Good news on 'African solutions to African problems' in health: SMS, bike ambulances, and pregnancy hostels

Eritrea opens guest houses for pregnant women, Malawi rolls out "completely natural" incubators, and herbalists given the stamp of approval in Senegal

AT the end of this week a high level ministerial meeting will take place in the Ethiopian capital Addis Ababa, to discuss how to fix the shortage of health workers on the continent.

Estimates say the continent needs over 1.8 million health professionals to meet the demand.

Meanwhile the World Health Organisation (WHO) last said Guinea, Liberia and Sierra Leone, which are all experiencing a resurgence of the deadly hemorrhagic fever Ebola, have budgeted over $2 billion between them to restore their health systems - money which they don’t.

While problems in Africa’s health sector can sometimes seem daunting, away from these dramatic headlines and epidemics, the continent has actually seen marked improvements in health outcomes during the past decade. There has been a considerable decline in child, maternal and adult mortality rates, and substantial decreases in the burdens of several diseases.

Life expectancy at birth, for example, improved from 50 years in 1990 to 56 years in 2011, as many countries have managed to stem new HIV infections, and get antiretroviral treatment to those who need it. Under-five mortality, too, fell from 173 to 95 per 1,000 live births, and infant mortality from 105 to 63 per 1,000.

Some of this has been due to demographic and economic change and improved political stability, leading to fewer conflicts. But much has also been due to sustained efforts to prevent illness and maintain good health, improve access to treatment when illness does occur, and to find ways to deliver a better level of health care in the African context.

Drawing from the WHO’s African Regional Health Report 2014, we take a look at some of the effective – and sometimes, surprisingly simple – interventions around the continent that helped reverse the tide in Africa’s health story:

Maternity waiting homes in Eritrea

To overcome high death rates during childbirth among women living in remote areas, Eritrea introduced maternity waiting homes in 2006. These enabled women living in far flung areas to travel and stay close to a centre offering skilled obstetric services a few weeks before they were due to give birth. 

The high maternal mortality rate among women living in remote areas and in nomadic groups had been attributed to the “second delay” – delay in getting to the health facility even when the decision to seek care has been made on time. 

Eritrea has since reduced its maternal mortality rates every year and is now one of the countries in the region on track to achieve the Millennium Development Goal (MDG) target of reducing maternal deaths.

Kangaroo mother care in Malawi

Although many African countries are reversing the trend in infant and under-five deaths, newborn mortality remains high, primarily from complications of premature births. But a simple intervention for preterm infants is at hand in the form of kangaroo mother care (KMC), which is carrying the baby skin-to-skin on the mother’s (or father’s) chest. 

It’s especially beneficial in resource-poor settings, where incubators are scarce, and power supply is erratic– the adult’s body warmth acts as a natural incubator, and it’s been shown to reduce mortality among preterm babies in hospitals by 51% if started in the first week of life compared with incubator care.

Malawi had one of the world’s highest rates of infant mortality, losing 5,600 babies every year to preterm complications. But over the past decade, Malawi has worked to scale-up kangaroo care in hospitals, training nurses and midwives, and including it in its standard hospital protocols. 

By 2011, the number of institutions using KMC had increased to 121, up from 18 in 2008; Malawi one of the few countries in the Region that has already achieved its Millennium Development Goal (MDG) 4 targets.

Motorbike ambulances in Guinea, South Sudan, Zambia and Malawi

Motorcycle ambulance in Guinea. (Photo/Flickr/Julien Harneis).

High-powered, multi terrain motorcycles fitted with stabilised wagon beds are being used as ambulances in places as diverse as South Sudan, Zambia and Malawi. There is also space at the back for emergency medical supplies and room to carry a health worker out to remote communities.

Apart from being able to access the toughest terrain, one 2009 study found that the motorbikes, which would cost around $6,000 each including shipping and parts, were more cost-effective than cars. The cost of a typical 4WD Toyota land cruiser would equal that of 22 motorbikes, it said, and operating costs were relatively low.

And also, because they are conspicuous and somewhat clumsy (owing to the fitted bed), the motorcycle ambulances are much less likely than car ambulances to be misused for non-health-related purposes; this also contributes to reduction of transport expenses.

