15, 2015, from AVERT: http://www.avert.org/hiv-aids-zambia.htm
Intensifying TB Case Detection--Swaziland. (2012). Retrieved April 15, 2015, from World Health Organization: http://who.int/tb/Swazilandfactsheet_CIDA_Oct2012.pdf
Madagascar Malaria Operational Plan FY 2015. (n.d.). Retrieved April 20, 2015, from President's Malaria Initiative: http://www.pmi.gov/docs/default-source/default-document-library/malaria-operational-plans/fy-15/fy-2015-madagascar-malaria-operational-plan.pdf?sfvrsn=3
Madagascar--The issue. (n.d.). Retrieved April 15, 2015, from UNICEF: http://www.unicef.org/madagascar/5557.html
Mozambique Malaria Operational Plan FY 2015. (n.d.). Retrieved April 20, 2015, from President's Malaria Initiative: http://www.pmi.gov/docs/default-source/default-document-library/malaria-operational-plans/fy14/mozambique_mop_fy14.pdf?sfvrsn=12
Mayosi, B. M., & Benatar, S. R. (2014, October 2). Health and Health Care in South Africa--20 Years after Mandela. Retrieved April 15, 2015, from The New England Journal of Medicine: http://www.nejm.org/doi/full/10.1056/NEJMsr1405012
Namibia Country Cooperation Strategy 2010-2015. (2010). Retrieved April 15, 2015, from World Health Organization: http://www.afro.who.int/index.php?option=com_docman&task=doc_download&gid=6579
Noyes, S. (2004). Prevalence of HIV/AIDS in adult (ages 15-49) populations (1999-2002). [Digital Image]. Retrieved from http://en.wikipedia.org/wiki/HIV/AIDS_in_Malawi. Available under Attribution-Sharealike.
Over 80,000 reached in a 3 day health screening campaign across South Africa. (2014, May 12). Retrieved April 15, 2015, from Centers for Disease Control and Prevention: http://www.cdc.gov/globalhealth/countries/southafrica/stories/healthscreening.htm
Primary health care: back to basics in Madagascar. (2008, June). Retrieved April 20, 2015, from World Health Organization: http://www.who.int/bulletin/volumes/86/6/08-010608/en/
Roke. The estimated number of people living wtih HIV/AIDS by country as of 2008. [Digital Image]. Retrieved from http://en.wikipedia.org/wiki/Epidemiology_of_HIV/AIDS. Available under Attribution-Sharealike.
Sbw01f. Map of World Poverty by Country. [Digital Image]. Retrieved from http://en.wikipedia.org/wiki/Measuring_poverty. Available under Attribution-Sharealike.
Stuckler, D., Basu, S., & McKee, M. (2010). Governance of Mining, HIV and Tuberculosis in Southern. Retrieved April 20, 2015, from Global Health Governance: http://www.ghgj.org/Stuckler_final.pdf
The Emerging Threat of Drug-Resistant Tuberculosis in Southern Africa: Global and Local Challenges and Solutions. (2011). Retrieved April 20, 2015, from National Center for Biotechnology Information: http://www.ncbi.nlm.nih.gov/books/NBK55577/
The Southern Africa Human Capacity Development Coalition. (2015). Retrieved April 17, 2015, from IntraHealth International: http://www.intrahealth.org/page/the-southern-africa-human-capacity-development-coalition
USAID U.S. Agency for International Development. Workshop on HIV/AIDS and Tuberculosis in South Africa. [Digital Image] Retrieved from http://en.wikipedia.org/wiki/HIV/AIDS_in_Africa. Available under Attribution.
US Relations With Swaziland. (2014, February). Retrieved April 15, 2015, from US Department of State: http://www.state.gov/r/pa/ei/bgn/2841.htm
Zambia Factsheets of Health Statistics. (2010, December). Retrieved April 15, 2015, from World Health Organization: http://www.aho.afro.who.int/profiles_information/images/7/70/Zambia-Statistical_Factsheet.pdf
Zambia Malaria. (2011). Retrieved April 20, 2015, from UNICEF: http://www.unicef.org/zambia/5109_8454.html
Zimbabwe Country Cooperation Strategy. (2014, May). Retrieved April 15, 2015, from World Health Organization: https://extranet.who.int/iris/restricted/bitstream/10665/136992/1/ccsbrief_zwe_en.pdf