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Margaret Chan Belatedly Recognizes the Value of Health Infrastructures in Preventing Epidemics

According to an article in the UN’s IRIN News “West Africa’s Ebola epidemic has cruelly exposed the weaknesses of health systems in the countries where it struck”. The director of the World Health Organization, Margaret Chan, is further quoted as saying that “what they lacked was a robust public health infrastructure to deal with the unexpected”.

This is a very odd way of looking at the situation. Firstly, almost every country in Africa lacks a robust public health infrastructure; secondly, most of them have lacked such an infrastructure for many decades, as a cursory review of relevant literature, going back at least to the 1940s, will reveal.

Tens of millions of people suffer from numerous avoidable health problems, such as malnutrition, vitamin deficiencies, parasitic conditions, infectious diseases, non-communicable diseases and more; epidemics and outbreaks are so common that most of them don’t even hit the headlines, least of all the headlines of non-African newspapers.

Not only that, but this has been the case throughout the whole of the WHO’s history. Lack of health infrastructure to deal with the ‘unexpected’ has been the norm in sub-Saharan Africa for decades, as the WHO (as an institution) can confirm. They were involved in various campaigns to reduce or even eliminate some health conditions, sometimes successfully, sometimes not so successfully.

In fact, many of their less successful forays into eliminating or eradicating diseases demonstrated that it is not possible to ensure that diseases can even be eliminated from large areas without adequate health infrastructure, let alone eradicated. Various programs to reduce prevalence of certain sexually transmitted infections were unsuccessful precisely because of failures relating to overall health infrastructures, rather than to any weaknesses in the programs concerned.

The HIV epidemic has raged in many sub-Saharan African countries regardless of various expensive and well publicized programs to reduce transmission. Some country epidemics have declined, but many did so before the bulk of prevention campaigns were even dreamed up; in other countries there are few credible causal links between HIV prevention programs and drops in transmission rates.

Chan would be better off asking why the ongoing ebola epidemics in West Africa are so much worse than any that have occurred elsewhere. It would also be interesting to know why HIV epidemics in West African countries were so much less severe than in African countries that are said to have far better developed health systems than Sierra Leone, Guinea and Liberia, such as South Africa and Botswana.

Chan goes on to bemoan lack of “background data on the usual…so that the unusual stands out”. I’ve been reading articles about sexually transmitted infections in African countries published between the 1940s and the 1990s. Most of them attest to the lack of reliable information and statistics. ‘The usual’ is what you find in the three countries who have suffered the most in the current epidemic: health systems in most other African countries are in a similar state.

Decades of epidemics have, apparently, yet to teach us that you are unlikely to be able to mount a successful campaign against disease outbreaks if you don’t have well developed health infrastructures. You can’t hurriedly put everything together in a package and send it off with some soldiers, so they can piece it together before heading off to their next dig a hole and fill it in scheme.

Chan is right in demanding “good quality care [that is] accessible and affordable to everyone, and not just to wealthy people living in urban areas; having enough facilities available in the right places with enough well trained staff and uninterrupted supplies of essential medicines; diagnostic capacity that returns rapid and reliable results; and information systems that pinpoint gaps and direct strategies and resources towards unmet needs”.

But she should start by taking a close look at those villages in Cambodia where several hundred people have been infected with HIV through unsafe healthcare. There is little point in developing health infrastructures without ensuring that they are also safe. Otherwise, she may end up with another Egypt on her hands, which has the highest prevalence of hepatitis C virus in the world following an otherwise successful schistosomiasis eradication campaign.

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