Highest reduction of mother-to-child transmission of HIV in Ghana

Until recently, Ghana had a high level of mother-to-child HIV transmission. In 2010, the country embarked on reversing the trend, setting a goal “to ensure a generation free of AIDS and to eliminate mother-to-child transmission of HIV by 2015”. 

By 2012, Ghana achieved the highest reduction in new infections among children in Africa and was ranked among the countries with the most successful prevention of mother-to-child transmission (PMTCT) programmes. The risk that a woman living with HIV will transmit the virus to her child has declined from 31% in 2009 to 9% in 2012.

Ghana did it by making PMTCT a standard part of providing maternity care. Health officials replaced the type of antiretroviral therapy (ART) drugs from a less effective formulation to a more effective one, they also used an SMS platform to monitor and report the availability of drugs so that they would always be in stock. PMTCT was also included in the curriculum at nursing and midwifery schools.

South Africa gets ART to almost everyone who needs them

South Africa has more people on life-saving antiretroviral therapy (ART) than anywhere else in the world, a decade after the country’s leaders launched a public sector programme to combat the HIV/AIDS epidemic. An estimated 2.4 million people are receiving ART, roughly 80% of those who require treatment based on WHO 2010 guidelines.

As a result, life expectancy has increased, for example by 11 years among adults in Kwa-Zulu Natal, the province hardest hit by HIV Aids. Fewer babies are born with HIV – rates have dropped from 25-30% of infants born HIV positive in 2003 to just 2.7% in 2011. The rate of new infections among adults is declining, and by December 2013, 1.2 million men had undergone medical male circumcision to reduce the risk of HIV infection.

Togo completely eliminates elephantiasis

The Culex mosquito is a vector for filariasis (elephantiasis) but not of malaria, which is transmitted by the Anopheles mosquito. (Photo/Flickr/ Ton Rulkens).

In 2010, Togo was the first country in the WHO African Region to eliminate lymphatic filariasis commonly known as elephantiasis. The country conducted at least six consecutive rounds of mass treatments in targeted districts. These mass treatments, conducted door-to-door with the support of community health workers interrupted local transmission of the disease. 

The success of the mass treatments was helped along by education and communication campaigns, carried out before and during the medicine distribution; and involvement of community health workers in the distribution of the medicines.

Further to conducting assessment surveys in 2009 and 2010, the country was confirmed free of local transmission of lymphatic filariasis. Since then the country has been under post-mass drug administration surveillance, which is carried out nationwide through a network of district level laboratories.

Using mobile phones for disease surveillance in Cameroon

Between 2010 and 2012, Cameroon distributed mobile telephones to 310 key personnel to enable them to communicate epidemiological information, thus improve the response to cholera, yellow fever, measles and polio epidemics. 

The mobile network now comprises nearly 2,000 members at all levels of the health system, all listed in a dedicated telephone directory. As a result, coverage of the epidemic-prone disease surveillance network, which was 30% before the provision of the mobile telephones, reached 98% in 2013.

Use of the mobile network has enabled a quick response to outbreaks; the deadlines for investigating cases have also been reduced from 2 weeks to 48 hours.

Traditional medicine is mainstream in Senegal

Traditional healer in Sudan prepares a treatment against mental illnesses by burning a paper with Koran sentences written on it with roots and charcoal. (Photo/Flickr/ Albert Gonzalez Farran).

By some estimates, 80% of Africans depend on traditional health providers as their first point of contact in seeking health care; one statistic from South Africa indicates the country has 200,000 sangomas and 40,000 medical doctors – a ratio of 5:1. But traditional health practitioners are often marginalised and misunderstood  by officialdom, a legacy of colonialism that branded all of them witchdoctors and wizards.

But in Senegal, traditional healers are expressly recognised by the government, and in one experimental centre, officially allowed to treat patients in collaboration with “conventionally trained” doctors. The aim of the Promotion of Traditional Medicine’s experimental centre in Fatick, Senegal, is to get empirical data on the effectiveness of traditional medicine.

The medical doctor measures the patient’s vital signs, such as blood pressure, pulse, respiratory cycle,  and temperature, and makes a diagnosis after analysis of laboratory tests, but cannot take part in treatment; the patient is instead sent to the traditional healer.

After treatment, the traditional healer sends the patient back to the modern medical unit to measure the impact of the traditional treatment, determined by comparison of pre- and post-treatment laboratory results, vital signs and physical examination findings. 

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