From Africa Recovery, Vol.11#4 (March 1998), page 18 (part of Special Feature on the 2-year review of UNSIA)
With few funds, WHO combats African maladies
Africa's most basic health problem is a lack of money, says Dr. Ebrahim Samba, Director of the Africa office of the UN's World Health Organization (WHO). "We need to invest in our health," he told Africa Recovery. "We need to invest in the education of the people, the training of technicians and specialists."
Dr. Samba believes that some of the necessary resources can be mobilized through harder work and greater discipline by Africans themselves. Yet additional financing also must come from the United Nations, World Bank and other donors, he argues forcefully, expressing disappointment with the results obtained so far by the UN System-wide Special Initiative on Africa. But whatever the constraints, Dr. Samba affirms his office's commitment to helping African countries tackle their most debilitating diseases and other health problems.
Malaria, for example, kills some 2 million Africans every year, making it the continent's biggest single health problem. Important progress has been registered in recent years,
Dr. Samba notes, through the expanded use of bed nets impregnated with repellents against malaria-carrying mosquitoes, better training for community healthy practitioners and increased collaboration with pharmaceutical companies to invest in research towards an anti-malaria vaccine.
But malaria remains a major killer, as African governments struggle with high population growth rates, rapidly expanding urban concentrations and devalued currencies that make it more difficult to purchase imported medicines and supplies. "The fundamental problem is a lack of financial resources," Dr. Samba says, noting that there has been a decline in international funding for research in tropical medicine in general. Africa's poverty means that the continent remains a very marginal market for the major pharmaceutical companies, which generally make research decisions on the basis of projected profits.
Given such financial handicaps, African ministers of health, meeting in Brazzaville in 1996 following the launch of the UN Special Initiative, felt that the Initiative's emphasis on such basic sectors as health and education was "a good idea," Dr. Samba explains. But they expressed some skepticism that it would yield significantly greater resources. Two years later, he confesses that "we felt rather disappointed" that the emphasis has been on finding money for health mainly through "recycling, reorganization, increased efficiency and all that," rather than raising additional external resources.
World Bank Vice-President Callisto Madavo acknowledges that coordination with WHO in carrying out the Special Initiative's health component has not progressed as well as it should, especially in comparison with education, where there has been close collaboration with UNESCO (see pages 8-13). Some $500,000 was raised in the context of the Special Initiative this February for a series of workshops in Africa to explore ways to make health sector collaboration more effective, an amount Dr. Samba considers highly inadequate, but which Mr. Madavo sees as a beginning, as "seed money" to start moving forward.
The WHO Africa office has programmes in a variety of critical areas, Dr. Samba notes, such as malaria, tuberculosis, HIV/AIDS and health sector reform, and will continue to pursue them even with inadequate resources. However, he adds, more "value added" from the Special Initiative would make it possible to "do them better and quicker."
Meanwhile, Africa itself must do more. "Africa is not poor," Dr. Samba declares. "Africa has very rich resources. What we need to do is to put our shoulders to the wheel" of economic development.
While greater investment in training, treatment, research and other aspects of health care is vital, Dr. Samba insists that improving the health of Africa's people also requires a broad perspective. "Health is not disease, it's more than disease," he observes. "Health is water, food, sanitation, good governance, peace, security. These are all health determinants. You cannot have health in isolation; health is just part of development. The way European health improved was not because of doctors and hospitals. It was because of the Industrial Revolution: people earned more, people were better educated, people took care of their health."
In Africa as well, Dr. Samba affirms, "We can do it. Africans are not stupid. We have to work harder. We have to be more transparent. We have to have better governance. We have to be economically competitive." In particular, Africa needs more "honest, hardworking leaders" at all levels, "whether it is in the state, in the school, in the hospital, wherever." Rather than taking jobs abroad, African professionals should stay home, or return if they have left. "If we have a critical mass of people dedicated, disciplined to work for Africa, Africa will make it."
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**This article is based on an interview with Dr. Samba conducted in early February 1998 by Olu Sarr in Dakar, Senegal.
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