8th June, 2007
Community health workers the answer to Africa's problems
AMREF's Director General, Dr Michael Smalley tells G8 leaders in an article for Kenya's Daily Nation that community health workers are the answer to Africa's health problems.
Daily Nation, Nairobi, Kenya - 7th June 2007
It's encouraging that as the Group of Eight richest nations in the world meet in Heiligendamm, Germany, Africa and African health are high on the agenda.
To her credit, Chancellor Angela Merkel, who holds the G8 presidency this year, has singled out strengthening African health systems as a pivotal issue. Disappointingly though, she looks at health systems only in the context of HIV and Aids.
What about childhood illnesses and maternal health? What about lack of safe drinking water? Or food and nutrition? And what about the human resources for health crisis in Africa? The solution lies in strengthening health-care systems.
While we recognise that HIV and Aids is a major issue for Africa, we must also appreciate that it is only one of many. For years now, programmes that have been implemented in Africa and supported by the North have focused on single diseases, mainly HIV, but failed to address the broader health needs of the community.
DISEASE DOESN’T EXIST IN ISOLATION; it thrives on an already weakened health-care system. Unless we address the system, we are just scratching at the surface of a deep-seated problem.
Addressing the system includes getting communities to participate in identifying their needs and addressing the social, cultural and economic factors that make them vulnerable in the first place.
Building health systems is not just about building the health sector or increasing health delivery. It is about building partnerships between the providers and the users of those services.
Since the dawn of time, systems have existed in Africa that can still be built on to address health issues. Traditional healers treated and cared for the sick, providing them with herbal drugs and psychological support.
These healers were, and still are, deeply trusted by the community members, many of whom consult them first and only go to hospital as a last resort. Rather than re-invent the wheel, we should harness the knowledge, resources and energy that exist in local communities and apply it to work together within a wider health system.
Large-scale funding like the current HIV and Aids programmes in Africa provide an opportunity to strengthen health systems, but this is lost when they only focus on short-term outputs, like the amount of drugs distributed.
By doing so, they miss the wider opportunity for capturing the changes that take place within communities as the focus is on numbers rather than impact.
Since it was set up by the G8 in 2000, the Global Fund has traditionally looked at malaria, TB and HIV as disease entities. But there has been a change of direction in the past two years, and the Fund is now encouraging recipient countries and implementing partners to look at broader aspects of the health system.
This shift entails greater participation by civil society and the private sector, building of infrastructure and networks, and establishing policies that provide a framework for partnerships, monitoring and evaluation, and integration of TB, Malaria and HIV with other major health problems. This is a long overdue, but nevertheless welcome, shift.
One of the greatest challenges within the African health sector is a critical shortage of human resources. Consider this: the average doctor-to-patient ratio across Africa is 1:20,000, but is 1:50,000 in some of the poorer countries.
In areas where HIV prevalence is 10 per cent of the adult population, this translates to 5,000 people with HIV, about 2,000 of whom may need treatment at any one time, follow-up and care — an impossible task for one doctor.
We are never going to find enough doctors for this — not even if we counted every clinical officer on the continent.
Nor can we afford to wait for more doctors to be trained, which takes about six years. If we go that way, we will never catch up with the epidemic.
Africa has proven mechanisms for using community resources to expand the human resource base: training community members as health workers.
WORKING IN A FAMILIAR environment not only makes community health workers effective, it also helps to ensure they are immediately responsive to local needs.
At Amref, we focus on catalysing community capacities to respond to their health challenges. We supplement this through training of community health workers to pass on information, monitor household health and provide support at the household level to those on treatment for HIV and Aids and tuberculosis.
It is important that the donors see health from the perspective of the users, the consumers. Vulnerable communities view their health problems from a holistic perspective: they will talk about sickness in the same breath that they talk about hunger, poverty or insecurity.
But how will the G8 know all this if they do not actively seek to engage African communities and learn their perspective?