The conclusion of the Millennium Development Goal (MDG) campaign presents a unique opportunity for self-reflection on the progress and challenges encountered as a continent in our efforts to achieve the health-related MDG’s. These include MDG 4: reducing child mortality, MDG 5: improving maternal health, and MDG 6: combating HIV/AIDS, malaria and other diseases. 1 Africa has made good progress despite the fact that 34 of the 54 least developed countries in the world are situated on the African continent. 2 Between the 1990-2015 MDG time frames, Africa has seen a 55% reduction in under-5 deaths, a 47% reduction in maternal deaths and a reversal of the incidence and prevalence of HIV/AIDS, malaria and tuberculosis. 3,4
Despite the observed progress, sub-Saharan African, which only carries an estimated 12.9% of the global population, 5 continues to contribute 50% of the world’s under-5 deaths, 69% of the world’s maternal deaths, 71% of the global HIV-burden including 91% of all HIV-positive pregnant women, and accounts for more than 50% of all HIV, malaria and tuberculosis related cases and deaths. 2–4,6 This is in contrast to significant advances made over the past few decades in healthcare services, medical technology and therapeutic treatments that have rendered the majority of these diseases preventable and treatable in developed settings. So why does Africa continue to have a disproportionately high burden of disease? Why have African nations lagged behind in providing these simple, low cost and high impact interventions to the people who need it, and how can we ensure that barriers to essential health services are removed, and universal health access becomes a reality in the post-2015 development agenda.
While low levels of development, extreme poverty, political instability and conflict have contributed to the poor health outcomes observed on the African continent; a lack of political will and poor leadership has also played a substantial role in hindering progress on MDG 4, 5 and 6. Take the case of South Africa, where under the administration of President Thabo Mbeki, AIDS denialism at a political level led to the restriction of access to and use of antiretroviral treatment by infected persons, including pregnant women. 7 This decision was responsible for the deaths of an estimated 365,000 HIV-positive people, with 35,000 babies perishing after acquiring the infection from their mothers. 8,9 Furthermore, it exacerbated the tuberculosis epidemic, leading to the emergence of multidrug resistant (MDR) and extensively drug-resistant tuberculosis (XDR), which contributes to thousands of preventable deaths. 10 The delayed political response to the HIV-epidemic was not limited to South Africa; Zimbabwe, Swaziland and Lesotho followed suit, leading to substantially high levels of maternal and under-5 deaths, far exceeding that observed in 1990. 3
This lack of political will has translated to a corresponding lack of financial commitment to health, with only two African countries allocating at least 15% of GDP to strengthening the health system. 11 The remaining African countries have made little progress, with seven countries reducing their health budget, resulting in weak health systems. 11 These failures to prioritize the health system coupled with a delayed national and international response to the Ebola outbreak led to the rapid dissemination of the virus, which culminated in a full blown epidemic that overwhelming the already weak healthcare systems and resulted in 11, 302 deaths. 12 This has had a direct and indirect effect on maternal health outcomes, with Liberia and Sierra Leone recording the world’s highest maternal mortality rates in 2014. 13
The simplest and clearest indication of the lack of political commitment to women’s health on the African continent is illustrated by the fact that, despite unsafe abortions contributing to 13% of maternal deaths, 92% of African women of childbearing age live in African countries with restrictive abortion laws.14
So in this political climate, characterised by poor government-promoted stewardship and leadership, it is unsurprising that many African states have to a large extent been unable to develop effective national responses to the multitude of health-related challenges encountered. Thus contributing substantially to the continued high burden of preventable and treatable diseases on the continent. As we move towards the post-2015 development agenda, it’s crucial for African leaders to reflect on their contribution to failures in meeting the health needs of their people in the past, and use these lessons to expedite progress in the future.
Chrystelle Opope Oyaka Wedi is a DPhil candidate in Obstetrics & Gynaecology and co-founder of the Ona Mtoto Wako organisation which takes lifesaving antenatal care to pregnant women in remote parts of low & middle-income countries, through a mobile antenatal program. For further information see the program’s Facebook Page. Follow Chrystell @chrystelleW.
- United Nations. Millennium Development Goals report 2014. Available at:http://www.un.org/millenniumgoals/2014%20MDG%20report/MDG%202014%20English%20web.pdf (accessed 4 June, 2015).
2. United Nation Economic Commission for Africa. MDG Report 2014: Assessing Progress in Africa toward the Millennium Development Goals. Available at: http://www.undp.org/content/dam/rba/docs/Reports/MDG_Africa_Report_2014_ENG.pdf (accessed November 18, 2015).
3. Unite Nations Economic Commission for Africa. MDG Report 2015: Assessing Progress in Africa toward the Millennium Development Goals. Available at: http://www.undp.org/content/undp/en/home/librarypage/mdg/mdg-reports/africa-collection.html. (accessed November 18, 2015).
4. United Nations Joint Programme on HIV/AIDS (UNAIDS). Fact sheet: 2014 statistics. Available at: http://www.unaids.org/en/resources/campaigns/HowAIDSchangedeverything/factsheet (accessed November 18, 2015).
5. Population Reference Bureau. World Population Data Sheet and Digital Visualization 2015. Available at: http://www.prb.org (accessed November 18, 2015).
6. United Nations Joint Programme on HIV/AIDS (UNAIDS). The Gap Report: 2014. Available at: http://www.unaids.org/sites/default/files/media_asset/UNAIDS_Gap_report_en.pdf. (accessed June 4, 2015).
7. Nattrass N. AIDS Policy in Post-Apartheid South Africa. After Apartheid: Reinventing South Africa? 2011; 181.
8. Chigwedere P, Seage GR, Gruskin S, Lee T, Essex M. Estimating the lost benefits of antiretroviral drug use in South Africa. J Acquired Immune Defic Syndromes 2008; 49: 410-5.
9. Boseley S. Mbeki Aids denial' caused 300,000 deaths. 2008. Available at: http://www.theguardian.com/world/2008/nov/26/aids-south-africa (accessed July 8, 2014).
10. Chopra M, Lawn JE, Sanders D, et al. Achieving the health Millennium Development Goals for South Africa: challenges and priorities. The Lancet 2009; 374: 1023-31.
11.Tafirenyika M. Ebola: A wake-up call for leaders 2014. Available at: http://www.un.org/africarenewal/magazine/december-2014/ebola-wake-call-leaders (accessed November 19, 2015).
12. The Economist. Ebola in graphics. The toll of a tragedy 2015; Available at: http://www.economist.com/blogs/graphicdetail/2015/08/ebola-graphics (accessed November 19, 2015).
13. Center for Strategic & International Studies. How did Ebola impact maternal and child health in Liberia and Sierra Leone 2015; Available at: http://csis.org/files/publication/151019_Streifel_EbolaLiberiaSierraLeone_Web.pdf. (accessed November 19, 2015).
14. Guttmacher Institute. Facts on Abortion in Africa 2012; Available at: https://www.guttmacher.org/pubs/IB_AWW-Africa.pdf. (accessed November 19, 2015).
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